Occupational Health Nurses on staff can help employers deal effectively with legal and safety issues caused by impairment, regardless of its cause
“Many employees are hard-pressed to swear that they have never been at work and impaired.” No doubt, this statement will raise eyebrows, but think about it: Impairment is experiencing a diminished, reduced, or damaged state of being. It stems from a disease state, injury, or substance-related condition. Yet, there are more sources.
Impairment is a problem in body function or structure. The World Health Organization terms it an activity-limitation — a difficulty encountered when executing a task or action — while a participation-restriction is a problem in life situations. This broader definition encompasses traditional sources of impairment along with other sources such as fatigue, shiftwork, medication, medication interactions, and aging.
Disease state
Illness/injury can result in employee disability and manifest as activity-impairment or participation-restriction. Employees absent from the workplace, or functioning in a reduced capacity, offer reduced productivity.
Presenteeism denotes employee presence at work, but reduced productivity due to fatigue, illness, injury or psychological disturbances. Presenteeism has been reported to cost nine times the cost of employee absenteeism (Aldana, 2009).
Substance-induced state
Employees can be working but still be functionally incapacitated. Impairment varies with substance properties, dosage, user gender and age, length and time since use, tolerance level, or the nature of the activity. Activities involving concentration, fine motor skills, information processing, deductive reasoning, quick response time, and memory are the most impacted.
Many people work two or more jobs. Our society is sleep-deprived: “Canada is the third-most sleep-deprived country, with nearly a third (31 per cent) of Canadians feeling like they don’t sleep enough” (Avia, 2016).
This is a problem, as fatigue is associated with functional and cognitive impairment such as vigilance, cognitive performance, memory, problem-solving, planning, and verbal fluency deficits which can cause workplace incidents. Employee productivity, attention to detail, learning, and creativity are reduced. Shiftwork alters workers’ circadian rhythm and sleep, negatively impacting alertness, decision-making, recall, and response time.
Diminished capacity state
With 20 per cent of full-time workers over 60, employers are witnessing the effects of aging:
• Increased morbidity due to sleep deprivation, chronic health conditions, increased use of medication
• Functional inability to undertake previous job tasks.
Older workers are likely to experience vision, hearing, muscle-strength, mobility, motor-performance, fine-motor-skill, perceptual-ability, and response-time changes, along with sleep changes and cognitive declines.
Risk management:
Risk management involves making and implementing decisions to minimize adverse effects of accidental and business losses. It is the systematic application of planning, organizing, leading, and controlling functions to:
• Anticipate and identify accidental loss exposures
• Evaluate the related risk
• Work to avoid or eliminate hazards
• Attain acceptable level of risk.
Risk is a state in which losses are possible. In disability management, the risks to Canadian employers include high employee-absence rates, legal obligations, financial losses, and thwarted societal expectations. The legislation impacting and influencing disability management are human rights legislation, workers’ compensation acts, privacy legislation, occupational health and safety (OHS) legislation, employment Standards, and labour law.
Permanent disability puts employees at risk for withdrawal from the workforce and premature death (Scott-Marshall, 2015). This is a human capital loss. Financial risks stem from losses the employer faces when an employee is medically absent – lost productivity, business interruption costs, disability claim costs, supplementary healthcare costs, worker replacement costs, time lost in rearranging work schedules, and increased insurance premium rates. Each year, full-time Canadian employees miss, on average, 7.8 workdays due to medical reasons and 1.7 days due to family reasons. Those 9.5 days cost employers $2,117.36 per employee.
Societal expectations emanate from Canada’s strong “social conscience.” Employers are expected to “do the right thing” for employees; if perceived to fail, their corporate image and reputation suffers.
Risk management is the responsibility of organizational leaders. They decide their “risk appetite,” preferred system for risk control, and how to enact stakeholder accountability.
