Nurses With Disabilities

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When Vicki Owens, RN, interviewed for a position in a psych unit in December 2002, she was assured there would be no lifting.

However, once on the job she found that wasn’t the case.

“Although I loved the work, there was always one patient, a gerontology patient from the nursing home, who was a total lift. And they had no other staff,” Owens said. “It was always the nurse that had to do it. So, I ended up, every shift, having to lift.”

An RN since 1996, she was dealing with residual pain from a previous on the job injury, which she would later find had caused bruising on her spinal cord.

Despite promises of assistance on the part of her nurse manager, she was expected to care for the patient alone. And so, even though she had extensive experience and knowledge Owens was forced to resign to protect her health.

Since then, discrepancies between the job description and expectations has continued to be an issue for Owens, as well as a professional culture that lacks understanding and support for nurses with sensory and/or physical disabilities.

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Inconsistent Expectations

Nurses with disabilities, like Owens, have the education and experience to provide bedside care, but discrimination and inflexibility on the part of facilities and management can limit their ability to utilize such skills.

Leslie Neal-Boylan, PhD, CRRN, APRN-BC, FNP, professor/graduate program director of the School of Nursing at Southern Connecticut State University, has conducted several studies focused on nurses with sensory and/or physical disabilities. Her most recent study looks at nurses working with a disability and their ability to perform their job based on job descriptions and actual expectations.

According to Neal-Boylan’s previous studies, people are saying that nurses with disabilities are being pushed out of the profession because they supposedly cannot do what they need to do. And so, she set out to see if this was true. The current study has shown that this is not the case.

“I have found that nurses with disabilities have been able to do what they are expected to do,” Neal-Boylan said.

“The job a nurse is hired to do might not include lifting, but on the job they might be expected to lift,” she added. “However, these nurses have no trouble doing what is actually delineated in the job descriptions.”

Over the course of her studies, Neal-Boylan has found several common themes, including discrimination against less-severe disabilities as well as a culture of “nurse heroics” that leads to well-educated nurses leaving the field.

Accommodations

Nurses, who are able, will hide their disability out of necessity. Education and experience are overshadowed by even minimal physical impairment, according to Neal-Boylan’s study.

Nurses are expected to lift patients and move equipment, but as Neal-Boylan points out, these are tasks that could be done by a nurse’s aide or with mechanical assistance.

This raises the question, “Why are qualified nurses not getting a job or losing a job because they cannot lift somebody?”

“People are made to feel like they can’t do the job, even if they might just need to be on a certain shift or make sure they take a break,” she added.

Nurse Heroics

Nurses are held to the highest of standards, expected to go above and beyond, and oftentimes they are their own harshest critics.

Over-time, working on off days, and missed breaks occur regularly, which is a pace that can be hard to maintain when working with a disability.

“We treat our patients and teach our patients about taking care of themselves, but this is another example of nurses not taking care of each other,” Neal-Boylan said.

She found that the nurses with disabilities who are working are either in a position where their supervisors are not nurses or they are nurses who also have a disability or a chronic illness. They are being managed by individuals who do not subscribe or know about the culture of nurse heroics.

In addition, a theme present throughout the studies was the disconnect between perceived values and practiced behaviors.

“As a profession we say that it is our intelligence, critical thinking and judgment that matters and yet time after time nurses who have these qualities are being pushed out of their jobs because they cannot physically keep up with that heroic speed,” Neal-Boylan stressed.

Power of Education

This environment has led nurses with disabilities to pursue higher education, in order to reach positions that while away from the bedside, allow them to remain in nursing.

Owens, who is six credits away from earning her BSN from St. Joseph’s College of Maine, plans to earn a higher degree in social work as well.

“I still want to be a nurse, but I can concurrently do that with an MSW,” she said. “Hospice is my passion and so while I cannot be a direct care nurse, I plan to become a social worker there.”

She recommends that other nurses with disabilities pursue advanced degrees and/or certifications. While physical limitations can change a nurse’s career path, it does not mean they cannot continue to serve the patients in another way.

“Education is certainly the route I have to take,” she stressed. “I cannot make a living, anywhere else in nursing. I absolutely can’t do it.”

Creative Solutions

While rare, Neal-Boylan, has found examples of managers who recognize the intellectual value of a nurse, despite their physical disability, and work to find a place for them within their facility.

Education and a shift in culture are necessary to make this attitude the rule, not the exception.

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Neal-Boylan emphasizes the need for raised awareness, which can be accomplished in a number of ways, including increased education among students.

“I know nurse educators already talk about supporting one another, but they really need to emphasize that a nurse with a physical/sensory disability is valuable,” she said. “We need to recognize that our colleagues have a lot to offer.”

Creative solutions, according to Neal-Boylan, are key.

A national database of jobs would give human resources and managers the tools to help place nursing professionals, who have the expertise, but are limited physically. In addition, trade-offs and compromises can help retain valuable nurses and improve healthcare overall.

For example, Neal-Boylan recalls a nurse, who sits on committees at her hospital, a task many do not want. In return, she is not required to do some of the more physically demanding jobs on the unit, but can still care for patients. Both the nurse and the facility gain from this arrangement and a valuable employee is not lost.

Culture Shift

While education and compromise is critical, ultimately change will come only when perceptions shift. The culture of nurse heroics must be replaced with a culture of acceptance and support.

“We need to encourage organizations to hire more nurses rather than continue to overstretch the ones we have,” Neal-Boylan concluded. “Because, as one of my participants said, everyone is a blink away from having a disability.”

For more information, Leslie Neal-Boylan’s book, “Nursing with disabilities: Professional Issues and Job Retention for RNs” (Springer) will be available in October 2012.

Catlin Nalley is editorial assistant at ADVANCE.

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