Staffing woes plague many employee health services as occupational regs increase
Some departments have no clerical staff, only one RN
Hospital employee health services are facing a serious staffing crunch as hospitals downsize to cut costs even while federal and state agencies move to beef up occupational health regulations.
Fourteen states now have laws requiring the implementation of safer needle devices, and a proposed federal ergonomics standard would mandate a response to each musculoskeletal injury. That’s in addition to the routine physicals, preplacement exams, vaccinations, and other duties of employee health. Yet 65% of employee health departments operate with just one or two full-time-equivalent employees, according to a survey of Hospital Employee Health readers. About 57% of respondents worked in hospitals with more than 1,000 employees.
A hiring freeze or staff cuts may even leave employee health departments without any clerical staff, notes Mary Ann Gruden, MSN, CRNP, NP-C, COHN-S/CM, executive president of the Association of Occupational Health Professionals in Healthcare (AOHP) in Reston, VA.
A survey conducted by AOHP found one-fourth to one-half of its members work without clerical help. In fact, Gruden, an employee health nurse practitioner at Sewickley (PA) Valley Hospital, recently found herself in that predicament. AOHP survey respondents who work in facilities with 1,200 to 1,800 employees reported having an average of two full-time-equivalent positions in their employee health departments, consisting of 1.52 registered nurses and .45 clerical staff.
While there is no clear-cut recommended ratio of employee health staff to employees, Gabor Lantos, MD, PEng, MBA, a Toronto-based occupational health consultant, recommends one full-time occupational health nurse for every 500 employees. "To do a proper job, to do what needs to be done, that’s what you need," says Lantos, who acknowledges that such a ratio is rare.
By "employee," Lantos includes part-time or per diem workers. "They all have to be educated, oriented, [and] vaccinated," says Lantos, who is president of Occupational Health Management Services in Toronto. "Everything has to be done, whether they’re there one day a week or five days a week. It’s the same amount of work in an occupational health unit."
Meanwhile, employee health professionals say they struggle to meet a more modest goal of one nurse for every 1,000 employees. In fact, some employee health nurses have no backup.
"What happens in the hospital where there’s only one [employee health] staff nurse? [If that nurse is out,] then their clinic is closed and there’s no one there," says Jean Randolph, RN, COHN-S/CM, MPA, manager of employee health at Children’s Healthcare of Atlanta.
Simply counting heads isn’t enough
It may seem obvious that greater employee safety and health will lower workers’ compensation costs and lost work days. But that argument may not be enough to justify additional employee health staff.
Employee health professionals need to begin by tracking their activities and conducting a needs assessment, employee health experts say. Yet determining how many staff you need — and even how many you currently have — isn’t as simple as counting heads.
Various people in the hospital may handle employee health functions. For example, infection control officers may coordinate the evaluation of new sharps devices, or a physiotherapist may provide ergonomics analysis and back care.
Conversely, some employee health professionals end up with other tasks, as well. As the "accident-illness prevention provider" for workers’ compensation, Gruden analyzes injuries and illnesses and seeks ways to reduce them. Pennsylvania law requires companies that are self-insured for workers’ compensation to have someone in that role.
"What the Commonwealth wants is a very proactive approach rather than a reactive approach to safety," says Gruden. "For some of us in Pennsylvania, we’ve been designated that individual but not necessarily gotten any more human resources to respond to that challenge." Gruden put together a budget proposal to provide the prevention services.
For Randolph, a merger produced the impetus to reassess employee health needs. When Children’s Healthcare of Atlanta was created through the merger of two hospitals, Randolph’s department became responsible for 4,500 employees, including some in urgent care and primary care centers.
"I said, We’ve got to have at least three staff nurses for 4,500 employees,’" recalls Randolph. "We are now looking at the possibility of a fourth, because it’s an incredible load."
This summer, Randolph found herself short-handed after one nurse went on family leave and another left for a long-planned vacation. She and one other nurse covered the 10-hour shifts. "That’s a stretch, needless to say," notes Randolph.
Track the time spent on physicals, care
Randolph tracks the number of preplacement physicals, annual physicals, wellness or sick visits, and other encounters of her department. She calculates how long each encounter takes, on average. If her numbers exceed 40 hours per week for herself and her staff, she knows she needs more help.
"That means you’ve not case-managed any injuries and you’ve not done any wellness education in the general community of your employees," she says.
Documenting your activities is a critical first step toward justifying the need for additional staff, says Danielle Richlin, MSN, RN, professional resource manager with the American Association of Occupational Health Nurses (AAOHN) in Atlanta.
It’s important to be able to demonstrate not just the scope of your services but the amount of nursing time devoted to them, says Richlin, who previously worked in a hospital-based employee health department.
"We had a sign-in log [for employees seen], with the time signed in, who you saw, and the reason for your visit. That’s a good way to track and discern how much nursing time is actually being utilized," she says. "If management comes and says we need to downsize, you can prove how many visits you’ve had and how much nursing time is spent on each activity."
AAOHN has published SuccessTools: Strategies for Thriving and Surviving in Business, a management guide for employee health professionals that includes information on staffing. AAOHN recommends gathering data on injuries and illnesses, workers’ compensation, absenteeism, disability, employee health service visits, and medical claims and conducting a cost-benefit analysis of services and programs. (See excerpt from SuccessTools on p. 87.)
By reducing injury and illness, employee health professionals can have a ripple effect on other parts of the hospital, notes Lantos. When a nurse is out, the hospital may be paying overtime to cover that shift.
"Go to payroll if you have to, look at those numbers and say, This is what it’s costing you,’" advises Lantos. "If we had an extra nurse, we could better manage the illnesses.’"
Worker illness could affect patient safety
For example, the average musculoskeletal injury leads to medical costs of $3,080, according to estimates from the U.S. Occupational Safety and Health Administration. Ultimately, those missing employees make a difference in patient care, as others work longer hours to replace them, notes Lantos. "Patient safety is the one thing that will get everyone’s attention," he says.
Sometimes, even a strong argument in favor of more employee health staff won’t succeed, simply because the hospital is struggling financially. In that case, says Gruden, "you have to prioritize and determine what needs to be done and do it in the best way you can, realizing it’s not optimal."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content