NURSES IN THE WORKPLACE SUFFERING FROM STRESS: BULLYING IN THE WORKPLACE, PSYCHIATRIC INJURY AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Nursing is one of the most difficult and demanding professions in the world. It is also one of the most important.  Nurses confront life and death situations on a daily basis.

Nurses work with Doctors who are some of the brightest and most difficult individuals on the planet.  These Doctors have demanding schedules and responsibilities which impact on their ability to work with others.

Nurses work with other Nurses who are confronted with the same stressors and responsibilities.  At times, they can be in conflict with each other.

Nurses also work with patients who may have emotional issues that are either pre-existing or are relating to their medical problem at issue.   Also, they may have anger issues relating to their perceived mistreatment at the facility. Nurses also work with patient’s family members who are emotionally involved with the patient’s well- being. They too may be upset at their perceived mistreatment of their beloved family member.

Nurses finally work with medical institutions which have rules and regulations that they need to be in compliance with concerning their operations.

With respect to these numerous interactions, some of these interactions have been viewed as unacceptable and have been labeled as “bullying.”

“Nurse Bullying” has been subject o was subject to a study which found interesting results.  This article will discuss the nature of nurse bullying, how nurse bullying should be analyzed within a workers’ compensation setting, and what a nurse should do if they are subjected to stress.

Even If I am not a Nurse, Why Should I Be Concerned about Nurse Bullying?

“Workplace bullying has also been acknowledged as a threat to patient outcomes and the delivery of quality of patient care, as well as the erosion of personal health and professional wellbeing [91314]. Excellence in patient care flourishes in an environment built on open communication and respectful professional relationships. An environment that condones bullying perpetrates destruction of professional communication.”  Gaffney DA, Demarco RF, Hofmeyer A, Vessey JA, Budin WC. Making things right: nurses’ experiences with workplace bullying-a grounded theory. Nurs Res Pract. 2012;2012:243210. doi:10.1155/2012/243210

What Is Bullying in the Nursing Profession?

Individuals studying bullying characterized the situation as on in which there is a power imbalance.   These interactions can have serious effects on the organization. Yoo, S.Y.; Ahn, H.Y. Nurses’ Workplace Bullying Experiences, Responses, and Ways of Coping. Int. J. Environ. Res. Public Health 2020, 17, 7052.

Who Was Responsible for the Bullying?

In the study, there are many types of bullying offenders, including patients, caregivers, doctors, and nurses. Of these, bullying most frequently occurs among nurses and is particularly committed by a colleague rather than by a manager. Yoo, S.Y.; Ahn, H.Y. Nurses’ Workplace Bullying Experiences, Responses, and Ways of Coping. Int. J. Environ. Res. Public Health 2020, 17, 7052.

Note: for workers’ compensation purposes, the employment position of the offender is very important

Bullying has also been defined in other studies.

“Bullying goes by many names: workplace aggression, indirection aggression, social or relational aggression, horizontal (lateral) violence, and workplace violence. It has become so popularized in the press; bullying is often, mistakenly, used as an overarching concept. There is a tendency to use many of these terms interchangeably [8]. Bullying is different from horizontal violence in that a real or perceived power differential between the instigator and recipient must be present [15]. Some of the most recent literature suggests that all of these behaviors exist on a conceptual continuum of workplace victimization [3].” Gaffney DA, Demarco RF, Hofmeyer A, Vessey JA, Budin WC. Making things right: nurses’ experiences with workplace bullying-a grounded theory. Nurs Res Pract. 2012;2012:243210. doi:10.1155/2012/243210

Is Bullying the Same as Job Stress?

Those researching this have distinguished it from ordinary job stress.  It is something different from the day to day social stresses or poor management.

What Types of Bullying are Going on?

Bullying has been described in situations where the nurse is new to the area,  in situations where the nurse witnesses mistreatment of others, in situations in which they are singled out for public censure or humiliation, in situation in which there are constantly being interrupted, situations in which they are not in the social clique and they are subject to juvenile-like behavior, situations in which they feel they are being punished with disciplinary  action or threats,   Gaffney DA, Demarco RF, Hofmeyer A, Vessey JA, Budin WC. Making things right: nurses’ experiences with workplace bullying-a grounded theory. Nurs Res Pract. 2012;2012:243210. doi:10.1155/2012/243210

What are the Consequences of Bullying?

Nurses being subjected to bullying is a societal concern.  If this bullying impacts patient medical treatment, it must be addressed in those terms in addition to the health concerns of the Nurse effected.

