By the end of my second year of recovery, it was time to try bigger adventures. I was convinced that with my experience (18 years), education (a master’s degree) and skill I could easily walk back into my former world and continue as if there had only been a slight detour. The massive CVA, I survived had left me with cognitive deficits, mobility problems, and some speech difficulties, yet I did not see myself as disabled.

Though I couldn’t run any longer down the halls of a hospital, and no longer have hands with lightening speed, I did gain a unique gift from my disability. The ability to be empathic and sensitive and ability to establish a rapport with families and patients to discuss what it means to have chronic illness. As a disabled individual, foolish or not, I have refused to view myself as having any limitations. In my mind’s eye, I am capable of great achievements. I see limitless potential and still have the same abilities to make positive contributions in the field of nursing and the lives of patients I touch.

The attempt to reenter the educational program for NP (nurse practitioner) was the first head on confrontation with discrimination against the disabled I encountered. What a rude awakening! The distance from the parking lots to the campus (here I had been a student prior to my stroke) were over 5 city blocks away, the clinical rotations required me to travel over an hour each way and to spend 8 hour days to obtain the necessary clinical hours for graduation. One class in particular had course completion requirements for a 2-hour oral presentation for final grades (can you imagine the difficulty this presents for some one with a form of aphasia from an acquired brain injury). The one-week experience for only one class had left me exhausted, frustrated and disillusioned. When contacting the university disabilities office concerning the requests for accommodations for parking, change in clinical hours and oral presentations exceptions, the disability specialist informed me this was denied. Exemption from oral presentations would cause an unfair advantage on my part compared to other students and parking slots closer to campus were reserved for faculty. Without the sensitivity and willingness to assist by making reasonable accommodations, it became an impossible situation for completion of a NP degree.

DISCRIMINATION AGAINST THE DISABLED

Discrimination is defined as “treatment to others based solely on their membership in a socially distinct group or category such as race, sex, religion, ethnicity, or disability”. As Americans, we have labored to influence society in accepting diversity as it relates to respect of the individual and their value to society. Because of this unmovable value, laws that make discrimination illegal at the federal and local levels have been enacted in this country. In the 1960’s the Civil Rights Movement brought to the forefront, the discrimination faced by African-Americans in our culture and birthed the anti-discrimination laws now in effect. Out of this movement, other issues related to inequality were brought to the nation’s attention including the Rehabilitation Act of the 1970’s protecting the rights of the disabled.

In 1990, the Americans with Disabilities Act (ADA) became law making it illegal in employment practices to discriminate against individuals with disabilities. Yet, today, disabled individuals earn less on average than people without disabilities do. The average annual income in 1992 of a disabled male was 61% of the nondisabled male. (Census Bureau statistics on disabilities)

As health care professionals, particularly nurses we are taught to be caring/ nurturing individuals in treating our patients. We are never to let the color of someone’s skin, ethnicity, country of origins, or religious beliefs or sexual orientations influence our approach in providing them health care. For some time now, the nation’s nursing schools and universities have taught cultural acceptance, require course work in diversity and training programs addressing such issues as sensitivity training.

Most of us in this country know and recognize discrimination, or do we? How about the not so blatant or obvious forms of discrimination? When the ADA was enacted, its intended beneficiaries were individuals with obvious disabilities of sight, hearing and mobility. Today however, the ADA defines a disability as a” physical or mental impairment that substantially limits one or more major life activities., a record of impairment or being regarded as having such an impairment.”(ADA 1990) The definition concerning disabilities has broadened over time as the awareness of other disabilities continued to emerge, including learning disabilities. How many of us make assumptions about people with disabilities, many of which we cannot see? We may assume that because an individual with a learning disability or a survivor of a catastrophic health event like a stroke can not work or succeed in a particular setting or even obtain an advanced educational degree in a particular career path. Discrimination and the significance of the statistics concerning disability are irrelevant in most people’s lives until being impacted on a personal level or by unexpectedly becoming part of the group of over 40 million people who are disabled.

Our ideas and perceptions of disabilities are formed by what we think we see, and what we think we know. The medical model encourages thinking of a disability as a condition that needs to be fixed. However, the challenge here lies in the ability to change these thinking patterns as they relate to disabilities and recognize them as diversities.

MAKING ACCOMMODATIONS

Despite ADA laws requiring universities and employers to be in compliance and to make reasonable accommodations, these concepts are not interpreted uniformly across the country. The intent of the law when written was to have employers and educational systems “make modifications or adjustments to the environment, program or job that would allow the disabled individual to have an opportunity to attain the same level of performance or engage in equal benefits and privileges that are available to persons who are not disabled”(ADA section 10). Such accommodations include redefining a job, modifying facilities for accessibility, providing special equipment or supports, assistive devices and allowing the use of working dogs on a campus or in a place of employment.

Deaf interpreters, tutors, photocopies of professor’s or other student’s notes, longer test taking times and frequent breaks in class may be requested by the disabled student as reasonable accommodations.

