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A storm stirred outside the hilltop home of Connie Churchill,
RN. Evergreens swayed in gusty winds, shedding mossy
branches on jade ground. Rain breezed across the Oregon
hillsides framed in wide windows lining her living room
wall.
But she couldn't see the details. Churchill is blind
in the left eye and has no peripheral or bottom vision
in the right.
Churchill lost her vision two years ago in a "series
of medical errors" at the Seattle hospital where
she worked. She wouldn't elaborate because of pending
litigation, but she was clear: The impairment doesn't
dictate her life. "I still wanted the view,"
she said of the house. And she still wanted her nursing
career, although it wouldn't be easy.
"For the first four months, I shut myself up in
my house," she said. She gave her scrubs and stethoscope
to a friend who "kept it all, because she knew."
The friend knew Churchill would work again. Churchill's
former employer said it couldn't accommodate her. She
tried telephone consulting, but that didn't suit her.
Then a colleague offered her a part-time medical/surgical
position at the VA Roseburg Healthcare System, where
she had worked previously.
"I needed someone to give me a chance to prove
that I could still do it," she said.
Workplace hurdles
Her story mirrors others. Beyond physical challenges,
nurses with disabilities face legal, social and mental
hurdles in the workplace. But persistence and drive
can inspire success.
Almost 20 percent of the U.S. population-close to 50
million people-have a disability. The 1990 Americans
with Disabilities Act requires employers to make "reasonable
accommodations" for employees with disabilities.
But in January, the U.S. Supreme Court narrowed the
definition.
Workers must prove that their disabilities limit major
life activities, as well as job tasks. The related questions
are tricky: What are the employee's limitations? What
are the essential job functions? Can the employee move
to another position? Is the employee qualified? What
accommodations are reasonable?
Each case is different.
If employees fit the legal definition of a disability,
employers must try to accommodate them in their positions,
said Chuck Davis, associate director for training and
technical assistance for Northwest ADA/IT Center. If
employers cannot accommodate, they can consider vacant
positions for which the employees qualify. They are
not required to create new positions.
"This is an issue of great concern to many,"
said E. Carol Polifroni, Ed.D., RN, an associate professor
at the University of Connecticut School of Nursing.
"I experience it on the end of students as well.
The law says that we must accommodate individuals with
disabilities if they are able to fulfill the responsibilities
of a position. So, if I have a back injury and the position
I am applying for requires me to move individuals, carry
heavy objects, etc., then there is no obligation for
the potential employer to hire me.
"However, if heavy lifting, or any other such
activity causing potential aggravation to a back disability
is not required or so stated, then they need to work
with me in terms of providing what is necessary for
me to do the job."
On-the-job injury-a particular concern for nurses who
do lifting-is another matter.
"The ADA issue most of the time does not come
into play when it's a work injury," said Glenda
Evans-Shaw, RN, a nurse case manager in Northern California
for Strategic Health Alliances. It's usually a workers
compensation >> issue. In her state, "employers
are really under the gun to accommodate injured workers."
But that varies from state to state.
Often, it's "cheaper to settle the case than it
is to accommodate," said Larry Kontosh, Ph.D.,
a rehab counseling specialist in the department of counselor
education at Florida Atlantic University. Some states
require accommodation under workers compensation; others
don't. There's no simple formula.
"The issues for nurses aren't any different than
they are for anybody else with a disability in a job
situation," Davis said. But nursing does raise
particular concerns because the work directly affects
other lives. If a nurse presents a direct threat to
another person, that nurse is not considered qualified
for the job, Davis said.
Such complexities make for confusion-and sometimes
discrimination:
The hearing-impaired nurse whose employer bought her
an expensive amplified stethoscope-then said she must
stay a year or reimburse the company.
n The nurse who was instructed to tell patients she
"talked funny" because she was deaf.
n The student with a back injury who was told, "People
like you shouldn't bother taking slots from people like
us who don't have disabilities."
But hopeful stories abound as well. Take Christine
O'Dell, a deaf nursing student at Research College of
Nursing/ Rockhurst University, who uses interpreters,
digital hearing aids and an amplified stethoscope.
"But I don't see deafness as a disability,"
she said. "It brings with it so many opportunities
and abilities." If challenges stymied her, "I
would never cross the street, go to a restaurant, learn
to drive." She is determined to succeed. "That
is my approach to getting a job as well."