It is reported that “[n]urses bullied at the workplace may complain of mental symptoms, such as depression, anxiety, and fear, as well as physical symptoms, such as fatigue, headaches, and palpitations. They are also more susceptible to burnout and turnover intention and have lower levels of organizational commitment and nursing productivity. Yoo, S.Y.; Ahn, H.Y. Nurses’ Workplace Bullying Experiences, Responses, and Ways of Coping. Int. J. Environ. Res. Public Health 2020, 17, 7052.

If a Nurse Is Having Medical Problems as a Result of Bullying, What Should They Do?

First, seek medical attention to treat your medical problems.  Second, seek assistance through your company’s Employee Assistance Program if one is available. Third, make a consultation with a lawyer as to whether there is some legal action that can be pursued.

There are two areas of law which should be explored.  Workers’ Compensation and Employment Law are two areas which should be analyzed with respect to the bullying.

If a Workers’ Compensation Claim is pursued, the Nurse can claim monetary compensation in the form of temporary disability benefits, permanent disability benefits, medical care, and vocational rehabilitation benefits.

What Are the Legal Barriers for Workers’ Compensation Psychiatric Claims?

With all psychiatric claims of work injury, a detailed factual analysis must be made.  With respect to bullying, there are issues of length of employment and whether the events causing the stress where personnel actions.  Bullying claims are viewed in the same light as all other psychiatric claims.

Labor Code Section 3208.3 provides the threshold requirements for psychiatric claims.

In general, an employee shall demonstrate by a preponderance of the evidence that actual events of employment were predominant as to all causes combined of the psychiatric injury.

Also, in general, there is also a six-month employment requirement.

Also, “[n]o compensation under this division shall be paid by an employer for a psychiatric injury if the injury was substantially caused by a lawful, nondiscriminatory, good faith personnel action.”

Note: Bullying can involve different players.   Some of them supervisors. Supervisors’ actions can be viewed as personnel action. Therefore, there may be “good faith personnel action” defenses that insurance Companies can be raise to defeat such a claim. Therefore, there is no guarantee that bullying cases will be accepted as a valid work injury claim.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

ROBOTS IN THE WORKFORCE, INJURED WORKERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

“ MY EYE! ROBOT!”

Isaac Asimov, author of the book “I Robot,” propounded the rules of engagement of Robots with Mankind: “ A robot may not injure a human being or, through inaction, allow a human being to come to harm. A robot must obey orders given it by human beings except where such orders would conflict with the First Law. A robot must protect its own existence as long as such protection does not conflict with the First or Second Law.”  This science fiction is quickly becoming a reality.  White Castle Hamburgers are set to employ robot cooks.   Postmates is testing electricity powered robots for food and grocery delivery. Robotics has long been part of the manufacturing.  Recent innovations have now brought robotics into the retail world.

This article will explore the how robots can interact with human workers.   It will discuss how robots can pose an injury risk to human workers and as to the nature of such claims of injury caused by robots.

Why Are There More Robots in the Workplace?

“In the 1960s, ’70s and ’80s, industrial robots were capable of gripping objects, moving them from one point to another and performing assembly tasks. industrial robots were capable of gripping objects, moving them from one point to another and performing assembly tasks. They were brightly colored and usually surrounded by fences or encased in cages – factors that enhanced the safety of the humans who worked in the same facilities.” Parvatenti

This was an evolution that occurred “many of the devices are designed to work specifically alongside humans. These collaborative robots – cobots – are dexterous and flexible and can perform a wide range of tasks, including welding, painting, product inspection, die casting, drilling, glass making and grinding. Supra.

Technologies have changed.  It is amazing how robotics and the internet can be integrated.

White Castle has been “integrated with delivery apps to sync an order’s completion with its pick-up time. Meanwhile, the machine’s sensors and cameras can keep eye on inventory and recommend bulk orders for supplies when needed.”  Flippy Robots Will Cook Sliders, Mariella Moon 10/27/20, engadget.

Postmates are using a robot for delivery that can carry 50 pounds and travel up to 30 miles on a single battery charge. which can carry 50 pounds and travel up to 30 miles on a single battery charge.

Have Human Workers Ever Been Injured By Robots?

Yes.   “Robert Williams is believed to be the first person killed by a robot in an industrial accident, in January 1979, at a Ford Motor Company casting plant. “Winfield, A. et al. “Robot Accident Investigation: a case study in Responsible Robotics.” ArXiv abs/2005.07474 (2020)

If a Worker is Injured by a Robot in the Workplace, What Can They Do?

