Take these steps if malingering is suspected
Take these steps if you are asked to provide information that might be used in assessing the need for starting or continuing surveillance of an employee:
• Think before you speak.
Because occupational health nurses are customer- and client-responsive in so many areas, it's very easy when asked this kind of question, to go ahead and volunteer the information. "Before you do that, stop and think what you are doing," says Chris Kalina, MBA, MS, RN, COHN-S/CM, FAAOHN, director of global occupational health programs and services at Wm. Wrigley Jr. Co. in Chicago.
Kalina says to "think through your ethical thoughts and feelings on this subject so as to be best prepared when asked such questions." She says to "consider fully and thoughtfully" the standards of occupational and environmental health nursing developed by the American Association of Occupational Health Nurses (AAOHN). (To read the AAOHN's Code of Ethics and Interpretive Statements, go to www.aaohn.org/practice/upload/Code-of-Ethics-2009.pdf.) The standards state that occupational health nurses should "respect and protect the autonomy, rights, and privacy of clients' data and personally identifiable information."
"Health information obtained in the workplace by the occupational health nurse should be held to the same high standards and ethics as anywhere else," says Kalina.
• Consult with others.
If you feel conflicted about your response, Kalina advises getting advice on a given situation from your manager, a mentor, or someone from an organization such as AAOHN.
• If you don't feel comfortable sharing information, respond, "No, there is nothing else I can share with you."
• Remember that information you give could be misinterpreted.
Consider this example: An employee might mention going grocery shopping after a doctor's appointment. "The risk manager may say, 'Well how can he do this when he's on limited duty?' The fact of the matter is, it may be good for that employee physically and psychologically to be out there walking with a cane and getting exercise," says Kalina. "Clearly a dialogue such as this presents a communication challenge and an opportunity for the nurse to educate."
• Take the opportunity to educate.
Kalina acknowledges that there have always been some employees who abuse the system, but she says the answer is to educate employees and employers on workers' compensation in general, what it's for, and how it's supposed to work. Explain that "it's an important benefit, and if employees abuse the benefit, companies can make it more difficult for them to get it. And caught up in that will be people who really need it," says Kalina.
• Take the time to learn more.
"If an employee is suspected of malingering, one needs to try and find the underlying cause," says Linda Walker, BSN, RN, CCM, COHN-S, occupational health manager with Reliant Energy, Houston, TX. "Many times it may be from fear of reinjury, a personal non-work related issue, or dissatisfaction with the job."
Any of these causes may lead to or enhance depression in the employee, says Walker. "If the occupational nurse can foster a trusting relationship with the employee, he or she can get the employee to discuss the apprehension of returning back to work," she says.
If the problem is depression, an employee Assistance program referral can be sought and the employee can get the help needed. "By approaching the situation as a fact finding issue first, you may be able to turn what may have been perceived as a negative situation into a positive by getting the employee the help he or she needed," says Walker.
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