Physical impairment/disability

Only 8 of the 41 states with State Board of Nursing alternative to discipline programs include physical illness in their definition of impairment. Connecticut's alternative to discipline program, HAVEN, allows the impaired nurse to petition for entry when unable to practice with reasonable skill or safety due to “Physical illness or loss of motor skill, including but not limited to deterioration through the aging process,” as well as mental illness or substance abuse.

The charge of the State Boards of Nursing is to protect the public from harm. As of 2013, according to Leslie Neal-Boylan, PhD, APRN, “There are no documented incidences of patient injuries caused by a nurse with a physical disability.” It is unclear why disabled nurses would be included in the definition of impairment leading to potentially harmful practice without documentation of actual or potential harm to patients.

There are few research studies about nurses with disabilities. Two qualitative studies were conducted by L. Neal-Boylan (Neal-Boylan & Guillett, 2008; Neal-Boylan, et al, 2012). The researchers interviewed physicians and nurses about career trajectories with disabilities. They found the following patterns in the lives of physicians and nurses:

1. Adjusting to the limitations of career choices in health care because of their disabilities.
2. Deciding whether to report their disability when being hired. They all feared discrimination because of their disability. One nurse, for example, wore hearing aids that set in her ear canal and were not generally visible.
3. Deciding not to seek legal counsel for reasonable accommodations. Felt it was their responsibility to adjust to work conditions wherever possible.
4. Learning how to deal with interactions with supervisors and other staff. Most often felt disregarded and thrown aside. Some staff would not enable minor adjustments in the environment when asked. Others were supportive.
5. Reconciling own emotional reactions to the disability from anger, to grief, to adjustment and acceptance.

Neal-Boylan & Miller (2015) invited a nurse attorney to find and review disability cases involving RNs that occurred between 1995 to 2013. Cases with mental health issues and/or substance abuse were excluded. Of the remaining 56 cases, 84% involved claims of disability discrimination, 46% claimed failure to accommodate, 12.5% retaliation and 10.6% hostile work environment. The nurses claims of disability were largely unsuccessful.

In 2008, the ADA was revised to broaden the definition of disability. A disability is still defined as a physical or mental impairment that substantially limits one or more major life activities. There also needs to be a record of the impairment (ADAA, 2008). One of the issues previously discussed in the courts was the determination of the term “substantially limits.” In the ADAA the requirement is delineated more broadly in favor of more coverage. Also, the ADAA includes impairments that are episodic or in remission.

The ADAA, like the initial ADA, requires employers to make accommodations for individuals with disabilities. There is no list of medical conditions that are considered disabilities. Some situations where the health professional qualified for disability and some accommodations according to the ADAA guidelines include: cognitive impairments, motor impairments, vision and hearing impairments.

There is a national organization designed to assist nurses with disabilities, The National Organization of Nurses with Disabilities, www.NOND.org.

Also, a journal called Minority Nurses, http://minoritynurse.com/, publishes articles about nurses with physical disabilities.