Nursing OnPoint

Snapshot: This article reviews the meaning and spectrum of disabilities in nursing, and provides some strategies and tips for accommodation for nurses with disabilities; also included are some links to online resources.

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What Is a Disability? Strategies for Nurses with Disabilities Accommodation Tips The Big Picture: Attitude & Nursing Culture Resources
 

What Is a Disability?

• According to the Americans with Disabilities Act (ADA), a person has a disability if he or she has a physical or mental impairment that “substantially limits” one or more “major life activities,” or if he or she is regarded as having such an impairment.
• As this article will explore, many skilled and valuable nurses with a range of disabilities are able to perform their jobs not only adequately, but well. In some cases, a nurse’s disability may even lead to improved job performance.
• Because the ADA does not maintain a specific list of conditions that constitute disabilities, whether or not a nurse is “disabled” is not a simple question to answer. “Disability” exists on a spectrum, and whether a nurse should be considered disabled depends upon whether that nurse’s particular mental or physical impairments limits his or her ability to perform the job in question.
• Nurses who face or may face disabilities should keep in mind the wide range of jobs and roles within nursing. A nurse that would be “disabled” in one nursing job may not be “disabled” in another, depending upon the tasks, roles and responsibilities of each job.

Strategies for Nurses with Disabilities

• Have a can-do attitude. Your attitude towards the limitations you face (or think you face) is arguably the single most important factor in how your disability will or won’t affect your work as a nurse. Nurses with disabilities who are passionate about nursing, and are able to seek out the right supports and work environments, will find that they can usually not only survive, but thrive, as nurses. Your disability gives you unique and valuable insight into the limitations your patients will inevitably face, and your disability can, in this way, make you a more compassionate, knowledgeable and effective nurse. If you believe your disability means “I can’t do it,” then you’re probably right. But, if you approach your limitations by asking instead, “what can I do with my unique abilities?” your options and pathways to success will be plentiful.
• Find a fit. Living with a disability doesn’t mean you can or should work in any environment. Your goal should be to honestly assess your strengths and weaknesses, and seek out work environments that suit you best. For example, a nurse who suffers from fibromyalgia (a condition characterized by widespread musculoskeletal pain and fatigue) might want to seek out case management, education or consulting roles, rather than a floor nursing position on a busy surgical unit, which could require frequently lifting and turning patients. A nurse, in contrast, who suffers from attention deficit disorder or ADHD might be a perfect fit for such an active, physical work environment. Acknowledging your limitations doesn’t mean you’ll be unsuccessful as a nurse. On the contrary, it’s a crucial step toward your professional success (whether you live with a disability or not).


• Strategize accommodations. Once you’ve found some job possibilities that can work for you, you’ll need to consider ways to maximize your ability to perform at that job. For example, if you suffer from depression, work with your manager to schedule days off between your shifts, and take advantage of whatever mental health benefits, such as counseling or psychotherapy, that your insurance plan offers. If you have a hearing impairment, find equipment (such as amplified stethoscopes) that will allow you to perform your clinical role. If you suffer from a back problem, and will be performing physical transfers of patients, make sure you’re on a unit with lift equipment if lifting is sometimes required, and be sure you learn how to use it. (In so doing you may become a valuable resource to other, non-disabled nurses!) The key is to be honest with yourself about the accommodations you’re likely to need – and to think through in advance ways to use those accommodations to your best advantage.
• Help others. Regardless of the job you choose and accommodations you make, your success – as is true for everyone – will depend upon how effectively you’re able to cooperate with and give back to others. For example, if you have arthritis that makes it difficult for you to turn and transfer patients and you’re in a job when this is sometimes necessary, you can allow more able-bodied nurses to assist you in exchange for helping others with less physically demanding tasks, such as passing medications or monitoring patients. If you suffer from chronic fatigue syndrome or are recovering from a physical disability and need to work day shifts, talk with your manager about scheduling yourself in this way, perhaps in exchange for joining a committee or helping with other professional tasks (which can be valuable in helping you build your skills and resume in their own right). If you approach your limitations with a giving and generous attitude, others are far more likely to respond in kind. Those ‘weaknesses’ could end up becoming strengths.


