8/9/2018 Employment Issues in Healthcare Settings Teresa Goddard, - - PDF document

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JAN is funded by a contract with the Office of Disability Employment Policy, U.S. Department of Labor.

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Employment Issues in Healthcare Settings

Teresa Goddard, M. S. Lead Consultant, Sensory Team Matthew McCord, M.S., CRC Consultant, Motor Team

Objectives

• JAN Overview
• Interactive Process
• Typical Issues
• Situations and Solutions
• Questions

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Accommodations - Healthcare Consultation

• Job Accommodations
• All industries, job categories, and

impairments

• Employment Legislation
• Americans with Disabilities Act
• Rehabilitation Act

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Job Accommodation Network

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Technical Assistance

• Free
• Confidential
• National
• Easy to Use
• Audience Focused
• Employers
• Individuals
• Service Providers
• Others

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Job Accommodation Network JAN’s Interactive Process

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Accommodations - Healthcare

Step 1:

Recognizing an Accommodation Request

Starting the Interactive Process

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What is a reasonable accommodation request?

• An applicant or employee asks for something that is

needed because of a medical condition.

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An employee is disciplined for poor performance. In response, she says, “It’s because I have ADD and I can’t concentrate with all these distractions.” Is this an accommodation request?

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Is this an accommodation request?

Yes.

• Quieter work environment is needed
• Because of a medical condition

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Step 2:

Gathering Information

Getting What You Need To Process the Request

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What is allowed?

• Limitations, work-related problem, accommodation

ideas

• Medical documentation
• Employee has a disability
• Employee needs an accommodation

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In response to a poor performance evaluation, a nurse practitioner provided a doctor’s note claiming her multiple sclerosis is contributing to her performance problems and says she may benefit from an accommodation. Is this enough information?

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Did we provide all the information?

No.

• Did not provide limitations
• Did not provide problem

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What is prohibited:

• Irrelevant information
• Information that is known or obvious

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Step 3:

Exploring Accommodation Options

Figuring Out What Accommodations Might Work

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What should you do?

• Brainstorm
• Think outside the box
• Talk with the employee
• Use available resources

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A child therapist wanted to continue working while undergoing treatment for cancer. Because of her treatment she had a suppressed immune system and her doctor recommended she wear a mask while

• working. She found a mask that did not interfere with her

speech, but found out that it frightened some of the young children she worked with. It looked like she might have to take leave time until finished with treatment. What might she or her employer do?

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Accommodations - Healthcare

What might she or her employer do?

Call JAN!

• Mask with cartoons
• Met employee’s needs and allowed her to perform her

job

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Step 4:

Choosing an Accommodation

Exercising Your Prerogative

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Consider:

• Employee’s preference
• Business needs

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A medical transcriptionist could not tolerate personal fragrances worn by coworkers. No private workspace was available. His employer was considering putting up cubicle walls and an air purifier in his work area. His job could be done from home, but the employer was concerned about isolating the employee. How can we help the employer decide which accommodation to choose?

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How can the employer decide which accommodation to choose?

Talk with the employee!

• Employee preferred to work at

home so not forced isolation

• Employee was more concerned

about the cubicle/air purifier drawing attention

• Employee expressed his preference

and concerns to employer

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Do not consider:

• Co-worker morale
• Customer preference
• Power struggles

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Step 5:

Implementing the Accommodation

Taking Steps Necessary to Make Accommodation Work

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May involve:

• Purchasing and installing equipment
• Ordering a service
• Training
• Notifying those who need to know

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An employee was given permission to park in a accessible (“handicap”) customer parking space. The employer decided not to tell the parking office because

• f ADA confidentiality rules.

Is this the right approach?

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Is this the right approach?

No.

• Parking office needs to know
• Limit details

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Step 6:

Monitoring the Accommodation

Making Sure the Accommodation Continues To Be Effective

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Do:

• Establish open lines of communication
• Check with the employee periodically
• Take responsibility for maintenance and updates

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A nurse had allergies to substances used in one type of diagnostic test. The test was done infrequently, so she had been informally allowed to trade duties with other nurses when the test had to be administered. A new supervisor wasn’t notified about the situation and when the nurse refused to help with the test, the new supervisor reprimanded her and then placed her on leave, stating that the nurse was not qualified for her job. How could this have been better handled?

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How could this have been better handled?

• Even informal accommodations should be

documented

• New supervisors and managers need to be trained
• Inform new supervisors and managers as needed

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A social worker with vision impairment requested a reader/scribe aid to do all her keyboarding for case notes. How can we figure out what else might work?

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How can we figure out what else might work?

Call JAN!

• Seek an individualized assessment
• Use state AT project’s services
• Consider assistive software and training
• Consider hardware needs
• Check to see if software needs to

be updated or modified with scripting

• Seek help from HR and IT

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Situations & Solutions

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Accommodations - Healthcare JAN Study Example

A pediatric resident with short stature used a power chair to maneuver. They were having trouble accessing the facilities, specifically employee entrances and office

• doorways. The school administrator called JAN to

discuss accessibility standards.

