Nurse Case Manager Chronicles

The Injured Worker’s Family

Incidents at work affect more than the injured. How can a nurse case manager help the family cope?
By: | January 10, 2018 • 4 min read

Wendy Woodard knows what it takes to get a catastrophic case moving. In just six months, this nurse case manager for Ascential Care got an injured patient back on his feet and cleared for work without restrictions.

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But the road leading to recovery wasn’t always smooth; like in many claims cases, Woodard had her fair share of obstacles to overcome.

“Nurses work with the patient’s family emotionally so they can get the patient where they need to be,” she said. “This [particular patient’s] family did not work in the medical field. They were worried about him being placed so far away with no one around him.”

The patient, a pharmacist by profession, was driving when a tree fell on his vehicle, cracking the roof of the car — and his skull.

He suffered a traumatic brain injury, a spinal fracture, pulmonary contusions and facial fractures, among other ailments. Woodard went to the hospital two days after the patient was admitted to the ICU.

His condition was critical.

“I didn’t know the extent of his injuries until I got there,” she said. “The hospital was still trying to stabilize the patient.”

Immediately, Woodard began coordinating the best care option for the patient. They lived in an area with a level one trauma center but not a rehabilitation center for traumatic brain injuries. The nurse knew the patient’s best chance at recovery would be at Shepherd Center, a spinal cord and brain injury rehabilitation center in Atlanta, Georgia — five and a half hours away.

Wendy Woodard, nurse case manager, Ascential Care

The family was hesitant.

“The patient was in his late fifties. He had four children, a brother and his ex-wife waiting for him. There was a lot of back and forth on who would manage his care,” Woodard explained.

The patient’s oldest daughter and his brother both wanted to be the go-to person for decisions, but they found the long trip to Shepherd daunting. They didn’t want their loved one so far away during a critical and demanding time in his life.

Woodard, a nurse case manager for 18 years, knew what to do: She talked to the family.

“We talked about not having the right rehab facility. If he was going to make a full recovery, we had to get him where he needed to be,” she said. “My role was to provide them with knowledge on brain injuries and get the right care to the patient.”

She brought in pamphlets, pulled up Internet searches on the patient’s injuries, explained each type of fracture to the family and answered questions. But Woodard didn’t stop with facts; she entered the hospital every day for three weeks, checking in on the family’s emotional state.

“I was there, every day, offering emotional support,” she said. “The patient’s daughter cried on my shoulder. We went over and over what his best options were.”

In the end, the family agreed to send him to Shepherd.

Recuperation and Recovery

Once the patient was stabilized — a process that took three weeks — he was moved to the rehab facility.

When he started to respond, Woodard said the team assessed any permanent damage. The injury left the patient with permanent left-side facial paralysis and cranial nerve deficits. He had lost hearing in his left ear, was dizzy, disoriented and discouraged.

“He wouldn’t speak, was withdrawn and depressed,” said Woodard. The team worried about the patient’s cognitive function. As a pharmacist, the man needed to gain back his cognitive abilities if he wanted to work in the field again. Woodard noted he was a very intelligent man, and, after three weeks, he started to understand.

“It’s remarkable how well he did. He was very determined.”

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Slowly but surely, the patient regained his speech and other cognitive functions back, and he transferred to a half-way house. Woodard coordinated with the physical therapist and the occupational therapist, setting up appointments and monitoring progress. She worked with the claims adjuster to guarantee the patient’s schedule for checkups with his neurologist.

By the time the patient returned home, the nurse had his appointments set, eliminating delays in care.

“My goal is always to get my patient back to work and back to a normal life, because that’s the best thing for them,” Woodard said.

Six months after the injury, doctors cleared the pharmacist for a return to work with no restrictions.

“I do not think he would have gained his cognitive skills if the family hadn’t agreed to move him,” she said. “The educational role nurses play is so important to the family.” &

Autumn Heisler is a staff writer at Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Absence Management

Establishing Balance With Volunteers

It’s good business to allow job-leave for volunteer emergency responders, whether or not state laws apply.
By: | January 10, 2018 • 7 min read

If 2017 had a moniker, it might be “the year of the natural disasters,” thanks to a phenomenal array of catastrophic or severe events— hurricanes, tornadoes, wildfires, ice storms and floods.

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Combined with smaller-scale fires and other emergencies, these incidents tax the resources of local and state emergency services, often prompting the need to call volunteer emergency responders into action.

But as lean as most organizations are already running, volunteer activities can sometimes cause friction between employees and employers. Handling conflicts the wrong way can potentially lead to legal headaches, harm employee morale and batter a company’s reputation.

State by State Variations

Most employers are aware of the various federal and state leave laws protecting their employees, including family and medical leave, pregnancy leave and military leave. But leave laws that protect the livelihoods of volunteer emergency responders are more likely to fly under the radar of some HR managers and risk managers.

Such laws don’t exist in every state, but more than 20 states do have some type of law in place to protect volunteers including emergency responders, firefighters, disaster workers, medical responders, ambulance drivers or peace officers.

Marti Cardi, vice president of Product Compliance for Matrix Absence Management

The laws vary broadly. Nearly all specify that such leave be unpaid, and that employees disclose their volunteer status to employers and provide documentation for each leave. But there is a spectrum of variations in terms of what may trigger an eligible leave. Some, for instance, apply for any emergency that prompts a call from the volunteer’s affiliated responder group. Others may require a government declaration of emergency for the law to be triggered.

While many of the laws do not explicitly require employers to let employees leave work when called to an emergency during a shift, most specify that an employee may be late or even miss work entirely without facing termination or any other adverse employment action.

