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Is There a Nurse in the Office

June 1, 1997
Related Topics: Workers' Compensation, Workplace Violence, Health and Wellness, Safety and Workplace Violence, Featured Article, Compensation
When Sue Gieske heard one of the employees at her company had returned to work after a disability leave, she was concerned. The employee had just received a pacemaker and was on the waiting list for a heart transplant. The problem was he seemed to be in denial and was performing his regular duties, not all of which were particularly appropriate for someone in his condition. As Supervisor for Health Services at Quaker Research and Development located in Barrington, Illinois, Gieske insisted on giving him some restrictions. Because the employee's supervisor didn't feel comfortable discussing these issues with him, Gieske contacted the cardiac team at Rush-Presbyterian-St. Luke's Medical Center in Chicago. Gieske read the team the man's job description and the health-care professionals helped her determine what he was capable of doing. One of the precautions they suggested was for the employee to avoid extreme temperatures. This was important advice considering that as an inventor, the employee frequently went back and forth from his air conditioned office to the heat and humidity of the plant where his inventions were put to use. Working with the nurse, his supervisor and the physicians at the hospital, the employee agreed to cut down on the amount of time he spent in the plant.

From a story like this, it's easy to understand how having a qualified nurse on staff at a company often can save lives. What may not be as apparent is how nurses also can save companies money—sometimes lots of money. Without Gieske's expert intervention, the employee could have collapsed and held the company responsible with a very expensive lawsuit.

But avoiding lawsuits isn't the only financially sound benefit of having an occupational health nurse (OHN) on staff. There's plenty of evidence to suggest that keeping an OHN on staff, no matter the company's size, can result in a substantial savings in health-care costs. Quaker Oats, based in Chicago, for example, has been able to save an estimated $1.6 million in health-care costs for its more than 6,000 employees who have participated in health intervention over the course of several years. According to Joan Cantwell, manager of health services for Quaker Oats, a big part of this cost-savings can be attributed to the strong role OHNs play within the company.

Quaker Oats, like many companies today, is self-insured and highly conscious of ways to trim health-care costs from its bottom line. After working with a health-risk appraiser in Minneapolis to determine where money was spent, Quaker Oats had more than enough justification for keeping its OHNs instead of contracting out health-care services to other providers. As Quaker and other companies have found, OHNs contribute to the bottom line both by helping to prevent health-and-safety problems, and by managing these issues in cases for which they're unavoidable. The challenge is to take advantage of all the skills an OHN has to offer and to use his or her services effectively in conjunction with the human resources department.

An ounce of prevention...
In an increasingly complex health-care environment, companies are working hard to manage employees' health needs. With escalating health-care costs and myriad options, many find that the most cost-effective way to cap soaring health-care bills is to take preventive measures. A strong focus on wellness is what keeps costs down, and this is an area in which OHNs can help. More and more companies are arranging health fairs which emphasize stress management, exercise and diet to help ensure employees focus on their own health. Many fairs offer screenings for high blood pressure and high cholesterol, provide mammograms, give vision and hearing tests, and assess other potential health risks. Catching problems early can result in significant savings, not only in health-care costs, but also in actual dollars lost when an employee is off work due to illness.

Although many health fairs are developed through HR, the advantage of having a staff OHN involved is that not only can he or she perform some of the screenings and save on outsourcing costs, but the OHN also can develop an ongoing relationship with those whose situations may need steady monitoring.

Workers' compensation claims are fiscally draining to corporations and are soaring at an annual rate of 12 percent.

For example, a worker who has his or her cholesterol checked and is told that it's high may need to increase exercise or make a change in diet. Having an occupational health nurse on staff means that in a few weeks, the nurse can ensure the worker is actively making these improvements. At Chicago-based Helene Curtis, reports Marilyn James, manager of employee health, several people's high cholesterol levels were detected during at-work screenings. James estimates the company has saved close to $200,000 in costs by monitoring such cases, because once a test's results have been confirmed, the company's health worker refers employees to their own family physicians for further monitoring. This then encourages employees to maintain a steady check-up schedule with their doctors and to continue monitoring their own conditions to prevent further complications.

