Weighing In On Hospital Hiring Policy

June 21st, 2012

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By , BSN, RN

Could the cause of your back pain also keep you from working as a nurse? If you are looking at one Texas hospital it could.

For the last couple of days I have been addressing the issue of nurses and back pain. I have written about steps organizations can take to keep their employees back-healthy and steps we can take as individuals to do the same.

One of the most common causes of back pain, particularly lower back pain, is being fat. Now, one south Texas hospital is choosing not to hire employees that are grossly overweight according the hospital’s chosen employment standards—but it’s not because the facility fears its employees getting hurt.

Too Fat To Be Hired

The story about Citizens Medical Center, in Victoria, Texas banning job applicants from employment for being too overweight broke a few months back and got lots of media attention. It was topical (considering the obesity epidemic in this country and around the world) and it was controversial (was it even legal?).

The hiring policy had been in place about a year when it was made public. It requires potential employees to have a body mass index (BMI) of less than 35 — which is 210 pounds for someone who is 5-foot-5, and 250 pounds for someone who is six-feet-tall.

According to The Texas Tribune, the policy states:

”… an employee's physique "should fit with a representational image or specific mental projection of the job of a healthcare professional," including an appearance "free from distraction" for hospital patients. "The majority of our patients are over 65, and they have expectations that cannot be ignored in terms of personal appearance," hospital chief executive David Brown said in an interview. "We have the ability as an employer to characterize our process and to have a policy that says what's best for our business and for our patients."

Pun intended, after reading about this issue for a while, I have decided to “weigh in.” I don’t know that I would have a lot of problems with this requirement if it were approached differently.

What this policy says, is if you don’t look good we don’t want you. Nothing about health, safety, and ability to perform job duties—just you are not physically attractive enough to work here. That, I have a problem with.

I want to make a couple of points perfectly clear here:

  1. I am a Texan, born and raised (south Texas as a matter of fact).
  2. By any measurement (weight, BMI, insurance tables, the once over) I am overweight
  3. I am a working nurse.
  4. Greater than 30 percent of my home state is obese as defined by a BMI equal to or greater than 30 according to a 2010 Centers for Disease Control and Prevention (CDC) Survey.
  5. Again, according to the CDC, in a report released just this past Tuesday, June 19, 2012—"These are the worst of times when it comes to obesity and diabetes, both of which are at high levels and still rising," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine. The rise in diabetes rates among older adults has its counterpart in the rising prevalence in children. "More adults reporting obesity similarly is mirrored by the unprecedented rates of childhood obesity. Obesity and diabetes portend other chronic diseases, such as heart disease, stroke and cancer, so these are ominous findings.”

With all that said, being overweight does not affect how intelligent you are. Being overweight does not effect job knowledge and in the case of a nurse, it does not effect how much you care about your patients and their well-being.

Does Obesity Mean Incompetence?

I have stolen that subtitle from another nurse who blogs, Marijke Durning, over at scrubsmag.com. I don’t feel a need to make up my own version of what she has said so well.

”Undoubtedly, a nurse’s skills have nothing to do with her body size. No matter who she is, her knowledge depends on three pounds, the average weight of a human brain. Retaining, assessing and processing information are no different between a nurse who weighs 120 pounds and one who weighs 180 pounds.

But what of the physical work? Nurses who are mildly to moderately overweight may not have difficulty with the physical aspect of nursing, but the heavier or obese nurses may not be so lucky. That is a generalization, of course, but usually, the larger the person, the more effort it takes to perform a physical task like running up the stairs to answer a cardiac arrest code. When a nurse is out of shape, she is also more prone to injury.”

Had this hospital, Citizens Medical Center, had a policy that said they felt compelled to consider an applicant’s general health, including weight and mobility, when placing them in specific jobs there probably wouldn’t have been such a firestorm. I have been asked repeatedly, when being considered for jobs in the operating room, if I can lift and carry items over 20 pounds, 30 pounds, even 50 pounds. That’s part of my job as a circulating nurse and if I couldn’t do it, a hospital would have every right to not hire me.

Weight is a touchy issue, particularly for women and most nurses are women. Only one state (Michigan) and six cities (Santa Cruz, CA; San Francisco, CA; Urbana, IL; Madison, WI; Binghamton, NY; and Washington, D.C.) ban employment discrimination based on size. Citizens Medical and other employers everywhere else are within their rights to reject overweight and obese job applicants.

While how an employee looks should be off limits, employers have both the right and the responsibility to keep their businesses safe. In the case of healthcare, that means keeping patients safe, keeping coworkers safe, and being fiscally responsible so that the doors to the clinic or hospital stay open.

In 2008, an article in the Health Affairs Journal showed that medical costs associated with obesity were estimated at $147 billion; the medical costs paid by third-party payors for people who are obese were $1,429 higher than those of normal weight.

I find all these statistics as daunting as my own bathroom scale. I know personally, I would rather be counseled about my weight problems, and their relationship to my recent back injury, by someone who looks more like me than like an anorexic ballerina. I guess, I figure, they might understand how difficult the weight game really is. But, is the potential for injury really grounds enough to keep you from working in your chosen profession if you are otherwise qualified?

That, to me, is a valid question. It might also be a valid consideration for not hiring someone. However, back to what the policy and the CEO at the Victoria hospital actually said. I do think the man was inappropriate, unprofessional, and ridiculous. The policy, as stated, is clearly a bad one.

However, the premise of being unfit physically to do a job is a fair one for employers to consider and for each of us to take to heart. If you are in a job that is physically demanding, like nursing, you owe it to yourself, your employer, and particularly your patients to take care of yourself. Easier said than done, I know. But, now that I am done “weighing in” I’m going for a walk. If you made it to the end reading this, why don’t you join me?

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