Dedication is key. "I wanted to be a nurse since
the age of 4, and people said, 'You can't, you're deaf,
you can't, you're deaf," said Morag MacDonald,
MSW, RN, an outpatient psych nurse in Connecticut. "You've
got to have the guts to challenge those subtle discriminations."
Disclosure issues
Negative attitudes can deter employees from revealing
their disabilities. "I believe there is no need
to disclose a disability if the issue is corrected,"
Polifroni said. "But if there is a need for special
equipment, modification of the environment ... then
there is a moral and legal imperative to disclose."
Telling patients is another matter. "A patient
operates on the premise that those caring for him or
her have the appropriate skill and ability," she
said. "As long as the disability does not impair
practice, there is no need to disclose."
Furthermore, Jane Archer, RN, who works in a Minneapolis
urgent care clinic, said informing all patients of her
hearing impairment "would feel contrived and artificial"
because it's not an issue unless she's triaging in a
noisy room.
"It would make as much sense to tell every one
that I am severely nearsighted and wear contacts,"
Archer said. "I don't see much difference, as long
as the disability is corrected and I am able to function
within the expectations of my job. It is my responsibility
to recognize when I am having difficulty with a task
as a result of my hearing."
Patient safety must not be compromised, said Donna
Maheady, Ed.D., NP, RN, founder of the Web site exceptionalnurse.com.
In 1999, Maheady published a report in the Journal of
Nursing Education titled "Jumping Through Hoops,
Walking on Egg Shells: The Experiences of Nursing Students
With Disabilities."
It describes hearing-impaired students missing patients'
calls for help, a student who almost fell because of
a gait disturbance, a diabetic student who was dizzy
and confused and students who graduated despite disabilities
that kept them from meeting admission standards and
graduation guidelines.
Davis agreed that nurses are obligated to disclose
disabilities that affect patient safety. Nurses should
learn their rights under the ADA and approach employers
with "a game plan" of ideas. Legally, employers
must discuss accommodations with them.
"It was a real challenge getting a master's and
being hard of hearing," said Patricia Carlson,
MS, RN, at Northwestern Memorial Hospital in Chicago.
"At the time, I had no idea that I could have asked
for note takers or an assistive listening device."
Sometimes, though, nurses take different positions.
"I knew I could never make it in a hospital setting
with intercoms, call bells, lots of telephone work,
so I looked at home health," said Dana Yelverton,
MPH, RN, whose hearing diminished for unknown reasons
10 years ago. "I was very upfront about my hearing
and told them I was not sure I could do the work but
would like to try," she said.
Preventing workplace injuries helps, too. The University
of Washington Medical Center in Seattle started a lift
team about 2½ years ago. When heavy lifting is
required, the staff calls in a trained two-person team
with specialized equipment. "It's really been wonderful,"
said Judy Shorr, MS, RN, manager of nurse recruitment.
It's worked so well, the team is expanding its hours.
Barriers and benefits
The biggest challenge, though, is social many agree.
Despite wonderful examples of sensitive patients and
co-workers, barriers remain.
"I really can't be part of the social scene,"
Yelverton said. "They jabber in groups and I don't
understand. They lower their voices for the punch line
or for the off-color joke and I don't hear. I'm really
on the fringes ... It's a big investment to get to know
a hard-of-hearing person well enough to be real friends."
Misinformed attitudes also linger, said Elizabeth Clubb
Cohen, RN, who works in the telemetry unit at Cleveland
Regional Medical Center in North Carolina. "My
hearing disability has not affected my ability to be
a conscientious, professional nurse."
In that respect, Churchill returned to work with an
advantage. "They knew me before and they knew I
would never put a patient at risk." Most often,
she said, a person with a disability asking for work
can do the job. "No one inherently wants to set
themselves up to fail. They know their limitations."
They also know their strengths. "I pay closer
attention to changes in patient condition, have the
ability to lip-read ventilator and tracheostomy patients,
and older patients who are hard of hearing are more
comfortable talking with someone who has a hearing impairment
as well as those who were born with one," Cohen
said.
Joseph Smith, MA, a hearing-impaired respiratory therapist
in Nebraska, agrees. "Many patients see the ability
to cope as a strong point and some patients are encouraged
by the fact that there are others with 'problems.' "
Churchill is learning to turn her impairment into a
strength. She better understands her patients' pain.
She's been on their side.
"It's made me a different nurse as far as being
able to relate to my patients," she said.
Contact Karen Coates at redcoates@hotmail.com
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