Managing Leaves When Employees Have Unpredictable Health Conditions

By Jenny Haykin, MA, CRC

Integrated Leaves & Accommodations
Puget Sound Energy

By Tom Sproger, MS, CEAS-II

Ergonomics Consultant
Solutions Northwest Inc.

A disability and leave of absence manager at a hospital system submitted the following question related to reasonable accommodations.

I recently received an accommodation request from a nurse requesting an exception to our two-hour call in requirement. The employee and her physician said that it is not always possible for her to know two hours in advance when an episode will render her unable to work. She may already be on her way to work and need to turn around and go home. She is not eligible for the Family and Medical Leave Act as she doesn’t meet the hours worked requirement and has exhausted her state leave. How should I evaluate and respond to this type of request?

Accommodation experts Jenny Haykin and Tom Sproger discuss how to approach unpredictable absences.

Managers struggle for solutions after last-moment absence requests by employees. Nonetheless, some health conditions do flare up unpredictably. Common causes for unpredictable absence patterns are migraines, irritable bowel syndrome, and anxiety attacks.

When an employee has a condition that causes unpredictable absenteeism, it is helpful to obtain estimated frequency and duration information from the healthcare provider. An employee who is likely to miss a few hours every few months on a temporary basis will be more easily accommodated than the employee who is out for days each week on an on-going basis. With this information, you can then assess what the impacts of the absences will be.

Given the employee’s role as a nurse, reducing the level of patient care and potentially putting patients at risk due to being short-staffed is not reasonable. Instead, if temporary nurses or floaters are available on short enough notice to cover the missed shifts, accommodating the absences may be reasonable. If staffing resources are not sufficient to address the frequency of absenteeism and/or the short notice, it is advisable to document the impacts on the staff and the impacts on patient care as well as gathering the job description, expectations, and requirements.

With this impact assessment in hand, you can explain to the employee why punctuality and attendance are essential to the position, making the case that she or he is not qualified for the position.

It is common for employees faced with the prospect of losing their job to respond that they may be able to have their restrictions changed. If this occurs, advise them that any revised restrictions information must be accompanied by an explanation from the healthcare provider of why the previous restrictions are no longer valid and provide a strict deadline by which any additional medical documentation will be considered.

If restrictions cannot be accommodated in the employee’s present role, the next step in the accommodation process is to seek reassignment to a vacant, non-promotional position that can allow more flexibility of work hours. Reassignment is indicated in the ADAAA as a type of reasonable accommodation. In case law, it has been determined that employers have an obligation to reassign an individual to a non-promotional position that the individual is qualified to perform, if such a position is vacant. The Equal Employment Opportunity Commission (EEOC) states, “an employer must place the employee in a vacant position for which he is qualified, without requiring the employee to compete with other applicants for open positions” (EEOC Guidance “Employer-Provided Leave and the ADA” May 9, 2016). There may be no vacant positions that can reasonably accommodate an unpredictable attendance schedule, but it is advisable to make a good faith effort to look before reaching that conclusion.