Disabled Nurses: Too Valuable to Sideline

Disabled Nurses: Too Valuable to Sideline
by Genevieve M. Clavreul, RN, PhD

One of our greatest fears is becoming so sick or injured that we cannot return to the work we love. Bedside/floor nursing is demanding and arduous work, and a severe, limiting injury or chronic illness can leave an RN without the job for which she has trained. Why? Because most hospital environments do not have a system in place that can accommodate a nurse in a role outside the bedside. However, with a little creativity and will, it is not impossible to "re-enter" a highly- skilled RN into another hospital role.While Director of Nursing (DON) in Bakersfield, I got my first opportunity to put into practice what was just the seed of an idea at the time. One of our older (by seniority not age) RNs suffered a back injury that caused her to be placed on long-term disability, and in the end it was deemed that she would never be fit enough to return to carry out the demands at the bedside. This is an all too common problem faced by many nurses, which results in nurses choosing to work through pain and illness rather than be deemed "unfit" for duty. However, as I reviewed this nurse’s personnel file, and received input from her fellow nurses, I made the decision to assign her to admitting and patient intake. She was at first reluctant to assume this new position, but once I shared with her what I envisioned her role would be, she agreed to give it a try. I ordered her business cards printed with her name, credentials, qualifications, and, of course, contact information. It wasn’t long before her skill with both patients and their families made her much sought-after in her new position, and she was always impeccable in her white uniform. The upside for the hospital was that we saw almost immediate reduction of complaints involving intake during the period she staffed the desk. Patients provided me with the feedback that they appreciated having an RN there and they felt comfortable calling her if they had questions or concerns. Also, the nurses on the floor felt that the quality of the intake information was much improved during the period this nurse staffed the admitting desk.Finding alternative assignments for the disabled RN is a not as difficult as it may seem. Some areas that could could be appropriate are below:

INTAKE DESK As mentioned above, I had a very positive experience assigning an RN to the intake desk. In this position, a nurse’s assessment skills provide much more accurate intake information, which in turn provides the receiving RN a clearer picture of the patient’s status. The intake nurse can be involved in bed allocation and placement.Patients have a greater sense of security and comfort when they are aware that an RN is listening to them as they explain what they think is wrong, or how they are feeling, or the reason why they have come to the hospital.An RN often has skills that make working with "scared" or difficult patients easier, skills that are usually developed from formal training and years on the floor.

NURSE RECRUITER There seems to be a growing trend to use non-RNs to recruit RNs. However, an RN (with the appropriate "people skills") who is no longer able to work at the beside could serve as an excellent recruiter. Prospective nurses like to speak with RNs when they are investigating a new hospital, and personally, I believe RNs recruiting and interviewing RNs for possible hire adds a professional touch, which leaves a good impression on the nurse being recruited.

PATIENT ADVOCATE/OMBUDSMAN This position should answer to the manager in charge of quality improvement or, even better, should answer directly to the DON. This position could serve as a good fit for an RN during her period of disability, since patient advocacy is a key component in their scope of work.

QUALITY IMPROVEMENT The RN who is disabled by a work injury could be an excellent member of the QI team. All too often the QI team is composed of individuals not recognized as "real" nurses by the bedside nurse. The addition of a nurse sends a message that the work of the bedside nurse is not minimized.

NURSE EDUCATION/SERVICE Bedside experience is an enormous asset to the nursing education/in-service team. There’s also an added benefit. After working as a nurse educator, the disabled RN might choose to pursue nursing education as a second career, thus filling a desperate need for nursing teachers.

MENTORSHIP PROGRAM An RN with bedside experience, but no active assignment, could be asked to mentor a student nurse or newly graduated nurse, even a new hire. Also, this will send the message that the hospital administration cares for all nurses and does not discard someone due to disability acquired on the job. This position could also keep a focus on the attrition rate and do exit interviews.

OVERSEE EQUIPMENT INTEGRITY The RN who is recovering from disability is in an excellent position to assist in this area, since they can provide the maintenance department with a more accurate review of how machines really function, versus how they are advertised to function. Being a member of this team allows direct and realistic input on new equipment purchases. I firmly believe that short of a catastrophic injury, hospitals should try to place their "disabled" nurse in a parallel position. However, it is important to note that in order to do this, nursing administration must be willing to embrace this concept, and then in turn, nursing administration must provide the plan and the leadership to implement it so that hospital leaders have reason to "buy in." Besides getting management to accept the plan, one must take into account whether or not the nurses or the clerical staff is unionized. In cases where one or both are represented by unions, written agreements should be in place that clearly delineate how the RN will be integrated into the position. The nurse recruiter and nurse educator positions are not usually represented by unions, and all efforts need to be made to ensure that the RN understands and accepts this change. One must also consider that compensation may change due to the level of work that is expected. RNs who assume a new role must do so with complete knowledge that the pay scale may differ, as well as benefits, such as vacations, and sick leave. In some cases, the assignment may only be temporary, until the nurse is well enough to return to floor work. When this stage is reached, all efforts need to be marshaled to prepare the nurse to reintegrate into the nursing team and return to full working status. Not all RNs who are sidelined by a severe injury may want to return to work, just as some, though eager to return to work, may lack the temperament, skill sets, or qualifications for placement in one of the alternate positions. However, when both the RN and the circumstances permit, all efforts should be made to move the RN into a position where her experience, critical thinking skills, and knowledge of nursing can best serve the patient, healthcare team, hospital, and the community. Nurses invest much (educationally, emotionally, and financially) into becoming a nurse, while hospitals invest a great deal in recruiting, placing, and supporting their RN staff. Neither can allow work injury to cause the permanent loss of a competent RN when, with a little creativity and ingenuity. a loss can be turned into a gain. The same program could be applied to the older nurse, one who is near retirement from bedside nursing, but is still a competent, capable, and contributing member of the healthcare team, who wants to continue working. Good nurses are too important to lose.

Geneviève M. Clavreul is a health care management consultant. She is an RN and has experience as a director of nursing and as a teacher of nursing management. She can be reached at: Solutions Outside the Box; PO Box 867, Pasadena, CA; gmc@solutionsoutsidethebox.net (626) 844-7812.