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Authors

  1. Ferguson, Donna Smouse RN, MSN
  2. Evans, Vivian S. RN, MSN, MBA
  3. Hajduk, Donna Bodnar RN, MSN
  4. Jones, Diane L. RN, MSN
  5. Liston, Donna RN, MSN
  6. Myers, Elizabeth RN-C, MSN
  7. Myers, Terri RN, CSN, MSN
  8. Sutara, Amy RN, CSN, MSN
  9. Zuraikat, Nashat RN, PhD

Article Content

Innovative ideas are needed to address the nursing shortage crisis. With a projected shortage of 304,000 RNs by the year 2020, delivery of safe, quality nursing care is a serious challenge.1 Due to the physical nature of the direct patient-care position, nurses have an increased likelihood of experiencing a physical disability or working with peers who have sustained debilitating injuries. If these disabled nurses prematurely leave the nursing profession, their experience and expertise are lost forever. The question shouldn't be if disabled nurses have a place in the profession but, rather, when are we going to accept them? A potentially large number of nurses considered disabled exists that could provide answers to the nursing shortage. There's no evidence available documenting that disabled nurses endanger patient safety. And a physical challenge doesn't lessen a nurse's expertise. Employing experienced nurses with disabilities can mitigate the effects of the nursing shortage on communities, healthcare organizations, and the profession of nursing, resulting in more efficient use of resources. Financial expenses that occur from overtime pay and the higher salaries of temporary staff may also be reduced.

 

Awareness through education

Nurse leaders may unknowingly uphold the historical viewpoint that prohibits nurses with disabilities from joining the workforce of today. Estimates aren't available as to the type of disability, employment status, or barriers to employment. Additionally, success stories that describe evidence-based solutions to help disabled nurses remain employed or return to the workforce are lacking. However, according to one study, disabled nurses have a unique understanding of their patients, are more empathetic, and possess a better understanding of the patient's physical, emotional, and spiritual needs.1 Nurses without obvious impairments may not identify themselves as being disabled for fear of adverse treatment. Positive environments encourage nurses to disclose their disabilities, potentially reducing the risk of injury to staff, patients, or themselves. Furthermore, organizations that promote an atmosphere that's physically and socially conducive encourage disabled nurses to function in the healthcare arena. When organizations provide systemwide training to increase awareness and sensitivity toward workers with disabilities, trust and confidence stimulate the employees' strengths rather than their weaknesses, resulting in a cultural transformation.

 

A systematic process is needed to address biases, fears, misperceptions, stereotyping, and resentment by employees and employers. Education can help disabled nurses identify needs and collaborate with employers to creatively develop reasonable accommodations that are congruent with financial resources and legal requirements. For example, analyzing work sites and design plans to make the necessary physical modifications and procure adaptive equipment to provide disabled nurses with employment opportunities. Accommodations for impairments in motor skills, mental health, cognition, and sensory systems are available, as well as counseling assistance to help employers determine effective accommodations that comply with Title I of the Americans with Disabilities Act.2

 

Information about sensitivity and awareness training can be obtained through several Web sites, such as the State Vocational Rehabilitation agencies (http://www.ed.gov/rschstat/research/pubs/vrpractices/busdev.html) and the Disability and Business Technical Assistance Center (http://www.adata.org). Funded by the U.S. Department of Labor's Office of Disability Employment Policy, the Employer Assistance and Recruiting Network (http://www.earnworks.com) provides free information and counseling on recruitment, hiring and placement, and workplace assimilation. Additionally, the Office of Disability Employment Policy sponsors the Job Accommodation Network (http://www.jan.wvu.edu/media/nurses.html), which provides employers with information dedicated to nurses with disabilities.

 

Financial feasibility

Although many employers believe the expenses related to employing a disabled nurse are too great, financial assistance through incentives and federal tax credits may offset expenditures. The assistance may reduce expenses associated with recruiting, hiring, and removing workplace barriers for nurses with disabilities. Federal tax incentives include:

 

* a $15,000/year deduction to improve accessibility by equipping items such as company vans with wheelchair accessibility or hand controls through the Architectural/Transportation Tax deduction (IR Code Section 190, Barrier Removal)

 

* up to a $5,000 credit for businesses with less than 30 employees or an annual income of less than $1,000,000 to provide assistive aides such as amplified stethoscopes through the Small Business Tax Credit (IR Code Section 44, Disabled Access Credit)

 

* up to $2,400 per employee who's hired through the Work Opportunity Credit.3

 

 

In addition, several states offer tax incentives, which can be accessed through the Department of Labor. Organizations should contact their tax advisor for specific guidelines and restrictions.

 

An attitude of flexibility

Appropriate accommodations are as varied as the disabilities experienced by nurses. Healthcare organizations should explore implementing accommodations and utilizing the assets that disabled nurses possess. Disabilities can range from limitations caused by hypertension or diabetes to injuries or illnesses affecting mobility or strength. Reasonable accommodations may include modifying job duties, allowing work time while seated, or providing modified equipment. Additional suggestions include purchasing an amplified telephone for the nurses' station, allowing shorter shifts or flextime hours, and allowing case management nurses and telephone triage nurses to work from home. Job descriptions should be revised to allow for flexibility of essential functions, such as the ability to lift a certain amount of weight or physically perform cardiopulmonary resuscitation. A nurse's role extends well beyond the physical demands of the job. There are numerous employment opportunities that need critical thinking and problem-solving skills, such as nurse recruiters, quality assurance, staff development, ostomy nurses, diabetes teachers, case managers, infection control nurses, legal consultants, or in the relatively new field of nursing informatics.

 

Promoting a positive work environment

Managers must examine their own views regarding disabled nurses and train staff to promote a positive work environment. Furthermore, nurse managers and leaders need to foster supportive and empathetic coworker relationships, reducing resentful feelings and promoting acceptance. Healthcare organizations should promote a harassment-free work environment for all employees and manage issues that may lead to resentment among staff. Employers should incorporate nurses with disabilities into recruitment and retention plans. Strategic, innovative planning by an employer will promote safe and competent delivery of nursing care by maintaining an adequate staff comprised of experienced RNs.

 

A healthcare delivery model to promote diversity awareness and sensitivity training for employees can be used and incorporated into the organization's strategic plan. Strategic plan components may include staff training and development, selection and procurement of appropriate adaptive equipment, environmental modifications, job retraining or restructuring, and coaching and counseling to address interpersonal relationship issues. Forming committees to evaluate the effectiveness of the program will help the organization stay abreast of new information and evidence-based findings in order to ensure equal opportunities for employment of disabled nurses.

 

A proactive approach

By implementing appropriate accommodations and offering alternatives to nurses with disabilities, organizations provide employment opportunities while recruiting and retaining experienced nursing staff. Healthcare organizations and their nursing leaders need to be proactive and involved in developing programs that increase the number of employed nurses with disabilities, thus helping to alleviate the nursing shortage. Many options are available for nurses with disabilities to utilize their knowledge and experience to remain successful and productive members of the nursing profession. Although a nurse may be considered physically disabled, her knowledge and skills aren't.

 

REFERENCES

 

1. Wolf GA, Greenhouse PK. Blueprint for design: creating models that direct change. J Nurs Adm. 2007;37(9):381-387. [Context Link]

 

2. The Job Accommodation Network. Accommodation and compliance series: nurses with disabilities. http://www.jan.wvu.edu/media/nurses.html. [Context Link]

 

3. The Employer Assistance & Recruiting Network. EARN's guide to tax incentives for hiring people with disabilities. http://www.earnworks.com/docs/FactSheets/Employer/FS-ER-TaxIncentives.pdf. [Context Link]