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Accommodations - Healthcare Accommodation:

The accommodation solution included modifying the worksite via door accessibility and help getting around. The employer stated they are not done with the accommodation, so they expect it will need improvements.

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Cost: No cost reported. Benefit: Allows the employee the ability to do their position without extra needs and going the extra mile.

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Accommodations - Healthcare JAN Study Example

A pharmacist was having difficulties standing for eight hours a day on a tile floor.

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Accommodations - Healthcare Accommodation:

The work area was carpeted using extra padding, which assisted in reducing fatigue, and a sit/stand stool was purchased to assist the employee when standing. Employee was also permitted to take frequent rest breaks throughout the day, so another pharmacist was available to cover his breaks.

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Cost: Approximate cost $2,500. Benefit: The pharmacist could continue working without exacerbating his medical condition.

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Accommodations - Healthcare JAN Study Example

A nursing student with essential tremors wore a wrist brace to help to steady her hand. After she entered her clinicals, the nursing faculty became concerned about the brace and transmission of bacteria/infections from the brace to her glove and to the patients. The student covered the brace with a hospital gown but they did not think this offered adequate protection. The school called JAN looking for alternatives.

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Accommodations - Healthcare Accommodation:

A JAN consultant discussed the use of a disposable sleeve protector and provided information on a variety of options ranging from basic plastic covers to sterile surgical sleeve protectors. Noted that the hospital may already have some in stock that could be tried. JAN also referred to exceptionalnurse.com as a resource for the student as she progresses in the program.

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Cost: Not reported Benefit: Caller felt better prepared for upcoming meetings regarding the student.

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Accommodations - Healthcare JAN Study Example

A laboratory technician with Deafness is unable to be alerted when someone uses the doorbell to enter the

• area. The employer contacted JAN for suggestions on

how to help the employee overcome this barrier.

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Accommodations - Healthcare Accommodation:

The employer agreed to add a flasher to the doorbell so that there will be a visual cue that the employee can see when someone uses the doorbell. At the time of our follow-up call, the flasher was to be installed the same week.

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Cost: Not reported. Benefit: The accommodation is expected to help the employee work better.

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Accommodations - Healthcare JAN Study Example

A chaplain in the hospital was having difficulty hearing when talking to patients and families. He had hearing aids, but they weren't working properly anymore. He was reluctant to repair or replace his hearing aids, but communication difficulties were beginning to affect his

• work. His employer contacted JAN for information on

employer obligations with regard to hearing aids as well as other potential accommodation options.

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Accommodations - Healthcare Accommodation:

The hospital supplied the chaplain with hearing aids and

• ther assistive devices. The exact type of device

supplied was not specified in the follow-up call. However, the JAN consultant responding to the call provided information on a variety of communication access devices for automatically captioning conversations.

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Cost: No cost reported. Benefit: The accommodation helped the business and increased employee satisfaction. The hospital benefited from improvements in employee satisfaction, customer service, customer base, and productivity.

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Accommodations - Healthcare JAN Study Example

A registered nurse working in telephone triage for a healthcare provider was experiencing intermittent aphonia due to vocal fold paralysis. She began experiencing vocal fold paralysis following surgery on her throat. She was also having difficulty managing her saliva and had to intentionally stop speaking to swallow, because her swallowing reflex was damaged as a result

• f the surgery. She was able to produce a voice at

times, but it was raspy and quiet.

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Accommodations - Healthcare Accommodation:

At first the JAN consultant discussed use of a TTY or hearing carry-over TTY , but the caller was concerned about the technical feasibility of using this for incoming

• calls. Additionally, due to the nature of the work the

employer had concerns about protecting the privacy of

• patients. The JAN consultant then discussed assistive

technology that did not require use of a relay service such as devices to amplify the user's voice during a telephone call as well as telephone-compatible AAC or speech-generating devices.

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Cost: Not reported Benefit: Not reported

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Accommodations - Healthcare JAN Study Example

A local government agency providing healthcare to children contacted JAN for accommodation ideas for three of their nurses. The nurses had hearing loss using their stethoscopes. They were seeking information on where to obtain amplified stethoscopes as well as information on an employer's responsibility to pay for amplified stethoscopes.

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Accommodations - Healthcare Accommodation:

A JAN consultant provided the caller with information on various types of amplified stethoscopes, vendors of amplified stethoscopes and related products such as hearing aid-compatible stethoscopes, and visual

• stethoscopes. They also discussed guidance on "tools
• f the trade" and how this could impact an employer's

responsibility for purchasing an amplified stethoscope.

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Cost: Not reported Benefit: Not reported

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Accommodations - Healthcare JAN Study Example

A health care worker with low vision was having difficulty using her computer.

