Management and modified duty

[TXcatcher]

Last month I was injured while transferring a patient. I hurt my back and have been on modified duty for over a month now.

At first, my manager was "nice" about offering me light duty assignments. I have been essentially acting as a free charge nurse, which my unit does not (but should) have. As the weeks have passed, my manager, though she has never particularly been friendly to me, seems to abhor the ground I walk on. She gives me the stink eye every time she sees me, and rolls her eyes when I bring in my new modified duty paperwork. Today she said "I took you off the holiday because there's no reason for you to sit around on a holiday," without even looking at me.

I do not "sit around." I try to stay up and active as much as possible because sitting hurts for one, and two, I want to be of service to my unit. I am often advocating for our staff and patients when the manager is mute on the subject. I am limited by the amount of weight I can bear and how much I can bend over, but I still try to be there for my coworkers where I can.

Recently, I was bullied (per usual) by a coworker. She has a history of being awful to me, as well as others, but she seems particularly keen on making my life hell. (Side story, even a patient and other hospital staff have recognized her being awful to me!) On this day, she and my manager both yelled at me for something that is not anything I had anything to do with. She also was rude about making me do her entire admission, which I did not do - I finally told her she needed to ask nicely after several hours of her berating me for being useless. Then later in the day, I was floated to another floor to be a telemetry technician. I have spoken with my manager and the nursing supervisors about my limitations, which include not sitting for several hours at a time (ie - reading tele monitors). I personally feel this was retribution for standing up for myself to this bully nurse.

My sister says it's a shame my boss doesn't like me, and I should try to get on her good side. Just a few months ago, however, my manager was the reason for a mass exodus of nurses from our floor. She does not respect the talented nurses on the floor, and we have lost some great nurses because of it.

Aside from the bully nurse and two or three lazy nurses, my unit has an awesome team of nurses and nursing assistants. We are all about teamwork and being there for each other. I do not know what to do about my relationship with my manager. I am in my early 30s, and I've been a nurse for three years. I am single, and without a backup plan. I do not want to return to full duty and hurt myself permanently, but at the same time, I am losing my self esteem because my boss makes me feel so useless and like I am a burden. Any advice?

[canoehead, BSN, RN]

Lawyer.

But try to accommodate them...for example you don't need to sit when you watch moniters, you can get up and stretch at your station. If you are feeling really accommodating try and find things you can volunteer for like committee work or chart review. There's lots of paperwork that no one likes.

[JBudd, MSN]

Since you were injured on the job, sounds like she can't fire you, so she is trying to make you leave on your own. Don't.

You know you are not worthless, or a burden; she may think you one because she has to accommodate you and it "makes work" for her. Tough. That's what happens when an employee is injured, it is her job to deal with it. Keep working hard, doing what you can as best you can. They owe it to you.

As for bully nurse, keep a record of dates and times when she says anything unprofessional, word for word. Be objective, don't inject your feelings into it. "Hostile work place" is something no HR wants to hear, let alone have documented.

[MunoRN, RN]

Keep in mind your employer is under no obligation to offer you light duty work, they are free to deny you any hours at all if you can't perform all of your assigned duties. To be honest, I would also be annoyed if I went out of my way to offer you light duty work, only to have you complain about being assigned duties that are too light (tele room), I'd tell you to go home at that point.

[blondy2061h, MSN, RN]

Keep in mind your employer is under no obligation to offer you light duty work, they are free to deny you any hours at all if you can't perform all of your assigned duties. To be honest, I would also be annoyed if I went out of my way to offer you light duty work, only to have you complain about being assigned duties that are too light (tele room), I'd tell you to go home at that point.

Then they can pay her worker's comp to sit at home.

I do agree having you watch tele monitors seems like a good use of light duty. My job does not offer light duty at all.

[TXcatcher]

Watching tele monitors requires sitting for twelve hours straight. Sitting is the worst thing you can do for a lower back injury. I don't even take a full lunch break because I cannot sit for that long. I was on restricted duty when I broke my leg, and they had an open tele tech spot on another floor, so I worked up there for a month. I'm okay doing it when it doesn't go against actually making me better.

[tsm007]

Watching tele monitors requires sitting for twelve hours straight. Sitting is the worst thing you can do for a lower back injury. I don't even take a full lunch break because I cannot sit for that long. I was on restricted duty when I broke my leg, and they had an open tele tech spot on another floor, so I worked up there for a month. I'm okay doing it when it doesn't go against actually making me better.