Injuries caused by robots present a unique situation for Injured Workers.  In some circumstances, the Robot may have acted in a defective manner which caused the injury to occur.   This may bring rise to a possible third-party product liability case against the robot’s manufacturer.  Further, a workers’ compensation claim may be pursued irrespective of whether the robot acted in a defective manner.  The reason being that workers’ compensation is a no-fault system.  Thus, if a human worker tripped and fell over a robot, and it was the human worker’s fault, they would still be able to pursue such a claim for benefits.

What If the Robot Was Not My Employer’s Equipment?

An injury caused by a robot who is not part of one’s employer’s equipment would still give rise to a workers’ compensation claim.   It may however give rise to a claim against the robot’s owner as well as possibly the robot’s manufacturer.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

STRESS AND INJURED WORKERS: INJURED WORKERS WITH DIFFICULTIES POST WORK-INJURY AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

This article is to discuss injured Workers’ stressors and a recent study on the matter. Prior to reviewing the study, I took it upon myself to list the stressors based upon my 28 years of representing Injured workers. The following is my assessment of stressors for Injured Workers while they are pursuing their claims are as follows:

Dealing with medical facilities and doctors
Being out of work
Dealing with your employer
Dealing with insurance
Dealing with attorneys
Dealing with litigation
Dealing with the Workers’ Compensation Appeals Board

Wow! Injured Workers have a lot of stressors!

As I indicated, a study was recently done which sheds some additional light on the stressors of injured workers. Is my assessments correct? Are there other items of concern?

Are Injured Workers Stressed Out?

Yes. The study found that the “[t]he prevalence of psychological distress among workers’ compensation claimants is high.” Collie, A., Sheehan, L., Lane, T.J. et al. Psychological Distress in Workers’ Compensation Claimants: Prevalence, Predictors and Mental Health Service Use. J Occup Rehabil 30, 194–202 (2020). https://doi.org/10.1007/s10926-019-09862-1

What Did the Study Find as Being Stressors?

Severe psychological distress, being off work, worse general health and requiring support during claim were most strongly associated with greater odds of service use. Collie, A., Sheehan, L., Lane, T.J. et al. Psychological Distress in Workers’ Compensation Claimants: Prevalence, Predictors and Mental Health Service Use. J Occup Rehabil 30, 194–202 (2020). https://doi.org/10.1007/s10926-019-09862-1

Are Injured Workers more stressed out than other People?

Yes. According to the Study, it was found. Collie, A., Sheehan, L., Lane, T.J. et al. Psychological Distress in Workers’ Compensation Claimants: Prevalence, Predictors and Mental Health Service Use. J Occup Rehabil 30, 194–202 (2020). https://doi.org/10.1007/s10926-019-09862-1

What Were the Factors that the Study Found as Stressful?

The study found “being off work, poor general health, low work ability, financial stress, stressful interactions with healthcare providers and having diagnosed mental health conditions had the strongest associations with presence of psychological distress Collie, A., Sheehan, L., Lane, T.J. et al. Psychological Distress in Workers’ Compensation Claimants: Prevalence, Predictors and Mental Health Service Use. J Occup Rehabil 30, 194–202 (2020). https://doi.org/10.1007/s10926-019-09862-1

One additional item that came out of the study that caught me by surprise that Injured Workers with prior psychological issues are susceptible to increased stress.

Can an Injured Worker Claim This Stress as Part of Their Claim?

With changes in the law, psychiatric injury claims are limited. Further, stress resulting from litigation is mostly considered as non-industrial. In certain limited facts, stress may be claimed. It is a factual inquiry.

Is There Case Law Re: Stress from Litigation?

Yes. The Courts have found that a psychiatry injury caused as a result of the litigation process is not work-related. Rodriguez v. Workers’ Comp. Appeals Bd. (1994) 21 Cal.App.4th 1747 [27 Cal.Rptr.2d 93]. There are some limited exceptions. See Patrick v. Marina City Club, 2010 Cal. Wrk. Comp. P.D. LEXIS 19 (carrier misconduct as the basis for stress)

What Should An Injured Worker Do?

Injured Workers should approach matter on multiple levels. One level is to seek medical attention and/or counseling for one’s stress. Another level is to address the situations that are causing the stress. This can include changing doctors, getting an attorney, addressing the employment situation is a substantial way and perhaps opening up to a friend or family member to get this stress off their chest. Also, if you are unrepresented, contacting the Information and Assistance Officer at the local WCAB may be helpful. Also, your company may may have an Employee Assistance Program which can help as well.

