The best nurse for a position may be least likely to get it, if employers and colleagues are unable to recognize that a disability doesn't mean a candidate can't do the job as well as, or better than, required.
"Instead of putting every nurse with hearing loss in the same category or grouping every one with a mobility aid, ask individuals how they would do the job," says Donna Maheady, RN, EdD, ARNP, an adjunct assistant nursing professor at Florida Atlantic University (FAU) in Boca Raton. Maheady is founder and president of Exceptionalnurse.com.
"When a nurse with spina bifida was asked how she'd do CPR if needed, she said she'd get out of her wheelchair and do it," says Maheady. "An ICU nurse with hearing loss developed compensatory abilities that were assets, such as lip-reading patients on vents."
And when caring for patients with similar conditions, "their extra knowledge and 'tricks' improve care," as well as patients' lives after discharge, says Maheady. She cites the case of the nurse manager of a spinal rehab unit who knew from her own injury how to transfer patients, drive, and manage daily tasks. "What does it say to patients if we value only able-bodied people? We have an ethical responsibility to take care of our own and set an example. And we're not exempt from ADA [Americans with Disabilities Act] requirements to make reasonable accommodations." Employers who focus on disabilities can shortchange themselves by overlooking invaluable abilities and experience. Violating the ADA or other laws may incur costs, including employee turnover, attorney fees, back pay, financial penalties, and legal settlements.
On the flip side, employers who hire or retain RNs with disabilities may receive government funds and tax breaks. And there are other incentives.
"Nurses with Parkinson's who recover from an exacerbation may be able to work. If they're let go, word spreads via friends, family, their neighborhood, the Parkinson's chapter, and support groups — all negative," says Maheady, author of two acclaimed books on nurses and nursing students with disabilities.
Nurses are accommodated every day, every shift, and often without fanfare, she notes. A poststroke nurse may return to the workplace if she can ease back gradually, rather than working three 12-hour shifts on consecutive days. A nurse injured while lifting may transfer to case management or Joint Commission preparation.
"It's a plus when the public knows where they work," she says, because people may go to the facilities seeking those nurses' care. Retaining them "improves the hospital's reputation among nurses and may help recruitment and retention," she adds. "It says, 'We take care of our people,' and like ads saying 'Nurses with disabilities are encouraged to apply,' it encourages nurses who need a nudge."
The 95% solution
"We can't always accommodate specific disabilities in every situation and change entire departments for one person," says former nursing recruiter Rebecca Koszalinski, RN, MSN, now an adjunct professor at South University, with campuses in West Palm Beach and Tampa, Fla. "But especially in a field where we have great shortages, we should concentrate on the 95% they can do in the right position. A quadriplegic nurse may be able to contribute clinically, but realistically might do more in research or another area."
Koszalinski was asked to appear in a nursing education video demonstrating some professional techniques. "It was such a compliment when the professor said she forgot I had a disability," she says. "I do things correctly, but when I'm using a wheelchair or forearm crutches, I may do some things slightly differently."
A knee injury, lymphedema, and subsequent misdiagnosis ended her aerobics and theater career. Surgery removing subcutaneous tissue caused more damage and compromised her immune system.
"I had so many awful nurses while in and out of the hospital that I decided we needed people who understood from the other side of the bed," she says. "It can be the biggest crisis patients experience. It feels like life and death, even if it isn't, and nurses are often nonchalant. Many times, we don't listen to the entire story. We rush to give meds or a quick fix and often insult them by prejudging their pain as depression."
Koszalinski's experience motivated her to become a patient advocate and nurse educator. She promotes awareness of lymphatic disorders (particularly of the lower extremities), neuropathy, and sensitivity to patient perspectives. She discusses the impact that chronic illness, constant pain, and disabilities have on patients and nurses. Besides her adjunct position at South University, she's returning to FAU as a clinical instructor in mental health and rehabilitation while working on her doctorate.
Some nursing colleagues worry they'll have to push RNs in wheelchairs from unit to unit — which Koszalinski says is untrue. They're delighted to learn that when getting charts, blood, equipment, and supplies, someone in a wheelchair can do it better and faster. "I can load up my lap and side pockets, pile things underneath, and go," she says.
She can reach patients sooner, too — an asset when departments expand. Although colleagues kid her she's lucky to sit while they trek distances, she's transferred the burden to her upper body. For aerobic and strength benefits, instead of a powerchair, she wheels a lightweight sports chair that makes tight turns in patient rooms.
"Nobody's asking nurses to take care of colleagues with disabilities," she says. "People barter all the time — 'If you turn my patient, I'll take care of your IV.' I'll ask colleagues, 'Can you help me for a moment with this, and how can I help you with your day?' I'm there to participate, not to burden."
From catastrophic to chronic
Kathy Cantu, RN, MSN, BC, CEN, CDE, was struck twice by deadly diseases during her career — first by type I diabetes, then by renal failure. Both times, she was sure her career had ended. And both times, her colleagues made sure it didn't. Doing so paid off in unexpected ways.