The disabled candidate for nursing school admission cannot be denied access or admission to a program or course of study based on a disability. The university must under the ADA law grant access for the student when the following four principles are evident (1) The program receives federal funds, (2) Candidates have reasonable chances for employment, (3) Auxiliary aids make the difference between successful program completion and failure, (4) Costs of accommodations are not an undue financial burden to the facility. (Strader )

There is an unintended down side of the ADA law. Educational systems (nursing schools) and employers are now designing laundry lists of essential functions or abilities that the student or potential employee must possess in order to gain admission to the educational system/profession or positions. The prospective disabled nursing student can not be denied admission for not meeting essential functions lists. However, once accepted the nursing student is expected to be able to complete the essential function skills. Essential function skills are often defined in terms of physical requirement such as manual dexterity, ability to lift fifty pounds and mobility. Incorporation of this kind of thinking as a plumb line to measure abilities and outcomes proves to be both myopic and undermining to the disabled individual’s chance in succeeding in a given profession. It serves to prevent achievements either through limitations or as their elimination as a potential candidate for that open slot. This is the exact opposite of what the intended laws is.

Nursing as a profession has the opportunity to define what the essences of nursing really is. Nursing is more than the ability to use both hands, ambulate or lift patients. Nursing is a diverse profession that allows technical standards and competencies for each area of expertise to be different.

The ADA was enacted to level the so-called playing field and allow disabled individuals an opportunity to rise to their fullest potential without hindrances. However, because of discrimination and prejudices many disabled individuals choose to hide or keep secret and not disclose their disability to educators and employers. Fearing discrimination, the resultant effects are limitations of legal rights and protections under the law for the disabled person.

As educators or hiring managers faced with assisting a disabled individual in attaining their goals, thoughts of “costs” involved in the selection process are natural. Bear in mind the ADA laws state “accessibility be improved and structural barriers be removed without taking on undue financial hardships for the business”(ADA Title II) Tax laws under the IRS (Section 44 and section109) allow for both tax credits and tax deduction for making structural improvements for accessibility. Additionally, the department of justice (who is the responsible for administering the ADA) has a provision in place for businesses to provide evidence that structural changes to the business can simply not be done. The business, however, must provide budgets and financial records as evidence of proof. . Remember, many accommodations for the disabled individual are not cost related, they are only thought related.

PERSISTENT BARRIERS

Subtle forms of discrimination continue to exist today despite laws. Just such discrimination can be and can be found in employer job postings in the healthcare arena and in our nursing schools. Recently, a major academic medical center was hiring for a registered nurse position in their case management department entitled “clinical guideline coordinator”. The web page posting read as follows: The potential candidate for this position must be licensed in the respective state, hold at least a BSN, with master’s degree preferred, 5+years of experience, be a consensus builder and have the ability to develop clinical pathways with members of the healthcare team. Just below the bold print was the phrase “must be able to walk long distances”. Knowingly or not, that medical center not only decreased their pool of qualified applicants, but also made it impossible for a nurse who was qualified to perform all the duties necessary for the position but used a cane to ambulate or was wheelchair bound to even apply.

The disabled individual faces a myriad of barriers everyday; and for many in this population performing or completing activities of daily living presents its own unique set of challenges before going into the world of education or seeking an occupation. What most people take for granted, for example, walking a few city blocks, or getting to a class across town, maybe an impossible feat for the nurse or student who is wheelchair bound or has other impairments in mobility or suffers from profound fatigue, the sequela from brain injuries and other medical conditions.

For the student who has suffered an acquired brain injury, and now has difficulty with multi tasking and comprehension, taking notes and participating in class simultaneously will ensure failure in our nursing programs in colleges and universities.

SOLUTIONS

Educators of today who can recognize the student’s potential can assist them in attaining their goals by building into the curriculum alternatives in presentation styles and delivery of classroom materials so the disabled student will not be excluded from an education. Posting class lectures on the web, taping the class and using Power Point presentations are examples of changes in delivery style that can benefit the disabled student. Information technology has enhanced education by introduction of distance learning via the Internet. This has bridged the gap for many disabled students who cannot succeed in traditional academic centers to obtain even advanced educational preparation, including myself.

Erecting societal barriers forces the disabled person to overcome physical, mental and social hurdles in jobs or education or simply be excluded. The educator along with the student can formulate creative ways for success. Sight impaired nurses can give injections by utilizing the same assistive devices that blind diabetics use. Since sight is not necessary for competency, just tactile senses for anatomical landmarks, the sight-impaired nurse can succeed through creative thinking formulated with preceptors. Stethoscopes with amplification are available for the deaf nurse. Nursing educators shut doors for the disabled student when they start viewing a disability as a medical condition that is a deficit, undesirable or in need of fixing. The educator is then denied an exciting opportunity to see a new world of completing tasks in a different manner when he or she does not have experiences with disabled students.

Disabled individuals need nursing educators of today and employers to work with them to provide support and assistance and the disabled individual will bring the drive, determination and the persistence necessary to complete the equation for success.

For the nation’s nursing educators and nurses in decision-making positions, I lay before you a challenge. Look at your next candidate for that open slot in your department or nursing school as if he or she were disabled. Now think what accommodations or modifications can I make to help that individual succeed here? Before you answer, remember a quote that comes from Donna Maheady, founder of Exceptional Nurses (a web site for disabled nurses www.exceptionalnurses.com) and Adjunct Professor of Nursing at Florida Atlantic University,” We are all only seconds away from a disability.” Now make your decision.