"In wellness, over the last five years, we've saved the corporation between $200,000 and $400,000, depending on the year," says James. "For example, in 1991, for a stroke or heart-attack patient, we might have spent up to $17,500 per patient. If you take 10 people per year, and keep them from having a major heart attack by monitoring their blood pressure and sending them to a doctor as necessary, you've saved up to $175,000 right there," she says. Considering that in 1991 and 1992, according to James, around 30 people each year at Helene Curtis suffered from cardiac issues, this is probably a conservative figure.

Other preventive, proactive measures that an OHN may initiate include ergonomic training for computer users; classes in nutrition, CPR, or back care; and other programs and screenings offered throughout the year to help employees become aware of potential health problems.

When accidents do happen—managing workers' comp cases.
And what about the value of OHNs after a problem occurs? A nurse who works closely with employees becomes even more valuable after a workers' compensation claim has been filed. Workers' comp claims are often fiscally draining to corporations that don't have the proper protocol in place. According to the Wisconsin Council of Safety Advisory Board, workers' compensation costs are soaring at a rate of 12 percent annually. That means that now, more than ever, companies are closely monitoring claims and seeking ways to retain employee productivity. Larry Kosiek, vice president of human resources and quality assurance for Arnold Engineering based in Marengo, Illinois, reports that in the company's Marengo facility alone, more than $600,000 was spent on workers' compensation settlement money in 1985, with an additional $200,000 spent on the insurance premium. In 1996, 11 years later, and with Certified OHN Peggy Ross to handle the cases responsibly, the company's costs were just under $100,000. "And today, we're twice the size we were in 1985, and we're now self-insured," Kosiek adds. "If one were to take those 1985 numbers and account for inflation, you tell me how significant this savings is."

After examining eight years of claims for Bethesda-based Marriott, International Inc., Rachel Ebert, director of occupational health services, determined there was a 30 percent to 50 percent reduction in litigation as soon as the company installed an OHN case manager to work in collaboration with human resources and safety managers. In addition, because cases were managed better with the nurse onsite, there was a 20 percent to 30 percent reduction in workers' compensation indemnity costs within two years of implementing an OHN nurse-management program. Finally, Ebert says, Marriott was able to reduce workers' compensation claims frequency by 30 percent after placing an OHN on staff.

Employees will usually stop by a nurse's office rather than call an EAP because it's easier and more personal.

Many companies report that closely managing workers' compensation cases is critical to the workplace. Acting as a liaison between worker, employer and physician, a nurse who performs medical case-management has a variety of duties including making daily calls to the patient, closely monitoring health and insurance records, establishing a dialogue with the health-care provider, and explaining workplace situations to physicians to ensure they properly assess a worker's ability to return to his or her job. Companies that use an OHN to handle workers' comp cases reportedly spend one-tenth the national average for workers' compensation costs.

OHNs provide myriad benefits.
Another area in which OHNs can save companies money is in their expertise of Occupational Safety and Health Administration (OSHA) regulations. Many are required to keep up-to-date on the latest regulations. Often OHNs will work hand in hand with safety coordinators and serve as watchdogs to make sure regulations are enforced. The OHN can assume the role of OSHA expert, relieving HR of some of the burden of these responsibilities and saving companies thousands of dollars in unnecessary fines.

OHNs similarly intervene when it comes to Americans With Disabilities Act (ADA) and Family Medical Leave Act (FMLA) issues. Again, using case-management techniques, the OHN works with a disabled worker to determine his or her capabilities and limitations, interacting with both physicians and supervisors. The same is true for FMLA issues.

