Psychological and Social Issues Impacting RTW Following a Work-Related Injury
by Rosalie Faris, RN, BSN, CCM, COHN-S
Employers, adjusters, providers and case managers working with injured workers have long understood that some individuals have more difficulty than others returning to work following an injury. After more than 30 years in the workers’ compensation field, it has become clear to me that the seriousness of an injury does not predict the injured worker’s ability to return to work (RTW). As a nurse case manager, I have developed “radar” that helps me identify which injured workers might have a difficult time returning to work.
My Discovery
In July 2005, Dr. Suzanne Novak and Dr. Bill Nemeth published an article in Journal of Workers’ Compensation titled “Preventing the Wounded Worker Syndrome.” This was the first time that I had read information which supported the findings that I had seen in my case management population. Since that time, several medical providers and workers’ compensation carriers have identified psychological and social issues impacting RTW.
catastrophic thinking
Early identification of red flags is key in assisting the injured worker to RTW. One of those red flags is when, at the very beginning of the claim, the injured worker expresses, “I’ll never be able to do my job again,” or “I just don’t think I will be back to work for several weeks, months…years.” This is described as “catastrophic thinking,” and for many people, it’s a way of life. So often we hear people say, “Just my luck.” Catastrophizing is seen frequently in individuals with preexisting anxiety or depression. Anxiety and depression occur in up to 23% of the general population.
How do we help injured workers refocus their efforts on recovery instead of disability?
Keep communication lines open between the injured worker and the employer. Let them know that they are valuable members of the work team. Have them ask the provider when he/she thinks they will be able to RTW. One of our best hand surgeons would tell his patients at the first post-op visit what date he anticipated that the injured workers would be able to RTW light duty and full release. We found that when this discussion occurred early in the treatment, the injured worker was more likely to RTW within the expected timeframe.
Another risk factor is job dissatisfaction. This one is difficult to address after the injury. The best way to manage this is to be a “friendly workplace.” When you have injured workers who hate their job/boss/employer, RTW can be near impossible. Keep open the lines of communication with front line staff members. Listen to their concerns and comments. Attempt to rectify issues before they escalate. Many times job dissatisfaction is nothing that the employer can address, but a friendly workplace can help.
What is the best way to help the injured worker return to the workplace?
KEEP IN TOUCH! Do not be afraid to say to the injured worker, “I am so sorry you were injured.” This is not an admission that the employer was at fault. Ask the injured worker if there is anything that he/she needs. Set up someone in your organization who will follow-up with the injured worker at regular intervals. “Just checking in to see how you’re doing? “We really miss you at work.” Simple things help an injured worker maintain a connection to the employer. Some of these may not be possible if the claim goes into litigation, so check with your attorney/carrier if the injured worker retains a lawyer.
Consider Nurse Case Management
I realize that I am prejudiced, but the involvement of a good nurse case manager can help the injured worker understand the treatments being provided, assist in compliance, serve as an advocate within the medical system, and facilitate good communication between the employer, injured worker, adjuster and provider. As a certified case manager, I understand the multiple psychosocial issues that can come into play after an injury and can help facilitate a timely, safe RTW.
Even More Factors
Many other social issues can play into delayed RTW. For example, a single parent can find that without having to pay for childcare, he/she is making more money staying off of work on Temporary Total Disability (TTD). Or a spouse or significant other may start helping around the house and paying more attention to the injured worker.
These types of social issues require a medical provider who can identify when the injured worker has non-medical issues preventing RTW. RTW must be based on sound medical evaluations and treatment. Providing detailed job descriptions to providers can help them determine safe RTW. Job descriptions should list the physical demands of the job. If the individual’s job requires more physical activity than the provider will approve, look for modifications that can be made to assist the RTW process. Many times the only information that the provider has regarding the job duties are provided by the injured worker. If you have modified duty, make sure to communicate that to the provider. Never ask injured workers to perform job duties outside of their restrictions.
Psychosocial issues can have an impact on RTW regardless of the severity of the workplace injury. When it seems there is a delay in RTW, look for underlying causes. Good communication between the employer, injured worker, provider, adjuster and case manager can help to identify these issues and lessen their impact on RTW.
About Rosalie
Rosalie Faris is President & Chief Operating Officer of Occupational Managed Care Alliance (OMCA). In addition to being a Registered Nurse, Rosalie is a Certified Case Manager and a Certified Occupational Health Nurse-Specialist. She has 20 years of hospital experience, having developed and managed an outpatient surgery center and a hospital-based occupational medicine program, and she has broad experience in ADA consulting. Rosalie designs, implements and manages multi-state case management and utilization review programs for workers’ compensation and group health applications. Additionally, she consults with hospitals and physician practices on a variety of clinical and administrative issues. Rosalie serves as Co-Chair of the Medical Rehabilitation Committee for the Southern Association of Workers’ Compensation Administrators (SAWCA).
R.E.W.A.R.D. Program
Employers interested in developing an effective return to work program or improving an existing return to work program will benefit from the R.E.W.A.R.D. Program (Return Employees to Work And Reduce Disabilities) Program.
To get started, download the toolkit.
Meet with like-minded employers
The REWARD Employer Group Meetings provide employers the opportunity to learn from one another by sharing experiences and successes. The next REWARD Employer Group Meeting is scheduled for January 26, 2022, at 9:30 AM CST. Rosalie Faris will be a panelist and Michelle C. Foote-Pearce LPC, MHSP, Director of Psychology Services and Director of Mindfulness Programs & Outreach will be presenting.
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