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Accommodations - Healthcare Accommodation:

At first, the employer tried upgrading the employee’s

• perating system, but when that wasn’t effective the

employer purchased screen magnification software.

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Cost: $325 Benefit: The company retained a highly valued a skilled employee and sent a message to her department that “We care,” even in a big company.

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Accommodations - Healthcare JAN Study Example

An educator at a health care facility had a vision impairment and wanted to bring her service dog to work.

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Accommodations - Healthcare Accommodation:

The employer allowed the employee to bring the service dog to work and was ready to permit her to access most parts of the facility. However, one department wanted the employee to provide additional documentation before allowing the animal to enter their space.

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Cost: $0 Benefit: At the time of the follow-up call, the employer reported that the accommodation was effective. The employee was able to bring her service animal to work.

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Accommodations - Healthcare JAN Study Example

A hospital employee was on a medical leave for cancer. Upon returning to the job, she experienced memory loss, learning difficulties, and problems concentrating. She was not meeting performance standards and her accuracy was not meeting the company’s expectations. A JAN consultant discussed ADA and applying performance and conduct standards to employees with

• disabilities. The JAN consultant also suggested

mentoring to re-orient her to problematic job tasks.

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Accommodations - Healthcare Accommodation:

The employer agreed to provide the employee with additional training as needed.

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Cost: $0 Benefit: Permits the employer to retain a qualified employee.

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JAN Study Example A nurse experienced anaphylaxis when exposed to chlorine fumes even at low concentrations. The hospital made accommodations including providing safe paths of travel from the parking lot to the employee's immediate work area and from her work area to the cafeteria, alternative cleaning products at her work location, a plan

• f action, removing the function of patient transport, a

parking space on the same level as her work area to avoid elevators since her most recent reaction took place when she was exposed to air coming from an elevator door that opened in front of her, and attempts to reduce and eliminate chlorine in the cafeteria.

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Accommodations - Healthcare Accommodation

Working together, the nurse and hospital have been able to develop paths of travel that allow her to avoid

• elevators. The employer and employee have explored

use of face masks and respirators, but, after consultation with the employee's medical team, it was determined that neither option would reduce chlorine to an acceptable level.

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Cost: Not reported Benefit: Too soon to tell. The employer is still working

• n finding a way for the employee to access the

cafeteria

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Accommodations - Healthcare JAN Study Example

A surgical technician reported upon hire that she has an an allergy to latex products. She currently works with

• ther surgical technicians to relieve her when a product

will be opened or used near her that contains latex. The employer contacted JAN for others suggestions that may help.

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Accommodations - Healthcare Accommodation:

The JAN consultant responding to the call also provided information on establishing latex-free or latex-safe areas within the hospital. The employer reassigned the employee to another position where her exposure to latex is better controlled.

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Cost: Not reported. Benefit: The accommodation allowed the employer to retain a qualified employee, increased company diversity, and morale.

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JAN Study Example A registered nurse with Bipolar Disorder is pregnant and because of the pregnancy she cannot take the medications she needs to manage the Bipolar Disorder. The employee has stated that she would like to telework 1-2 days a week because of this. The employer contacted JAN for information to assist the employee in making this request.

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Accommodations - Healthcare Accommodation:

The employer permitted the employee to telework for a temporary basis. However, a decision on whether this telework would be permitted permanently had not been made at the time of our follow-up call.

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Cost: Not reported. Benefit: Not reported.

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Accommodations - Healthcare JAN Study Example

A VR counselor with a mental health impairment was having difficulty with memory and organization after relocating to a more fast-paced environment. Their main concern was keeping track of meetings, deadlines, and paperwork requirements. The employee contacted JAN looking for possible accommodation ideas.

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Accommodations - Healthcare Accommodation:

The JAN consultant discussed different organization strategies such as color coded filing and setting alarms and alerts on their digital calendar.

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Cost: Not reported. Benefit: Not reported.

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Accommodations - Healthcare JAN Study Example

A pediatrician with ADHD was having difficulty meeting the performance standards at work. She was struggling to meet the patient quota per day and often had to stay late to finish her duties. This was starting to cause issues with coworkers picking up extra patients and the employer having to pay overtime. They tried a few accommodations but were struggling to find something

• effective. The employer called JAN looking for some

ideas.

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Accommodations - Healthcare Accommodation:

After speaking with a JAN consultant, the employer provided a WatchMinder vibrating watch as an

• accommodation. The watch was set to alert the

employee every five minutes (vibrate). This helped the employee pace herself throughout the day and break down what she needed to accomplish during each five- minute interval of the appointment.

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Cost: $100 Benefit: An accommodation was made and the employee was able to improve performance.

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JAN Consultants can be reached M-F 9am-6pm ET

• Phone - (800) 526-7234 (voice); (877) 781-9403

(TTY)

• Email - jan@AskJAN.org
• Skype - Janconsultants
• Text - (304) 216-8189
• Chat available online at http://AskJAN.org

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