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Hi again Tracey Just a quick idea; may be worth having the manager do a HSE stress assessment to identify the areas in work of concern. I imagine he's concerned about the adrenaline response and in stress cases - triggers tend to be "perceived" much like "pain is what the patient says it is" - therefore a stress risk assessment is likely the only methodical objective way of identifying areas of concern in the workplace. that would save the hassle, time delays etc of writing to the consultant who may very well respond that the work environment is your area of expertise - a response i got a few times when i used to write. So maybe advise - fit for work - reduced hours to allow for adequate rest etc and perceived stress is trigger so advise Stress RA ; The Health and Safety Executive have published recommendations to assist employers in dealing with stress related issues. These are best used as a framework for meeting with the individual concerned, and I feel that they may help you in your dealings with Ms X and in identifying any areas of concern - with resulting recommendations implemented as feasible before the return. The areas that should be covered are: [image: *] *Demands *– such as workload, work patterns and the work environment. [image: *] *Control *– such as how much say the employee has in the way that they do their work. [image: *] *Support *– such as the encouragement, sponsorship and resources provided by the organisation, line management and colleagues. [image: *] *Relationships *– such as promoting positive working to avoid conflict and dealing with unacceptable behaviour. [image: *] *Role *– such as whether the employee understands their role within the organisation and whether the organisation ensures that they do not have conflicting roles. [image: *] *Change *– such as how organisational change (large or small) is managed and communicated in the organisation. Regards Carr ] 04/01/2008, Bluestone, Tracy <[log in to unmask]> wrote: > Thank you for your advice. > The Consultant has > Dear All, > > Thank you for your advice. > The Consultant has got back to me, his advice is that the staff nurse > may return to work in a reduced capacity whilst awaiting the report. > Also advised to write to the consultant again to clarify issues of > 'stress' and to have their view on the nature of the working > environment. To have a face to face review with client to discuss their > ideas of what is stressful? particular shift, aspect of work or role, ? > not to be in charge etc. > > So I have written back to the manager incorporating all advice given, > again many thanks for your help. > > Tracy Bluestone, RGN, SCPHN (OH) > Deputy Head of Occupational Health > Ext 3982 > > > -----Original Message----- > From: [log in to unmask] [mailto:[log in to unmask]] On > Behalf Of Wilkes Mary > Sent: 04 January 2008 14:38 > To: [log in to unmask] > Subject: Re: [OCC-HEALTH] return to work > > Your consultant may have felt that by separating out the days worked by > the staff nurse it would enable her to have a longer interval of rest > before she next had to work; thereby possibly reducing a contributory > factor to her condition - rather than thinking she would have chest pain > on alternate days. > > I would contact the cardiologist's secretary to find out how long it > might be before a report is forthcoming. If it is likely to arrive soon > I would ask the nurse to be patient and wait until you get it. However > if it is likely to be a long time in coming you could consider allowing > her to return to work on your consultant's previous terms; or > alternatively you could ask her to wait until your consultant is back > from holiday so that they can review their previous advice in the light > of recent events. > > Mary > > -----Original Message----- > From: [log in to unmask] [mailto:[log in to unmask]] On > Behalf Of Tracy Bluestone > Sent: 04 January 2008 13:07 > To: [log in to unmask] > Subject: [OCC-HEALTH] return to work > > > Hello again, > Case - staff nurse, recurrant chest pains, aged 33 ? aortic stenosis. > Seen > by cardiologist, OH waiting for report back. Verbal information from > client, who is very keen to return to work, advised to avoid stressful > situations, but can work. > Client works on an acute assessment unit, which is very busy, they have > had > chest pains at work and at home. Advice from OH consultant prior to last > > epoisode of chest pains was to work three 7.5 hours shifts on alternate > days. when client had chest apins at work again, was sent off sick until > > seen by cardiologist, but I have no report back yet. > dilemma, am I being over cautious? if client is at work and has chest > pains, they can go to A&E, but this disrupts the ward. Client has 45 min > > train journey to work, stress ful, ward environment, stressful, but if I > > keep them away from work they are stressed beacuse they want to be at > work! OH consultant on holiday..... 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