In sum, if an Injured Worker is having stress, there is help and solutions out there. Don’t try to go it alone.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

THE WONG BAKER PAIN SCALE AND WORKERS’ COMPENSATION: INJURED WORKERS, PAIN SCALES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Frequently Injured Workers, when attending workers’ compensation evaluations and treatment are asked to fill out a lot of questions and forms.   One of these forms that they may have to fill out is the Wong-Baker FACES® Pain Rating Scale.

These Scales can impact an Injured Worker’s industrial claim.

This article will discuss the Wong-Baker FACES® Pain Rating Scale, how It is used in a Workers’ Compensation claim, and how it can impact an Injured Worker’s claim.

What is the Wong-Baker FACES® Pain Rating Scale?

The Wong-Baker Pain Rating Scale is a tool which is used to allow for patients to provide a self- assessment of their pain.  It was created by Donna Wong and Connie Baker in 1983 to help children communicate about their pain. .

Part of the goal is to improve the assessment by using the scale for the purposes of assisting in pain management.  The Wong-Baker Faces Foundation indicate that the Scale is self-assessment tool [that] must be understood by the patient, so [that[ they are able to choose the face that best illustrates the physical pain they are experiencing.  The Foundation note that the Scale is “not a tool to be used by a third person, parents, healthcare professionals, or caregivers, to assess the patient’s pain. There are other tools for those purposes”.

What Does the Scale Look Like? How It is Scored?

The picture above is a version of the scale. This picture was taken off of the Wikipedia article.   The Scale is copyrighted. The Scale is proprietary. Therefore, if you are interested in the material you should contact the Foundation.

The instructions for its usage is to “explain to the person that each face represent a person who has no pain(hurt), or some, or a lot of pain.”  “Face 0 doesn’t hurt at all.  Face 2 hurts just a little bit.  Face 4 hurts a little bit more. Face 6 hurts even more.  Face 8 hurts a whole lot. Face 10 hurts as much as you can imagine, although you don’t have to be crying to have his worst pain.”

The person is asked to choose the face that best depicts the pain they are experiencing. Supra.

Besides the Scale, the Patient may be asked to “to mark their areas of pain on a drawing of a human figure then rate each area using the faces scale.”.

What Was This Scale Designed for?  What is Your Opinion Concerning It?

Originally, it was designed for children to help them communicate their pain.

In California, there are a number of Injured Workers who do not speak English.   There are some Injured Workers who are illiterate.  Some are illiterate even in their language of origin.  This type of Pain Scale can assist these individuals express themselves with respect to their pain.  It is noted by the Foundation that for children there was “considerable difficulty using any scale with unfamiliar words or scales based on numbering or ranking concepts. The use of the Numeric Rating Scale [were] growing in popularity at this time, but young children had trouble using the numbers.”  Thus,  this type of scale is of some value with certain Injured Workers.

With respect to other workers, the Scale is more problematic.  In the world of workers’ compensation, there is a focus on activities of daily living and how an injury impacts them.   This particular scale, while it may be effective with respect to ascertaining pain information for other reasons, does not provide information used for disability assessment in the workers’ compensation system.

With respect to Adults, pain is viewed must differently than with children. Adults react to pain as an irritation, a distraction, frustration, and may generate anger and upset.  Adults do not necessarily cry because of their pain.   Most adults, however, can understand how the scale signifies a range from no pain to extreme pain.  In sum, its inquiry is superficial.   Again, this is not an indictment of the Scale, it is simply the problem that occurs when it is employed for something it was not intended for.

How Can The Wong-Baker Scale Be Used For In Workers’ Compensation?

In my opinion, the Scale may have some credibility value.   Also, it may document the trajectory of an Injured Worker’s condition.   If this Scale is used on multiple occasions, one can look to see how consistent the reporting it.   Also, it can possibly bring light to possible exaggeration.  Scores at level 10 may give rise to suspicion of exaggeration.

Any Advice Concerning the Scale?

It is very important for Injured Workers to try to be accurate with respect to the score.   While providing a “10” may be a “cry for help,” I would suggest that the Injured Worker actually “cry for help” and tell the evaluator or treater that they are experiencing some level of frustration with respect to their treatment and their relief from the pain.  This will prevent an allegation of exaggeration.

What If I Need Advice? 

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information.

 

ALTERED MEDICAL STATES (AMS) AND WORKERS’ COMPENSATION: INJURED WORKERS, MENTAL STATUS, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Altered Medical States (AMS) is a medical condition of import within the Workers’ Compensation System.  Irrespective of whether the Injured Worker’s AMS is work-related or not, the fact that an Injured Worker has such a condition which may impact their ability to communicate and their ability to understand is of concern.