• Handle misunderstandings and misperceptions. It would be great if everyone, from patients to colleagues to our bosses, were always thoughtful and enlightened, but this is obviously not always the case! If someone questions or demeans you because of a disability, whether real or imagined, respond in a thoughtful, professional manner. For example, if a colleague comments on the fact that you walk slowly because of your age or a physical disability, and questions your ability to respond to patients in an emergency, you’re much better off saying “I work hard to keep my patients safe, and I don’t believe my physical ability determines my skill as a nurse,” than saying, “you don’t understand what I’m going through. Don’t say that to me.” Another way to respond is to turn the comment around, and open up a discussion. For example, you could say, “do you have a safety concern? I believe our focus should be on our patients’ wellbeing.” Regardless, be clear, concise and courteous, not belligerent or confrontational. The way you respond can clarify and invite a productive conversation, or lead to unnecessary conflict. You set the tone that others will follow.
• Take care of yourself. No matter who you are, or the challenges you face as a nurse, it’s imperative that you look after your own mental and physical wellbeing. While nurses are often skilled at caring for others, we’re often far less skilled at caring for ourselves. Don’t forget the importance of the basics – eating well, getting adequate rest, exercising, and spending time with loved ones. Being a nurse with a disability is a special gift, and a special challenge. You deserve the same care you give to others in your professional life, and you’re far more successful to meet the challenges you face if you’re building from a solid foundation.
• Recognize your strengths – and your limits. Being a nurse who also possesses a disability is a balancing act – recognizing, on the one hand, your unique strengths and contributions, and on the other, being honest with yourself and with others when you’re unable to do something. Of course, your patients’ safety always comes first. If you feel you are mentally or physically unable to perform the responsibilities of your position, you have a duty to say so and to seek the assistance you require.

Accommodation Tips

• Physical impairments. Physical impairments may range from difficulties manipulating objects with your hands and fingers, to challenges walking, standing, sitting, and lifting.
  • Consider using transfer aides and lift equipment whenever possible, and work in teams to lift or transfer patients.
  • Negotiate to care for patients closer to the nurse’s station (perhaps even if these are patients with more complex medical problems), so that you walk shorter distances between patients.
  • Schedule periodic rest breaks, and partner with other nurses to ensure you all have a chance to get off your feet.
  • Make sure you don’t schedule yourself to work too many shifts in a row, and communicate clearly and respectfully with your manager about your need to recuperate physically between shifts. If you work better at a particular time (e.g. day or night), schedule yourself for those shifts as much as possible.
  • Depending on the scope of your challenge, look for nursing jobs in areas “off the floor,” such as in case management, education or consulting, which are less physically taxing.


• Mental health. Mental health impairments range from mood disturbances like anxiety and depression, to more complex psychiatric challenges and diagnoses.
  • Take full advantage of your health plan benefits to obtain the counseling and/or medication you require to treat symptoms. Don’t make the mistake of ‘skipping’ therapy or medications because you ‘feel good.’ Your goal should be to try to prevent exacerbations of mental health problems, not wait until they’re more serious.
  • Try to take breaks during your workday. If this proves difficult, consider working in a non-acute care environment – such as in home health or case management – where you can more easily schedule such breaks.
  • Keep things in perspective, and don’t assume all the challenges you face are because of your mental health challenges. Nursing is tough for everyone. Don’t fall into the trap of assuming you’re ‘less than’ because you sometimes feel overwhelmed. You’re not alone!
  • Know your limits, and if you’re too unwell to work, don’t come in. Your first priority, of course, is the safety and wellbeing of your patients. While your mental health challenges can give you a unique perspective on your work, don’t try to care for others if you aren’t well enough to care for yourself.


• Substance abuse. Substance abuse is defined by use of alcohol and licit substances that impair your health and wellbeing, or by use of illicit substances, such as illegal drugs, that results in harm to yourself or others.
  • Be honest about needing help, and understand that suffering from substance abuse doesn’t necessarily mean your nursing career is over. Take advantage of any Diversion programs your state Board of Nursing may offer. Such programs are meant to protect the public from impaired nurses, and allow such nurses to treat their problems, in a voluntary, confidential manner.
  • Many employers also offer counseling and rehabilitation programs for nurses struggling with substance abuse. Look into the benefits you possess; you may be surprised by what’s on offer.
  • Enroll in 12-step programs, such as Alcoholics Anonymous or Narcotics Anonymous, or find other such support groups. For many individuals, recovery from substance abuse is a life-long process, and requires the support of others.
  • Know your ‘triggers’ and seek work environments – in terms of your clinical role and stress level – that help you stay healthy. Consider avoiding practice areas (such as oncology, hospice, and many perioperative and surgical units) where frequent access to narcotics may prove problematic.


