Occ health, human resources: Natural partners, but expect some conflict
Confidentiality, employee fitness by far the biggest points for debate
In addressing health in the workplace, the partnership between occupational health and human resources is among the most important. But despite their shared objectives, many occupational health nurses (OHNs) and human resources (HR) managers find the relationship could be better.
The two specialties have so much in common and share so many of the same goals that sometimes the lines between the two can blur, leading to frustration on both sides.
Employee health and safety consultant Elayne Preston, RN, DOHS, COHN-S/CM, COHN©, says it is easy for OHNs and HR professionals to overstep each other's boundaries if they don't clearly understand each other's responsibilities and body of knowledge.
"Both the occupational health nurse and human resources are considered professionals, and I think that's where we have common ground," says Preston, who has spent time as an OHN working out of a hospital HR department. "As professionals, we share that you have to have a common, specialized body of knowledge; an agreement to perform to standards; we are represented by professional organizations; we are perceived by others as being professionals; we have a certification that is sort of a stamp that we've achieved a level of expertise; and we both have a code of ethics."
The code of ethics for HR, she points out, is very similar to that for OHNs, including requirements for confidentiality. "I sometimes have to remind HR professionals that we are similar that way," she says.
Similar goals lead to overlap
OHNs often work out of the same department as HR, and that closeness, coupled with the similarities of their work – both are usually members of the management team, both have some input into collective bargaining, both deal with issues regarding employee health and illness.
- The similarities are enough that each might assume the other has the same goal in mind when specific incidents arise, when in fact the objectives of each might be different.
- Some examples:
- The OHN might feel HR refers cases to him or her that are managerial, not medical. HR might view the advice given by the OHN as not practical to the employer's situation, or is not clear enough.
- HR wants to know what employees can do, not what they can't; OHNs want more effort directed at prevention, and finding alternate or light duty.
- OHNs feel HR and management expect them to divulge more information than confidentiality laws permit. HR managers are frustrated by what they sometimes perceive as OHNs blocking information they say they need to devise light-duty or alternate-duty assignments.
- The OHN's focus is on employee health and safety, keeping employees working and productive. The HR manager's aim is on business issues, including how to keep employees focused on achieving the employer's goals, increasing worker competency, and attracting and retaining staff.
"Basically, both professionals are concerned about the relationships between employees and employers," says Preston. "That's where our paths intersect."
That intersection can be seen in the selection and hiring process, when OHNs are conducting baseline medical examinations, identifying potential work limitations, and recommending placement.
"There is always room for discussion between nursing and human resources, particularly as it relates to hiring and establishing that workers who are hired are able to do that particular job and do it safely, without harm to themselves or their coworkers," says Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, president of the American Association of Occupational Health Nurses.
Sometimes, Preston adds, "the OHN has to be the one to say, 'I went over this employee's health and limitations, and I don't think they can do the job you just interviewed them for.'"
HR and OHNs also have to coordinate efforts when an established employee needs to be resituated due to an illness, injury, or exposure.
"The OHN does periodic health assessments, and for specific hazards, has to work with HR to make sure job placements continue to be safe," Preston points out.
"With the issue of attendance and fitness for duty, we're looking at things like medical certificates, trying to identify the likelihood that this employee can continue regularly and consistently. You might get employees referred by HR saying their attendance is really bad, and [asking what's] the likelihood that they can live up to their contract, what are their health issues, and is this an issue of accommodating a disability?"
When an employee's fitness for duty is evaluated, it usually falls to the OHN to translate that information into functional limitations that can be provided to the HR manager and the employee's supervisor, treading that fine line between providing information the company needs to know and protecting information that must be kept confidential.
"Then, there's what I call weird and wonderful workplace behavior, when an employee is doing something that is considered to be out of the ordinary, and HR looks to us to decipher whether there's a medical reason behind the behavior," Preston adds.
Confidentiality creates conflict
Confidentiality issues are the most common ground for tension between HR and OHNs. If an employee is exhibiting behavior and attendance problems, HR might initiate disciplinary action; but if substance abuse becomes suspected as the cause, discipline stops and medical intervention commences.