Workers’ Compensation is a medical-legal system.   An Injured Workers with an altered medical state raise both medical and legal concerns.  The Workers’ Compensation System requires Injured Workers to provide truthful and accurate information.   The System also allows for Injured Workers to enter into binding contracts and agreements.   Therefore, an Injured Worker’s mental state is important.

This article will discuss Altered Medical States, how Altered Medical States can impact medical treatment and reporting,  and how Altered Medical States can impact Workers’ Compensation Litigation.

What is an Altered Medical State?

Altered Medical State can range from “total loss of consciousness to extreme excitation.” Evaluation and treatment of altered mental status patients in the emergency department: Life in the fast lane Hai-yu XiaoYu-xuan WangTeng-da XuHua-dong ZhuShu-bin GuoZhong Wang, and Xue-zhong Yu World J Emerg Med. 2012; 3(4): 270–277 doi: 10.5847/wjem.j.issn.1920-8642.2012.04.006 PMCID: PMC4129809 PMID: 25215076

Altered Medical States include central nervous system inhibition which can include coma, drowsiness, and confusion.   It can include central nervous system stimulation including irritability and aggressiveness. It can include “abnormal behavior.” Supra.

What Are the Medical Causes of Altered Medical States?

There are many reasons as to why someone may have an Altered Medical State.  Many of these AMS conditions can be work-related.  Medical Causes of AMS include both Neurological and Non-Neurological Causes.

AMS causes differ based upon based upon age. Top causes of AMS for elderly patients can include cerebrovascular disease, systemic or organic failure and infection.   Top causes for non-elderly are drugs and toxic factors, systemic and organic failure, and metabolic and endocrine disorders.  Supra.

Various causes of AMS can include drugs and substance intoxication, infection, metabolic endocrine abnormalities, trauma, cancer, and system/organ dysfunction.  This can include acute alcoholism. It can also be caused by trauma, i.e. head trauma, and infection. Supra.

What are the Workers’ Compensation Concerns with respect to Injured Workers with AMS?

With respect to the Workers’ Compensation Claim, an Injured Worker with an altered medical state can have problems with respect to the medical-legal reporting to support the claim of injury.   If the work injury caused an altered medical state, then there is a likelihood that the immediate medical treatment may not have an accurate history as to how the injury/medical condition was work-related.    For example, there are times when an Injured Workers are found unconscious and is then sent for medical treatment.   In those circumstances, the initial medical providers may not be able to document any information that can support the work injury.

Altered Medical States can also be when an Injured Worker is attending workers’ compensation related medical appointments.   Injured Workers may be taking prescription medications that impact their abilities to comprehend and answer questions posed by medical providers.   This again can impact the quality of the medical-legal reporting as to both the history of injury and ongoing complaints.

An individual may be so intoxicated that evaluations may be terminated.   This problem does not only relate to prescription medications.   Injured Workers may consume alcohol or take street drugs that may impact their mental state.

In sum, there can be work-related and non-work related AMS issues which impact medical treatment and medical-legal reporting.

Additionally, there are some Injured Workers that suffer from severe mental health issues where they have problems being communicative.   Further, these Injured Workers may have such problems where the evaluators have serious doubt as to whether they can provide accurate information.

What are the Legal Concerns of Altered Medical States?

The Workers’ Compensation System is a legal system and statements made by Injured Workers are placed under a legal microscope.   False Statements can lead to allegations of Workers’ Compensation Fraud.   Criminal penalties can apply.

Thus, there is a concern as to whether an Injured Worker with an altered medical state is capable to speaking the truth.   For example, if the Injured Worker is having hallucinations, there may be some question as to whether they know what they are doing and saying.  Additionally, an Injured Worker may be taking medications when they are having their deposition taken.   The medications may impact on their ability to understand and answer questions in a truthful fashion.

Thus, if an Injured Worker has AMS issues, it is important that AMS be documented.  It may be needed to address accusation so fraud.  Note: there are three times in which reporting may be required: medical examinations and evaluations, the Injured Worker’s deposition, and the Injured Worker’s trial.

What Should Be Done with Respect to Injured Workers with AMS? Temporary versus Permanent AMS?

If an Injured Worker has a permanent AMS state, the use of a Guardian Ad Litem is indicated.   In other words, a trusted person, i.e. parent or spouse, should be appointed by the Workers’ Compensation Appeals Board to make decisions with respect to the case.

If the Injured Worker has a temporary AMS state, the parties should all take careful consideration that the Injured Worker is understanding what is going on and is making their decisions and statements in an unaltered state.   If there is some settlement, the fact that the individual is capable of entering into the agreement should be documented.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information.

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