• Cognitive impairments. Cognitive impairments include problems with concentration, thinking, and memory loss. Such impairments may result from a wide range of conditions including depression and substance abuse, and neurological conditions such as dementia, Alzheimer’s disease, and Parkinson’s Disease.
  • Seek out work environments that are compatible with your impairment; individuals who have difficulty concentrating may thrive in fast-paced, acute care environments, while those who require more time to process information may be better suited for slower-paced education, case management or consulting roles.
  • Record information and learn in the ways that match your cognitive style: by writing or note-taking, using visual cues, or by asking permission to record written instructions or clinical information as appropriate. Consider working with a cognitive or behavioral learning professional to find the learning style that works best for you.
  • Carry ‘cheat sheets’ and written checklists as needed. Such key information can often be integrated into the ‘brain sheets’ and other clinical aids nurses of all kinds often use to help them organize and remember patient information. (See “Brain Sheets” for more information).


• Sensory impairments. Sensory impairments include alterations in vision, speech, or hearing, and may result from both congenital conditions, such as premature birth, and non-congenital conditions, such as sensory loss with advancing age.
  • For those with visual impairments, consider purchasing ‘talking’ clinical equipment, such as ‘talking’ thermometers, watches, blood pressure monitors, and blood glucose monitors.
  • For those with hearing impairments, consider using amplified stethoscopes and other clinical equipment, equipment with digital displays, vibrating alert devices, and using text telephones (TTY or TDD).
  • For those with speech impairments, consider clinical roles where communication can frequently occur via written or electronic communication, speech therapy, and working in lower pressure, non-acute care environments where quick verbal communication may be less imperative.

 The Big Picture: Attitude & Nursing Culture

• To disclose or not to disclose. Living with a disability isn’t simple, and being a nurse with a disability adds another layer of complexity. Many nurses are so skilled despite their disability – or, perhaps some would say because of it – that deciding whether or not to tell others about their disability status isn’t straightforward. The benefits of disclosing your disability include better communication with colleagues and patients, an increased chance of obtaining the accommodations you require (should you need them), and not feeling like you have something ‘to hide.’ In other cases, disclosing your disability can lead to judgment and misunderstanding, often by colleagues and superiors who should know better than to judge you in this way, but who may be unable or simply too ignorant to know better. Whether you choose to disclose or not to disclose your disability, think through who you wish to tell, how to tell them, and when. Your goal should be to instill trust and confidence in your ability as a nurse, and to demonstrate that not only can you safely care for your patients but do so with the compassion that comes from having overcome a health challenge of your own.
• The myth of being physically perfect. One of the largest challenges nurses of all kinds face is the myth that one must be physically ‘perfect’ to provide competent care. Such notions are part of a larger nursing culture, and perhaps healthcare culture generally, that often values stamina, endurance and even self-denial over balance, prudence and caretaking. Nurses, including even disabled nurses, can sometimes be their own worst enemies when it comes to making false or illogical assumptions about the attributes needed to be a competent nurse. As you navigate your disability as a nurse, keep in mind that you may have internalized some of these myths and assumptions, and work to examine and reconstruct those beliefs as you tackle your career.
• Find a community, and support. Nurses with disabilities face special challenges – and can reap unique rewards from the incredible work that they do. Finding a community to support, nurture and celebrate your path as a nurse with a disability is key part of your success. Reach out to others in your employer and your local community for support, and take a look at some of the resources below. Remember that you’re not taking this journey alone. You can seek out assistance from others, and having received help, find a way to give back to that same community.

Resources

• Exceptionalnurse.com. Exceptionalnurse.com. This website was created by a prominent nurse educator and disability activist, and has become a ‘go to’ resource for disabled nurses and their advocates. The site offers a wide range of written and video content with ideas, tips, advice, links, and other resources for the disabled nursing community.
• National Organization for Nurses with Disabilities (NOND): http://www.nond.org. This is an open-membership, cross-disability professional organization that works to promote best practices in education and employment, provide resources to individuals and organizations, and influence nursing culture.
• Discover Nursing. http://www.discovernursing.com/nurses-with-disabilities. This is useful section of Johnson & Johnson’s “Discover Nursing” website, and provides career tools, nurse profiles, recommended articles and books, and links for disabled nurses and the disabled nursing community.