"This really re-routes the HR professional when that disclosure is made, because OHNs spearhead employers' recovery programs," Preston says.
Independent medical evaluations (IMEs) are part of many workplace employee health files, but ownership of those files — although clearly restricted by federal laws — can still be a bone of contention between the OHN and HR.
"A lot of my practice is working with HR, and maybe they identify the need for an IME, but the OHN is the keeper of the IME process so that we can keep the medical portion of the record confidential," she explains.
The role of translator, when handled well, can really be a bridge between HR and the OHN. Handled poorly, and it creates opportunities for conflict.
Medical jargon should be eliminated, whenever possible, when the OHN passes along information to HR or management. Managers seek simple, clear information and advice; if the information is being passed along to an HR manager who will then be passing it along to an employee's supervisor, the clearer and simpler it is, the less likelihood there will be for misinterpretation.
"I'm often asking the HR professional, 'What are the questions you need answered?' and I will include those in my letter to the medical evaluator," says Preston.
"And that takes quite a bit of trust on the part of the HR professional and management, because the company pays quite a bit for an IME, but never sees the report. All they get is what they're told by the occupational health nurse."
Denise Figueiredo, president of the National Human Resources Association, says that most "educated employers" know that there are limits to the amount of information they are entitled to from employee health records, but that doesn't mean they like it.
"There is pressure from upper management and management overall to have a return on investment and have the bottom line covered, and human resources is caught in the middle," Figueiredo explains. "[The HR professional] wants to be supportive of the employee, but there is that pressure from management for a return on investment."
Because employers need to have hard data on the cost savings their companies can realize from employee wellness, the HR/OH team can find themselves needing to work together to demonstrate the bottom line benefits, she adds.
"Management of some companies are committed to health and wellness, and really believe in it," she says. "And yet some still don't have a clue."
When the OHN shares office space with HR, special diligence must be paid to keeping medical files separate from personnel files. Preston says she has worked with companies where performance files were mixed in with occupational health and independent medical examination files, creating some messy confidentiality issues.
"When the HR professional has the same keys to the same files as the OHN, that never works," she advises.
Randolph says if the OHN reports to HR, both should learn early on what the expectations of each specialty are, and what each needs to run the best OH and HR program they can with the resources they have.
"The objectives of the occupational health nurse should be the same as human resources' and the company's," she says. "Their approaches might be different, but their goals should be similar."
Learn roles, build on shared goals
Preston says the better the HR and OH professionals understand each others jobs and boundaries, the easier it will be to work together toward joint goals and to work through situations where their efforts do not mesh.
OHNs should learn the roles of labor relations and HR, she urges. The core competencies of HR include a section on occupational health and safety, giving the two some common ground of knowledge.
Sharing case law resources and discussing new decisions having to do with occupational health and safety, labor relations, and arbitration is another way for the two disciplines to learn more about each other. Attending HR educational events, and learning more about labor relations and the grievance and arbitration process is another.
But an important part of building a relationship with HR colleagues is knowing what each discipline's responsibilities and limits are.
"We need to be quite aware of our boundaries, where that line is in the sand, and be able to defend that line and communicate it clearly," Preston points out.
Even if the OHN reports to HR, the rules on confidentiality remain the same, and the OHN "runs sort of a balancing act," Randolph points out. While they are the exception, Randolph says there have been cases of OHNs losing their jobs for "insubordination" in refusing to divulge protected information.
"The OHN is trying to maintain the confidentiality of the records and what is required by standards, and balancing that against what human resources needs to learn to do their particular job," she continues. "Human resources has reasons for wanting to know this information, and so when you have a good working relationship with HR and you know where they're coming from and they know where you're coming from, there can be some understanding."
[For more information, contact:
Elayne Preston, RN, DOHS, COHN©, COHN-S/CM, occupational health consultant, Employee First Health and Safety Consulting, Surrey, British Columbia, Canada. Phone (604) 531-2848.
Denise Figueiredo, director of business development, Platinum Professionals; president, National Human Resources Association. Phone: (805) 370-8110. E-mail: [email protected].
Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, clinical instructor, occupational health nursing, University of North Carolina at Chapel Hill. E-mail: [email protected].]
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