Workman's comp issue - please help me!

[stidget99]

I really need some help/advice. I injured my back almost 2 weeks ago. I have seen the WC doc twice. He's placed me on light duty. Definition of light duty: no lifting, pushing, pulling >5#, mostly sit-down paperwork type of duties, no standing for more than 8 hours out of a 12 hour shift. I have been given medications to help w/ pain, spasms, and inflammation (ibuprofen - makes me sleepy, same w/ darvocet, and flexeril knocks me on my keester for a good solid 12 hours+). I can handle some pain and discomfort so I opt not to take them while at work.

Ok, here's my problem. I work the nite shift. I have kept in touch w/ my director and passed on the limitations as set by the WC doc. I feel that I am totally able to do the light duty as written by the doc. However, my work assignments are so far out of that realm it is unreal. My first nite working went well. I oriented a new grad on the nite shift. Her and I equalled one "full nurse". Had no problems. The 2nd nite that I worked, the same deal was supposed to happen. Me and one new nurse (experienced med/surg of 7 yrs) were supposed to equal one "full nurse". That nite did not go well at all. To start the shift out...I was already forced to take a pt assignment of at least two pts. I took two "walkies talkies, independent". But still was orienting the other nurse who, after 2300, had 7 pts. Now our matrix says, no more than 7-8 nurses on the 11p to 7a shift. Between the two of us, we already had 9. This was her either 2nd or 3rd nite on the nite shift and was still quite "needy" re: many of the hosp protocols. She had a lot of questions and required a lot of extra help. IMO, it was too soon to expect her to take a full pt assignment. Then, on top of that, I was required to take another admission. Very needy, fresh post-op (s/p MVA where he survived and his dad didn't). Somehow we managed to get thru the nite. I called out the next nite for fear that the same thing would happen again.

Now tonight rolls around. I saw the WC doc early Wed morning. He re-iterated restrictions. I again talked to my director. She assured me that she would be able to accomodate the restrictions (i.e. doing chart checks, acting as unit secretary, etc). She even sent out an email to concerned staff members (i.e. house supervisors) reiterating what my restrictions were. I get to work and am immediately informed by her that I would be taking 3 admissions. Do 1, finish up, take a 2nd, finish that up, and then take the 3 - each admission about an hour apart from the next. At 2300 I would be passing them off to the nite shift. [Of interest here...there were 3 other nurses on the floor and 23 pts and only one CNA. This staffing level is way short for the 7p-11p shift. None of them were in any position to be able to help me.] Anyways, I start the first admission. Even before I am half way thru the adm paperwork and getting them settled in the bed, I am being called for the next one. Just barely finishing the first and I am being called already for the 3 bed. As #2 comes up, #3 (a direct admit) hits the floor. I haven't even had a chance to really do anything w/ #2 and I have to get IV access established on a very hard stick. Took 3 separate IVs (first and second infiltrated about 30 mins apart from each other). In the meantime, #2 continuous bladder irrigation has clotted off and needs to be irrigated. I also have to make sure that these pts are medicated w/ their HS meds and pain meds. Also, #3 needs a foley placed. Not terribly easy task. Before I have a chance to do anything w/ #2 and #3, they are wanting #4 up to the floor. He comes up and I haven't even eyeballed him yet. By this time, it is 0030 or there abouts. I am in no way prepared to report off to the oncoming shift.

There was no way any of my co-workers could give me a hand cuz they were slamming busy w/ their pts from 7p - 11p..

Now........here's my issue..........the WC doc tells me to do one thing, chastising me earlier in the day because I didn't follow thru on his restrictions and am told that I must follow his orders or WC won't pay.........my director tells me that I have to take 3 admissions.........and after the director leaves, the house supervisor is telling me that I will be taking a total of 5 admissions "just get them settled in bed, do all of their paper work and then pass them off once settled". I can't say "no" to the house supervisor (although I did reinterate numerous times what my restrictions were). I left work about an hour and a half early because my back absolutely would not take anymore (I can only take so much pain and spasming).

I am afraid to go into work this weekend for fear that the same thing will happen. I am contemplating calling the WC insurance company but am afraid that it will ultimately end up costing me my job. Another issue: I am a nite person. Even on my days off, I maintain my nite shift schedule. I am terrified that if I say anything, I will be "punished" and made to work day shift.

Another point of interest here....there's another nite nurse who is also on restrictions. Very similar to my own. She has worked the floor several times and her restrictions have been accomodated in every way, shape, and form. She is there to do paperwork only! She stays busy for the whole 12 hours doing just the paper work and assisting other nurses as she is permitted by her restrictions.

I would be most greatful for any advice anyone could offer me. I apoligize for the long post here. I guess this turned out to be a vent and help me please combination post.

[mommatrauma, RN]

1. I would maybe talk to the MD and see if he can intervene and make a difference with your manager.

2. You obviously aren't getting satisfaction with your boss...so up the chain you go...go to her boss, explain the situation and the restrictions and the lack of regard for them when you go to work...and make sure you emphatically stress that this was an on the job injury and that you would just like to be as compliant to the restrictions as possible to prevent further injury, more days off, and more cost to the hospital for doctor revisits...

3. If all else fails, hate to say it, but get a lawyer...sometimes, you have to play dirty to win...and quite honestly, this is your health and your job at stake here...employers don't like lawyers, they are troublesome and are bad PR...it may only take the threat of legal action to see it your way and be more compliant with what the doctor ordered...

Good luck, hope you feel better!

[Daytonite, BSN, RN]

As another nurse with a bad back I feel your "pain", but I have some questions. I understand that you are very busy at your job, but unless I missed something here, you have not mentioned that you are lifting, pushing or pulling. What I got from reading your message is that you were very, very busy.

I worked for many years with a ruptured disc and neuropathic pain going down my leg. One of the things I did was use every available opportunity to sit down. It was a little awkward and embarrassing at first, but after awhile the relief from the pain was so welcome that I didn't care what anyone else might have thought. I started and attended to IV's, did any question asking, and even some vital signs sitting in a chair at the bedside. I looked for every opportunity to sit down in order to take the strain off my back and the nerve root which was being irritated by the rupture. An added bonus was that the patients felt like I was interested in them (little did they know!).

If you are in so much pain that you feel you cannot work under your present circumstances then perhaps you should not be going to work. Discuss this with the WC doctor and what is happening to you at work and see what he can do for you. He needs to know if his orders are not being followed and you need to make sure it is being documented in case you become further injured. If you feel that your work assignments are not appropriate based on your medical restrictions then the thing to do is to inform the WC doctor and also move your complaint up the chain of command: head nurse, clinical supervisors, coordinators, etc. all the way up to the director of nursing and even the director of personnel. You always have the option of going to your own physician. Perhaps he will see things differently and feel that you need to be off work and is willing to provide you with a work excuse. This, however, would not be the same as workmen's comp. It is not a secret that sometimes people are disgruntled about the care they receive under WC. You are dealing with an insurance company contracted by either that state or your employer. They are almost always going to prescribe conservative, less-costly treatment and get the worker back into the work place ASAP.

I am a bit puzzled though. How big of a facility is it that you work in? I couldn't tell. A larger facility would have other administrative people above your unit manager and your shift supervisors that you could take this problem to. Another choice you have might be to take a medical leave of absence until your pain subsides.

What is the problem that the WC doctor diagnosed? You didn't say. Muscle strains of the back take longer to resolve than strains in other places due to the high number of nerves in the area. They also can be excruciatingly painful. They do, however, get better. You might ask the WC doctor if you can have heat and ultrasound treatments for your lower back to help the pain.