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Work Experiences of RNs with Physical Disabilities
Registered nurses who consider themselves physically disabled are a population that has been understudied. The literature is replete with research and information regarding nursing students with disabilities (Arndt, 2004; Carroll, 2004; Kolanko, 2003; Maheady, 2004, 2005; Marks, 2000; Nelson, 2005; Ney, 2004). Although these articles support the case that nurses with disabilities should be active participants in the workplace, no research regarding the work experiences of these nurses has been published. This article describes a qualitative study (Neal-Boylan & Guillett, 2008) that explored the work experiences of registered nurses (RNs) with physical disabilities and sought to understand the perspectives of both RNs with disabilities and RNs who interview other nurses for hire (hereafter referred to as nurse recruiters).
The United States is currently experiencing a nursing shortage. The demand for RNs is predicted to increase by 40% during the next 20 years as the number of people over the age of 65 increases and improvements in technology create an increased demand for acute-care services (Buerhaus, Staiger, & Auerbach, 2003). Unfortunately, the supply of nurses is not likely to increase proportionately. In fact, there is concern that the current supply of nurses will decrease because the average nurse is middle-aged, and many nurses will be eligible to retire soon (Sochalski, 2002). Buerhaus and colleagues note that although retaining older RNs is desirable because of their “wealth of clinical expertise, nursing knowledge, interpersonal skills and judgment,” the older RNs’ “ability to keep up with the physical demands of nursing is questionable” (p. 198). This situation raises the question of which abilities in nursing are most important. Only a handful of studies related to nurses with disabilities could be found in the literature, and most of those studies focus on the experiences of nursing students (Carroll, 2004; Kolanko, 2003; Maheady, 2004, 2005; Marks, 2000; Nelson, 2005) rather than those of RNs in practice. The few studies of RNs that could be found may no longer reflect the current environment, attitudes, and experiences of nurses with disabilities because they predate the passage of the Americans with Disabilities Act (Pohl & Winland-Brown, 1992).
No studies document the number of nurses with disabilities, but one in five Americans has some sort of disability, so it is likely that the number of nurses with disabilities is significant (Maheady, 2004). The literature also offers some evidence that nurses with disabilities contribute to the profession and that disability ought to be seen as one element of a diversified workforce that is currently underrepresented (Carroll, 2004).
The researchers sought to answer the following questions:
Methodology and Sample
A qualitative methodology was used. Two coinvestigators conducted the study. One investigator was located in the Washington, DC, area, and the other investigator was in Maine. Approval was obtained from the institutional review boards of Marymount University in Arlington, VA, and the University of Southern Maine in Portland, ME. Using the snowball sampling technique, a process whereby potential participants are recommended by other participants, RNs from Virginia, Maryland, and Maine were recruited to participate and were interviewed for the study. RNs were solicited through word of mouth and announcements in two trade publications in the New England and Washington, DC, metropolitan areas. Potential participants were contacted by telephone and asked if they met the criteria for the study. Participants provided verbal and written informed consent to participate. As data collection continued, participants who could add variation to the sample were sought.
Participants for two samples were recruited. The criteria for participating in the first sample were that the nurses were RNs and considered themselves to be physically disabled. Nurses who were working or had recently worked in a variety of roles constituted the sample. Many of the nurses had left their positions because of their disabilities and either had acquired new positions or were no longer working in nursing.
The second sample consisted of nurses who interviewed other nurses for potential employment. The nurse recruiters were not asked whether they had disabilities. Their job titles were administrative director of critical care, charge nurse, clinical supervisor, director of nursing, director of nursing services, director of school of nursing, nursing director, owner of women’s health clinic, program manager, and RN supervisor. The nurse recruiters worked in a number of settings: addiction counseling, cardiology, case management, critical care, education, emergency department, gerontology, intensive care unit, long-term care, medical and surgical nursing, private duty home care (intermittent home health), psychiatry, and women’s health.