Can you stand and do tele monitors? When I was in the military I had a back issue and was stuck standing/sitting watch to accommodate. I would rotate sitting with standing and stretching. I'd talk to her and try and meet her in the middle. Stand, sit, stretch, repeat.

[TXcatcher]

Can you stand and do tele monitors? When I was in the military I had a back issue and was stuck standing/sitting watch to accommodate. I would rotate sitting with standing and stretching. I'd talk to her and try and meet her in the middle. Stand, sit, stretch, repeat.

I tried it on the first day they put me to read. It was torture. If you stand, you have to look down, and you're basically standing in one place because the area is so small. I was actually in so much pain at the end of that day, I called my mother crying on my way home.

On the most recent day when I was sent somewhere to read, that floor had an extra nurse acting as a free charge. It seems silly to pull a free charge from one floor to keep one on another. If our tech had left, they wouldn't pull a nurse from another floor because we had a free nurse. The logic behind sending me definitely seems iffy...

I know one thing is for certain, I won't be preventing falls from now on. If my patient starts to fall, well then to the ground they will go.

[Libby1987]

What useful tasks are you able to do?

And what difference does it make how someone asks you to do a task (admission)? Unless she said FU, why didn't you jump on a meaningful way to show your value to the unit and build your coworkers support of your light duty position? That seems like an opportunity lost.

[nurseprnRN, BSN, RN]

I did work comp case management for years (and am still involved in catastrophics). There are a few things going in here.

1) If you were injured at work, did you file an injury report at the time with them, or is this all ad hoc? If filed, you should have the name of your work comp insurance carrier's adjuster for your claim. If ad hoc, you need to file a report of injury stat to preserve your rights. You don't need an attorney to do that. Your HR department should be able to deal with this immediately if you haven't already.

2) If you have a work comp claim (formally, with your state division of (whoever handles this there)) then if your treating physician mandates you to be on light duty, s/he should specify what your limitations are. (Sitting for no more than X minutes without a change of position, no more than X minutes on your feet without rest, lift & carry weight limits, bend/squat/stoop limits or restrictions, hours per day or per week, etc.) Every ortho doc has this form in the office. It gets submitted to the comp carrier and a copy to your employer.

3) Your employer is NOT obligated to give you modified duty. However, if they do, they are mandated by law in all states of which I am aware to give you your regular rate of pay and benefits (including vaca and seniority accrual) for the hours that they do. They are not obligated to give you your regular shift, schedule, etc. If they don't give you modified duty, their comp insurance carrier has to pay you a wage replacement, called indemnity, (which may NOT be as much as your regular pay; in many states, it's capped or otherwise limited or reduced, and may not entitle you to vaca or seniority accrual, and they could even d/c your regular benefts, and they have to offer you COBRA for health insurance-- but this costs YOU). This directly affects your employer's bottom line, though, so it's really better for them to provide modified duty.

4) If your employer disagrees with your treating physician's restrictions and plan of care (I do hope you're in physical therapy or a formal back rehab program!! for which comp should be paying) they can send you to an independent physician for an exam and plan of care. In most states they cannot mandate that you treat with any particular physician or follow another plan of care, but they can sometimes limit their payment for care that they don't agree with. Not always, though, so find out.

5) Ask your adjuster to assign a nurse case manager to your case to help manage your rehab. A good one will advocate for you and get you the best care. Tell him/her you don't necessarily want to have an attorney get involved. (Keep that option in your back pocket-- there are some disadvantages to that, believe it or not.) But the key is to file for a comp claim stat if you haven't.

[TXcatcher]

I help out with all admissions, and even attempted to help that admission. Not one other nurse on my floor has ever treated me with as much disrespect as this girl. It has been going on for over a year. I've just now started standing up to her. Please don't assume I just sit around all day and read magazines. I'm always walking laps and checking on my coworkers, answering call lights, doing lab draws and dressing changes, and doing anything I can to help out.

I filed a report with occupational health, and have been seeing their assigned doctor. I was only given three PT sessions, but continue to do the exercises. The doctor doesn't really give me any recommendations for recovery, just asks if I still have pain and that's it. My restrictions do give the amount of time I can be doing certain activities. "Sitting for up to 50% of time or as needed." To me, fifty percent is too much. Even at home, I'm rarely sitting.

[applewhitern, BSN, RN]

You wouldn't be protected at my facility at all. You can be fired without cause here. I wonder why you didn't get workman's comp. to start with? That said, you can still stand up and stretch, walk around, etc., when watching tele monitors. I do it all the time; they have alarms, you know.