Occupational health nurses (OHNs) are involved in risk management situations and daily provide risk communications. Occupational health (OH) programs and disability management programs (DMPs) are risk management tools: they are human resource “risk management approaches” aimed at promoting employee well-being, preventing illness and injury, and mitigating medical costs. They preserve human capital.
OH nursing is risk management operationalized. Synonymous with every aspect of an Occupational Health and Safety Management System, OH nursing minimizes the costs of risk. It is an administrative, managerial function like standard OHS hazard identification and loss-control, but more sophisticated and focused on potential risk.
A DMP serves a risk management function; it controls the human and economic costs of injury and illness, conveys a message that employees are valued, and demonstrates legislative compliance. It is a risk management and risk-communication approach designed to integrate corporate resources, minimize associated losses and costs, and prevent future occurrences.
Managing employee impairment
Employee impairment is concerning. Organizations should combine risk management approaches – uphold the legal duty of providing a safe and healthy workplace while meeting business strategies and obligations.
Employers must have policies and procedures to address impairment situations – an OHS policy and program; safe work procedures; and enforcement. Employers need to ensure the health impacts of work conditions like work hours, demands, pace, shiftwork, and travel requirements, are evaluated. If deemed hazardous, employers must remedy the situation and adequate resources and expertise must exist to identify and manage employee impairment.
OHNs can help, as they are qualified to undertake the management of employee impairment by:
• Ensuring employees are fit to work
• Ensuring the worksite is free of uncontrolled hazards
• Medically monitoring employees exposed to hazards
• Conducting health-risk assessments
• Communicating risk nature and severity
• Conducting ergonomic assessments and identifying remedial action
• Facilitating critical incident stress debriefings post-incident
• Assisting with OHS strategic-issues management.
Managing the disease state
OHNs are educated, skilled, experienced and can be positioned to facilitate the management of employee absenteeism and injury or illness. They liaise with external individuals and agencies to advocate for the employee and organization as well as:
• Mitigate workplace illness/injury through timely response and referral for medical treatment
• Determine employee fitness to work
• Manage injury/illness cases
• Co-manage insurer responsibilities and actions
• Co-ordinate disability management assistance
• Assist employees to return to work in a safe and timely manner
• Evaluate service outcomes and determine return on investment
• Conduct trend analyses aimed at illness/injury prevention and introduction of suitable loss-control measures.
The outcome is assurance that the employee is fit to work, as opposed to being impaired due to illness/injury.
Managing the substance-induced state
OHNs are qualified to plan and provide employee-centred, goal-oriented care involving:
• Assessment (of organization/employee’s needs)
• Diagnosis (of human response needs)
• Planning (of organization/employee’s care)
• Implementation/intervention
• Evaluation (of the implemented care).
This problem-solving process enables OHNs to determine the degree to which a substance-induced state impairs employee performance. Knowing the physical and cognitive demands of the employee’s “own” job, the OHN can determine the degree of dissonance between the work demands and the employee’s capability. The OHN can activate corporate policies to eliminate the risk of an impaired employee in the workplace. Secondly, the OHN can assist the employee to obtain appropriate medical and psychological assessment and treatment. The OHN can also determine if the employee is indeed fit to work following treatment.
Managing the diminished capacity state
OHNs can address worker fatigue through:
• Management/union education on the negative impacts of sleep deprivation
• Employee education on the negative impacts of sleep deprivation
• Employee health surveillance and assessment of fitness to work
• Early intervention, referral and treatment
OHNs are also well-versed on the health impacts of shiftwork and can help protect employees and organizations from the negative health effects of it.
An aging workforce is a new phenomenon. To effectively manage the related-health effects of impairment, OHNs can intervene by providing:
• Management/union education on aging and how to counteract the related impacts
• Employee education on aging and how to protect against the related body changes
• Employee health surveillance and assessment of the older employee’s fitness to work
• Early intervention, referral and treatment
Employee impairment can be addressed regardless of cause. By promoting workplace health and safety and mitigating health losses, OHNs can contribute to organizational business strategies and profits while reducing legal and safety risks in the workplace.