Gieske, for example, works closely with women who return to work after giving birth. Quaker offers a LifeWorks Program that helps new mothers by providing research on all the child-care options available to them. "By the time they've been away six weeks, it's scary to leave the baby and come back. By staying in touch with [new mothers], encouraging them to bring the baby in for a visit, providing breast-feeding options, perhaps even renting breast pumps, it makes it more comfortable for them to return," says Gieske. At the same time, she says, the company retains a valuable worker.

Not all of an onsite OHN's efforts will reap tangible results. One service an OHN can provide is boosting employee morale. Acknowledges Steve Haraf, human resources manager for U.S. Tobacco Manufacturing Co. Inc., based in Franklin Park, Illinois, "Having someone listen to people, give medical advice and answer employees' questions is worth quite a bit. It helps to maintain a feeling of caring for our employees." Although the company also has an Employee Assistance Program (EAP), employees will usually stop by a nurse's office first rather than call an EAP, because it's so much easier and more personal.

Ebert confirms the intangible value of having nurses at hand. "There are lots of things you can't measure. I call them 'issues of the heart.' Employees feel valued; they have a health and medical resource they can go to for personal or medical information. There's less time lost because a nurse is there to see people and to keep them on the job."

In addition, nurses can assess a condition promptly and save it from worsening later. "We measured [the effect on absenteeism of having an in-house nurse]," says Ebert. "The nurse reduced absences by 30 percent just by being aware of which employees were absent and monitoring their return to work."

In other instances, a nurse's medical knowledge can help an employee even when that worker needs to use an outside physician. "Let's say someone cuts himself or herself right through a tendon and can't use his or her finger. I accompany the employee to the emergency room and make sure the most qualified physician available attends to the person immediately," says Gieske. "I also make sure the physician knows what kind of work the employee does. That way we can figure out together something for that person to work on once he or she returns to the plant. And I can communicate this to the employee's supervisor, as well."

How OHNs interact with human resources.
Often an OHN can work closely with HR and serve as an objective third party. Haraf recalls one incidence in which an employee had contracted a work-related injury and was reluctant to return to work. His doctor was perfectly willing to endorse his patient's attitude, and the department staff the employee worked in wasn't willing to modify his job to account for his injury. The OHN, Mary Lou Klosinski, was able to step in, working as an intermediary between the doctor, employee and department, and work out acceptable job duties so that the person could return sooner.

Being an objective third party helps when it comes to record keeping also. "For areas in which there are confidentiality issues, such as maintaining medical records separately from personnel records, we can make a clean distinction [between the two departments]. Depending on who's asking for information, the OHN can make the determination of what his or her 'need to know' is," Haraf says.

OHNs also can serve as a knowledgeable resource to answer questions on health-care programs. Managed care, preferred provider organizations (PPOs), health maintenance organizations (HMOs) and other recent health-care options can become a confusing web of insurance-speak that the average worker has neither the time nor the interest to unravel. An onsite nurse will often be able to explain the system, making sure employees are referred appropriately and that they're properly compensated.

Recent health-care options can be a confusing web of insurance-speak that workers can't unravel.

Also, nurses are invaluable when it comes to handling employees with emotional or performance problems. "Nurses can assess the problems and determine good referral places for people with these problems. Usually they can draw on their backgrounds in psychology and sociology, and their knowledge of community resources," says Ebert. "That way they can take the monkey off the back of HR personnel who normally have to deal with these issues."

Says Haraf, "Our safety program wouldn't be anywhere near as successful without having [the psychosocial] focus of an OHN. We have truly been able to take her theoretical training and use her as a resource in all safety-and-health aspects of the company."

There are many roles and duties for an OHN to perform in the corporate environment. HR departments that work closely with nurses to determine how they can effectively meet today's growing health-care needs won't be disappointed. Through proactive health-care programming and education, case management and consultation, rigorous attention to federal regulations and a genuine interest in the welfare of employees, occupational health nurses help to maintain a healthy and productive workforce—as well as a healthy bottom line.

Workforce, June 1997, Vol. 76, No. 6, pp. 107-113.

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