Cantu was an ED nurse when she nearly died from ketoacidosis. "Even though I'd been there for seven years and had a lot to offer, I assumed I wouldn't be wanted," she says. "Instead, I was encouraged and promoted for 15 more years, until the hospital closed."
Before Cantu learned to diligently take meal breaks, check her blood, and regulate her insulin levels while working, her blood sugar plummeted several times and she even lost consciousness. "I thought colleagues would resent stopping to take care of me, but they were very supportive. I was a good worker, and they didn't want to work without me."
Cantu became a certified diabetes educator, then proposed and opened a diabetes center, a popular resource for patients and physicians. It was profitable — the center attracted patients with diabetes and related specialists, and the reimbursements flowed in.
She didn't expect equal consideration from her next employer, Plaza Medical Center in Fort Worth, Texas, but was pleasantly surprised. Four months into her new job, she had an MRI. The dye triggered kidney failure, necessitating four hours of hemodialysis three times a week.
"I didn't think they'd let me take the time off, but they're supportive because they want me here," she says. "My boss accommodated my schedule, and I could do work during dialysis, so I didn't have to forfeit pay or sick time." She's progressed to overnight home peritoneal dialysis, using flex time to free her mornings. She's been promoted to director of nursing quality and is responsible for education, Magnet coordination, and wound care, among other services.
Cantu says her disability gives her more credibility, compassion, and influence: "People say if I can do it, so can they, especially if their disability is not as severe. They say they get strength from me and come to work because I [do]. Nurses with disabilities feel they have to prove themselves, so we do the most we're able to do — as much as or more than other nurses."
From critical condition to CCU
A gunshot wound at C1 put 14-year-old Chris Sellers in critical care as a quadriplegic on a vent. Today, he has a pronounced limp, paresthesia, chronic pain, and progressive scoliosis. "But he's not just functioning," says Cantu. "He's fabulous." He's also her coworker.
"I was a scared little kid in an adult body, and critical care nurses helped me through," says Sellers, a coronary care staff nurse with CCRN certification. "It gives me a great sense of empathy. It's really scary to be stuck in bed with bells and whistles, plus equipment, needles, and tubes. Every day I work, I tell my patients my experience as a critical care patient. Colleagues often ask me to talk to their patients and families who are feeling hopeless and looking for a bright spot."
At 27, Sellers was on permanent disability and frustrated by his lack of accomplishment and contribution, he says. "Nursing had been a calling, and I decided to see if I could do it."
He enrolled in nursing school and faced an unlikely academic hurdle during his first semester.
"I spoke to my instructors and asked them to accommodate me," he says — by not giving him special treatment. "Some, especially clinical, were soft on me. I wanted the exact load and difficulties as everyone else. I wouldn't get special treatment in work environments, and I wanted to see if I could do it."
He could — and worked three years in med/surg/telemetry units as a foundation for critical care: "A perfect fit," he says. After a year, Sellers was promoted to charge nurse and clinical coach.
Six feet tall and weighing in at 200 pounds, Sellers says he's a bit stronger than most women. Because his disability preceded his career, he's incorporated the best technology and techniques for lifting and turning patients, particularly the obese. He responds to codes and the RRT in other units and says there's no significant difference in his response times.
His workload differs in one respect: The man once considered physically unemployable now works four 12-hour shifts a week.
Disability's ups and downs
Additional stigma, even blame, may be attached to certain disabilities, particularly those with psychological or behavioral components.
"For 12 years, I survived as a nurse and was good at it, but I never felt together or that I did enough," says Sarah Fellows, RN, APRN, CS, P/FNP. "It wasn't until I felt suicidal that I got a thorough, knowledgeable evaluation. It was really nice to get diagnosed with biochemical, atypical depression and learn that I wasn't crazy, that what I felt was completely normal for a physical reason."
She informed her supervisor and nursing director that month and never regretted telling other colleagues. "It helps to have objective folks monitoring my behavior and reassuring me my work is fine when I don't think I'm doing well," she says. "They know certain times, such as winter, are difficult, but in summer, I'm very productive."
She's been promoted in several areas of acute care and public health. Now, as child health program manager for the South Carolina Department of Health and Environmental Control, she oversees state-wide issues, policies, and training and provides some direct care.
Fellows informs clients only if she knows or suspects they're experiencing depression. "It helps them see that you can be productive and have control, that how you feel may be perception, not reality," she says. "They're not worthless, and it's not hopeless."
Colleagues feel safe talking to her about their mental health and treatments. "We all talk and joke about what we deal with daily, such as stress, ulcers, arthritis," she says. "I'd feel very differently if I met with negative reactions, but I never have, because of these individuals or because we do a lot of psychosocial care and are up on mental health." Nurses may need caution disclosing impairments, because colleagues may assume it's an excuse or not a legitimate problem.
"Taking care of yourself is part of being a good employee, good nurse, and good professional, as much as keeping up with continuing education," Fellows says. "[That includes] finding a setting where you can be healthy and productive. It's wonderful that nursing has so many places."
Wendy Bonifazi, RN, APR, CLS, is a senior staff writer for Gannett Healthcare Group. To comment, e-mail firstname.lastname@example.org.
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