National Nurses United

Disabilities:1 10/15/08 11:00 PM Page 11 Maheady, a pediatric nurse practitioner who holds a doctorate in education. Maheady is the founder of Exceptional Nurse, a nonprofit organization dedicated to providing support, education, and opportunities for disabled nurses. Its website offers pages on continuing education, disability resources, employment, and financial aid. Like many nurse disability activists, Hoepner and Maheady believe that with the present nursing shortage, capable nurses, disabled or otherwise, should be wooed, encouraged, and nurtured to enter a profession hungry for people with the bravery to commit to what is often more a calling than a career. Yet all too often, nurses with disabilities encounter a workforce insensitive or even hostile to their needs. D iscrimination against both mental and physical disabilities often begins in nursing school. While some disabled students are welcomed with open arms, others attending the same school report a negative experience. Changes in faculty or staff can influence a school's approach to disability. "The influence of one faculty member can be contagious," says Maheady. The Americans with Disabilities Act (ADA) of 1990 sets disability guidelines for employers and schools, and prohibits discrimination based on disability. Disability is defined by the law as "a physical or mental impairment that substantially limits a major life activity." The law is designed to protect disabled persons in all conditions and privileges of employment including hiring, advancement, job training, and compensation. The law states that an employer or educational institution must make "reasonable accommodations" for disabled persons. But there are Catch-22's in both the law and school entrance requirements that allow nursing schools and healthcare facilities to circumvent accepting disabled nurses, a catch that may encourage nurses to keep their disability underground. For example, the University of Washington Nursing School's entrance rules state that "an Cara Hoepner's individual (applying for school) must show disability, bipolar both that a disability exists" and that he or she disorder, gives her can meet the requirements of the program, special insight into with or without 'reasonable accommodation.'" her patients. The But without that "reasonable accommonurse practitioner dation," Maheady says, a student often can't chose to work with demonstrate that he or she can meet the psychiatric patients requirements. because she In the past, nurse educators believed that wanted to spare only able-bodied people could be nurses. them the cookie"For some educators, that attitude contincutter approach to ues," Maheady says. mental healthcare Since the advent of the ADA, many nursing she suffered. schools have implemented new standards designed, they say, to promote safe nursing practice. But some disability rights workers argue that these standards are designed to enforce discrimination against students with disabilities. When faced with hundreds of applicants for limited space, nursing educators can argue that to maintain the schools standards, they will accept only applicants without impairment. Even if they are accepted and succeed, new nurse graduates must enter a healthcare industry that takes issue with the idea of "reasonable accommodation," interpreting the law to mean that if accommodation is too expensive for the hospital, it becomes "unreasonable." Some of the most common ways to accommodate nurses with OCTOBER 2008 vision and hearing loss are the use of adaptive devices and technologies. A nurse with hearing loss may use an amplified or electronic stethoscope. Hospitals may install special telephones that switch easily between standard and amplified modes with the push of a button. But other accommodations exist as well. A nurse who loses a limb may require a silicone prosthesis. A nurse with paralysis may use a wheelchair. While some hospitals have made efforts to accommodate disabled nurses with amplified devices or a change in assignment, others have been slow to retool hospital environments or job descriptions. Marylea Hall works in the neonatal intensive care unit at Saint Mary's Regional Medical Center in Reno, Nev. Recently she helped organize CNA/NNOC representation at her workplace and served on the bargaining team. Hall also has a hereditary hearing deficit that is often misunderstood by her coworkers. Hall feels it is important to be open about her disability to her coworkers and supervisors, and she regularly discloses her deficit to parents of babies she cares for in the NICU. Despite working six years with a deficit, for which she requires hearing aids, she receives good evaluations and has never been cited for anything related to her hearing. But she has been placed in situations she calls frightening, despite her objections. Last year Hall was told to attend a caesarean section in the NICU operating room. She kept telling her supervisor that she could not attend the C-section because in some situations with high levels of background noise, Hall relies on lipreading to understand what people are saying. "There is no window in a surgical mask," Hall says, explaining her frustration. Her supervisor kept telling her everything would be fine, but Hall continued to object. She was sent to the OR anyway. It was soon apparent that Hall couldn't understand what the doctors were saying. Hall left the OR and some of her coworkers finally understood how difficult a position she'd been placed in. The department accommodated her by agreeing that she no longer had to attend C-sections. But Hall says it has been a challenging and sometimes isolating process to make sure her coworkers stay sensitive to her condition. Recently a supervisor asked Hall if she would be a charge nurse. Hall had to remind her, "I can't be a charge nurse. Charge nurses do C-sections." Hall had to explain her disability yet again, followed by a lesson in hearing impairment. "Imagine leaving a loud concert with your ears plugged up," Hall told her supervisor. "Then imagine being underwater. That's how I hear." Hall's journey is made even more difficult because most healthcare plans, including hers at Saint Mary's, does not cover the cost of hearing aids. Hall's devices cost about $5,000 and could go up to $20,000, depending on the severity of the hearing loss. For now, there is no amplified phone on the unit designed specifically for hearing impairment to accommodate Hall. She turns the volume on the standard phone as high as it goes to listen to doctors, coworkers, and medication orders. In the end, Hall says, it's the team effort, essential to all nurses, impaired or not, that allows her to do her job effectively. She points out that other nurses don't just help her because of her impairment. "We help each other," she says, "because that's what all nurses do." Ultimately, some nurses have been forced to litigate over their right to accommodation. Unfortunately, statistics on these cases are difficult to find. "Many of these cases result in out-of-court settlements and gag orders that prevent nurses from talking about their case," Maheady says. W W W. C A L N U R S E S . O R G REGISTERED NURSE 11

• Cover