Physical impairment/disability

Americans with Disabilities Act of 1990 (ADA)

All nursing staff as well as managers should be aware of the ADA requirements related to nurses with substance abuse disorders, mental health disorders, and physical disabilities. According to the government’s Equal Employment Opportunity Commission (EEOC), a person is an individual with a disability under the ADA when he or she: (1) has a physical or mental impairment that substantially limits one or more major life activities; (2) has a record of a substantially limiting impairment; or (3) is regarded (treated by an employer) as having a substantially limiting impairment. https://www.eeoc.gov/facts/health_care_workers.html One of the examples the EEOC describes is whether individuals who are alcoholics or engage in illegal drug use are considered to have a disability. Here is their response about someone with alcoholism. Under the ADA, someone with alcoholism is an individual with a disability if the alcoholism currently substantially limits a major life activity, was substantially limiting in the past, or is regarded as substantially limiting. An employer may not discriminate against, and may need to accommodate, a qualified applicant or employee with past or present substantial limitations relating to alcoholism who can competently perform his job and can comply with uniformly-applied employer conduct rules prohibiting employees from drinking alcohol at work or being under the influence of alcohol at work.  https://www.eeoc.gov/facts/health_care_workers.html

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.

One historic incidence:

In a city hospital during the 1970s, a very hard of hearing nurse worked during the evening and night shifts. When she tried to get information about a patient to a resident, she would put in the call and wait a certain amount of time for the resident to pick up the call because she could not hear the resident acknowledge the call. The residents tried to answer the call as soon as possible but sometimes they missed part or the entire message. This nurse was unable to hear their questions on their call back. One evening this nurse hung a bag of blood for a patient whose bed was in a ward with a large standing fan. The bag of blood got caught up in the fan. As the nurse walked away, the other patients tried to tell her that the blood was caught in the fan. She could not hear them well enough to understand what they were saying. Fortunately, another nursing staff saw what happened. Times have changed but it is important that certain standards of performance be met when assigning nurses to care for patients, particularly. More research needs to be done to assess nurses with disability to both add opportunities for inclusion into the workforce but also importantly to provide safe and comprehensive care for patients.