Essentials in Return to Work Issues

Abstract

To manage potential disabilities, the occupational and environmental health nurse has an extensive understanding of disability issues, provides functional worker assessments, and meets business requirements. They appropriately assess worker health issues and offer creative solutions to address both worker and business needs.

A 55-year-old male production worker with a history of insulin-dependent diabetes mellitus and prostate cancer was taking multiple 30-minute rest room breaks during his shift. The quality of his work had declined in many areas, including achieving target numbers, speed, and accuracy. In addition, he was making novice errors in the manufacturing position he had held for more than 20 years. The employee worked second shift in a clean room environment and wore a required Tyvek suit. The manager was concerned that continued performance issues would lead to discipline and potentially job termination.

After consultation with the occupational health nurse practitioner, a fitness for duty examination was arranged. The definition of being fit for duty may differ depending on the health care provider’s perspective (Combs & Heaton, 2016). Fitness for duty may be addressed when employees are returning to work without accommodations as well as for employees who may need transient or permanent adjustments. During the encounter, the nurse practitioner learned the worker had significant and frequent episodes of urinary incontinence since his prostatectomy and subsequent radiation treatments. His incontinence required repeated and extensive rest room breaks while he changed out of a Tyvek suit and his wet clothes, cleaned up, and redressed.

As of 2012, prostate cancer was rated as the second most frequently diagnosed cancer in men globally after skin cancer (World Cancer Report, 2014). It is the most common cancer among men in the United States and one of the leading causes of cancer death in the male population of all races (Centers for Disease Control and Prevention, 2016). The American Cancer Society (2016) recommends a care plan for urinary incontinence of prostate cancer survivors that includes pelvic floor muscle exercises, medication, and/or condom catheters. Zhang et al. (2016) conducted a study of 267 men and documented that urinary function can continue to deteriorate without appropriate ongoing care.

The employee was granted 2 weeks of Family Medical Leave (FMLA)/short term disability. He was given a supply of Tyvek suits and condom catheters to practice using and wearing under the Tyvek suit prior to work return. The catheters offered immediate improvement in his symptom management and resultant performance which enabled him to successfully return to work. He was also referred for pelvic floor muscle exercises to assist in long-term symptom resolution.

Disability management includes careful, detailed health and functional assessment of the ill or injured worker for work return as well as an extensive understanding of disability issues while meeting business obligations (Dyck, 2016). As the workforce ages, the incidence of both work-related and non-work-related chronic disease will increase in actively working employees.

It is costly to a business to replace a worker. The keys to business success are reducing costs, increasing productivity, and managing absenteeism, both in and out of the workplace (Sandal, Click, Dowling, & Guzik, 2014). Occupational and environmental health nurses are poised to facilitate the optimum health management of workers. They can provide education to workers about their specific health concerns and advise employers about developing flexibility in work schedules, providing on-site health care to treat minor illnesses, offering disability time to manage illnesses, and encouraging home–work life balance and stress reduction programs (Sandal et al., 2014).