Some states mandate a maximum number of unpaid leave days that a volunteer can claim. But others may place more significant burdens on employers. In California, for instance, employers with 50 or more employees are required to grant up to 14 days of unpaid leave for training activities in addition to any leave taken to respond to emergency events. For multistate employers, keeping on top of what obligations may apply in each circumstance can be a challenge.

Significant Risks

Large or mid-sized employers may rely on absence management providers to keep them in compliance. For smaller employers though, it may be as simple as looking up a state’s law via Google to find out what’s required. However, checking in with the state department of labor or the company’s attorney may be the best way to get the correct facts.

“I would caution that just because you don’t find something [on the internet], it doesn’t mean it’s not there,” said absence management and employment law attorney Marti Cardi, vice president of Product Compliance for Matrix Absence Management.

For example, Cardi said, an obscure Texas law provides job-protected leave for volunteer ham radio operators called into service during an emergency.

Cardi said employers should task HR to investigate the laws in each state the company operates in, and to ensure that supervisors are educated about the existence of these laws.

“If a supervisor is told by one of his or her employees, ‘Sorry I’m not coming in today … I’ve been called to volunteer firefighter duty for the [nearby region] fire,’” she said, you want to be sure that the supervisor knows not to take action against the employee, and to contact HR for guidance.

“Training supervisors to be aware of this kind of absence is really important.”

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An employer that does terminate a protected volunteer for responding to an emergency may be ordered to pay back wages and reinstate the employee. In some cases, the employee may also be able to sue for wrongful termination.

And of course, “you don’t want to be the company in the headlines that is getting sued because you fired the volunteer firefighter,” she added.

If an employer bars a volunteer from responding, the worst-case scenario may be a third-party claim. Failure to comply with the law could give rise to a claim along the lines of “‘If you had complied with your statutory obligation to give Jane Doe time to respond, my loved one would not have died,’” explained Philadelphia-based Jonathan Segal, partner at law firm Duane Morris and managing principal of the Duane Morris Institute.

“That’s the claim I think is the largest in terms of legal risk.”

Even if no one dies or is seriously injured, he added, “there could still be significant reputational risk if an individual were to go to the media and say, ‘Look, I got called by the fire department and I wasn’t allowed to go.’”

The Right Thing to Do

What employers should be thinking about, Segal said, is that whether or not you have a legal obligation to provide job-protected leave for volunteer responders, “there’s still the question of what are the consequences if you don’t?”

Employee morale should be factored in, he said. The last thing any company wants is for employees to perceive it as insensitive to their interests or the interests of the community at large.

“Sometimes employers need to go beyond the law, and this is one of those times,” — Jonathan Segal, partner, Duane Morris; managing principal, Duane Morris Institute

“How is this going to resonate with my employees, with my workforce, how are people going to see this? These are all relevant factors to consider,” he said.

There’s an argument to be made for employers to look at the bigger picture when it comes to any volunteer responders on their payroll, said Segal.

“Sometimes employers need to go beyond the law, and this is one of those times,” he said. “Think about the case where’s there’s not a specific state law [for emergency responders] and you say to a volunteer, ‘No, you can’t leave to deal with this fire’ and then people die. You as an employer have potentially played a role, indirectly, because you didn’t allow the first responder or responders to go,” he said.

The bottom line is that “it’s the right thing to do, even if it’s not required by law,” agreed Cardi.

“I feel that companies should have a policy that they’re not going to discipline or discharge someone for absences due to this kind of civic service, subject to verification of course.”

Clear Policy

While most employers do strive to be good corporate citizens, it goes without question that employers need to guard their own interests. It’s not especially likely that volunteer responders will try to take advantage of the unpaid leave allowed them, but of course, it could happen.

That’s why it’s important to have policies that are aligned with state laws. Those policies could include:

  • Notifying the company of any volunteer affiliations either upon hire or as soon they are activated as volunteers.
  • Requiring that employees notify a supervisor as soon as possible if called to an emergency (state requirements vary).
  • Requiring documentation after the event from the head of the entity supervising the volunteer’s activities.

If at some point it becomes excessive – someone has responded to emergencies five times in nine weeks, then it’s time to examine the specifics of the law and have a discussion with the employee about what’s reasonable, said Segal. It may also be time to ask specifics about whether the person is volunteering each time, or are they being called.

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In some cases, the discussion may need to be about finding a middle ground, especially if an employee has taken on an excessively demanding volunteer role.

“We encourage volunteers to pick the style that best fits their schedule,” said Greta Gustafson, a representative of the American Red Cross. “Disaster volunteers can elect to respond to disasters locally, nationally, or even virtually, and each assignment varies in length — from responding overnight to a home fire in your community to deploying across the country for several weeks following a hurricane.

“The Red Cross encourages all volunteers to talk with their employers to determine their availability and to communicate this with their local Red Cross chapter.”

Segal suggests approaching it as an interactive dialogue — borrowing from the ADA. “Employers may need to open a discussion along the lines of ‘I need you here this week because this week we have a deliverable on Friday and you’re critical to that client deliverable,’” he said, but also identify when the employee’s absence would be less critical.

No doubt there will be tough calls. An employer may have its hands full just trying to meet basic customer needs and need all hands on deck.

“That may be a situation where you say, ‘First let me check the law,’” said Segal. If there’s a leave law that applies, “then I’m going to need to comply with it. If there’s not, then you may need to balance competing interests and say, ‘We need you here.’” &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]