Back to Square One
How to cut red tape after a work-related back injury

By Keri Schultz
February 26, 2002

A back injury from nursing can end your bedside nursing career. I learned that the hard way last year and much more about work injury that I wish I had known when I started nursing. I have traveled down the lonely and confusing road of workers compensation ever since.

I've only been a nurse for six years and today I am retraining for another position in nursing. I have always felt strong and capable enough to lift patients properly to avoid injury. I remember always being the one to tell my co-workers to slow down and use good technique. I also know there are days that are so unbelievably busy that I didn't even have time for a break.

One of those days became my "date of injury," words I would repeat a thousand times to the practitioners I would meet after I strained my back.

It was a typically busy day. My feet groaned and whimpered as the day wore on. I wasn't feeling well (first warning sign) but couldn't go home because of short staffing. At the end of my shift, I quickly changed and repositioned a patient in a hurry (second warning sign) to finish my day. All I remember is a minor strain in my back while I lifted. The next morning, I couldn't straighten to stand up because of the pain.

I reported my injury to my supervisor. After an injury, even if it feels minor, it is important to report it as soon as possible. This is for your benefit to begin the proper care of an injury in order to heal quickly. Another important reason is that a delay in reporting brings into question whether you actually were hurt on the job.

By the time I made it into Occupational Health that morning, I felt silly for being there. The ibuprofen was working and I seemed to have a minor strain in my lower back. They never even took X-rays.

The doctor gave me weightlifting restrictions for work and orders for physical therapy and ibuprofen. I would soon discover that a nurse with any restrictions couldn't work at my hospital. Many minor injuries lead to restrictions for lifting or bending. If you examine your job description, the physical duties listed for floor nurses are extensive, even if you work in pediatrics.

Suddenly, a minor injury keeps you out of work.

The complications start if you are per diem. Because per diems don't have benefits, you are out immediately without sick pay. The government does not pay workers compensation.

After your work injury, your case is handed to a risk management company employed by your organization. The office worker on the other side of the phone now has the power to approve or deny your claim that your injury was work-related. Legally, they do not have to decide your case for up to 90 days. After those three months, you may hire a lawyer and argue your case. Meanwhile, you are out of work, without pay, and financing your own recovery.

I was off work, without pay, for six weeks. This little back strain was persistent and quite painful. Fortunately, after being "disallowed, but temporarily" until my claim could be approved, I was able to see my regular doctor for treatment.

Meanwhile, my human resources department was confused about what to tell a per diem nurse. First, I was told to apply for disability through the state because per diems don't have benefits. I applied, was denied and was told that workers compensation cases were not paid by the government. The medical treatment and lost wages budget are managed by the risk management company deciding your case and paid for by your employer.

The bottom line is to remember that if you are injured at work, the human resources department should be the people helping you. The government is not involved with the process at this point.

If your HR department is confused like mine was, the next step is your union. Do not underestimate the power of your union. This is a good time to belong to one, because they can make the internal phone calls and push the paperwork forward for you.

A couple days after I called and cried to my union representative after two months of frustration, my case was approved and Ifinally received the coveted benefits check.

During my initial diagnosis, I heard over and over that back strain is common and chronic. OK, I said, so just when is this pain going to end and when am I going to get back to work? It's chronic; translation-nobody knows. The frightening prospect of never healing looms after months out of work without improvement.

I asked my favorite physical therapist a few questions about her experience with work injury patients.

The most common back injury she sees is sprains and strains. "Mostly repetitive injury from the use of improper body mechanics. They don't know that the injury builds up and all of a sudden the back gives out," she said.

Another physical therapist once told me that most people think that only one injury hurt them, but it usually is a cumulative effect that will occur from poor muscle tone and repeated abuse.

I now know that my injury shouldn't have been a surprise. My job is physical and I had dropped out of exercising for lack of time and effort. I had assumed over the years that if I wasn't injured from my technique by then, I was doing it correctly. In fact, I was slowly injuring myself with my daily duties of lifting, rotating and walking from room to room. My drop in muscle tone most likely precipitated the inevitable.

If I had taken the time to strengthen my lower back and abdominal muscles before my injury, I would be in good physical shape by now, instead of just attempting to work toward daily functionality.

Some organizations will allow an RN with physical limitations to continue working. Because my hospital couldn't accommodate me, I was introduced to a vocational rehabilitation counselor.

After your injury has been decided by your doctor as "permanent and stationary," (P&S in rehab lingo), your wages will be immediately ended and your company has 30 days to offer you another position within the company, given certain conditions mandated by law such as pay scale.

Unfortunately, nurses with injuries are so common that generally there aren't any positions that satisfy your wage and skill standard, according to my vocational rehab counselor.

If there is no position for you, vocational rehab is the next step. Basically, you may choose any training that you wish to have paid for by workers compensation within a mandated price range while being starved out on a monthly stipend.

The saying "left out in the cold" seems appropriate here. Just how many desk jobs are out there for non-BSN nurses who make even close to the same wage as hospital nursing?

Like me, I think a lot of RNs don't have an equivalent position to fall back on. I am afraid the nursing shortage will further stress even more nurses into injury than before. The best solution for injury is to avoid it at all costs.

Incorporate abdominal, pelvic and back strengthening exercises into your daily routine. Buy disability insurance, finish your BSN and recruit new nurses.

Your precious back depends on it.