Audiotaped interviews took place in person at a site convenient for the participant and occasionally by telephone. Telephone interviews were also audiotaped using technology designed for that purpose. An unstructured interview guide was used for each sample group (Figure 1). The questions on the interview guides were designed to elicit discussion from the participants about their experiences as disabled nurses and from nurse recruiters about their encounters with nurses with disabilities. Data were collected until data saturation was achieved, that is, until the themes became repetitive and no new information was gleaned from the interviews.
Nurses had a wide variety of conditions that they considered physically disabling. Some were already disabled when they were hired, and others had sustained their disability while on the job. Twenty nurses with disabilities and 14 nurse recruiters were included in the final samples. Three interview transcripts were unusable and were not included in the final samples.
The sample of RNs with disabilities included 18 females and two males. Nineteen participants were Caucasian. The ages ranged from 28 to 75 years. Terminal degrees were distributed fairly evenly among the categories of those with high school diplomas, associate degrees, bachelor’s degrees, master’s degrees, and doctoral degrees. The disabilities represented were arthritis, back pain, chronic pain, Crohn’s disease, diabetes mellitus, epilepsy, fibromyalgia, fused foot, fused wrist, hearing impairment, herniated disk, joint pain, latex allergy, memory impairment, multiple sclerosis, muscular dystrophy, post polio syndrome, psoriatic arthritis, rheumatoid arthritis, spinal cord injury, status post brain tumor, and stroke, and the areas of nursing expertise varied widely: critical care, day surgery, education, gerontology, home care, intensive care unit, maternal child health, medical-surgical nursing, mental health, office nursing, oncology, orthopedics, pediatric nurse practitioner, prison nursing, psychiatry, public health, rehabilitation, skilled nursing facility staff nurse, traveling nurse, and women’s health.
The sample of nurse recruiters consisted of 12 females and two males. Thirteen were Caucasian. Ages ranged from 43 to 63 years. Terminal degrees were also fairly evenly distributed among the categories mentioned in the discussion of the first sample. Job titles and work settings were varied (see the discussion in the section “Methodology and Sample”).
Audiotapes were transcribed verbatim and were analyzed by isolating words or phrases that described some aspect of the experience, grouping similar expressions and labeling them, eliminating irrelevant themes, clustering similar themes, and identifying core elements. Core elements were then cross-checked against the transcripts to search for discrepancies and compared with themes in the literature (Munhall & Oiler Boyd, 1999). The co- investigators analyzed the data independently.
It is most helpful to describe the findings contextually and to discuss the elements and data from the nurse recruiters and the nurses with disabilities together. To understand the work experiences of nurses with disabilities, the researchers sought to balance their perspective with the views of nurse recruiters. However, it should be clear that the purpose of the study was to explore the experiences of nurses with disabilities, not those of nurse recruiters. Therefore, a discussion of the findings focuses more on the nurses with disabilities. The core elements will be addressed with regard to the research questions to present an organized flow for the reader.
1. How does the work of an RN change after he or she becomes disabled?
Some RNs reported becoming more empathetic toward patients and actually thinking of themselves as better nurses following the experience of disability. Other changes included a decrease in stamina and increased fatigue and pain. Having disabilities caused RNs to become more creative about how to practice nursing. Many sought further education. Others did not know what to do and longed for guidance regarding how to continue to practice nursing while disabled. Many nurses left their jobs because they felt that they were no longer able to care for their patients safely.
Nurses with disabilities found that they needed accommodations to be able to do their jobs, such as easier patient assignments, reduced workload, and part-time scheduling that avoided night-shift work. Disabled nurses did all they could to compensate for their limitations and to continue to meet their own and others’ expectations of their jobs. The following quotations offer perceptions of how the nurses’ work changed after they became disabled.
More Empathy for Others
“I think it makes me a better practitioner that I have had these problems. It can really strengthen the patient-nurse relationship.”
Reduced Stamina, Fatigue, and Pain
“I figured out that I couldn’t work full time and particularly not at a job where I was having a lot of commuting. [Changing my work schedule] made it so I could get through a day and be able to do anything other than work.”
“It’s actually been a blessing in disguise for me. At the time I hurt my back, I just had a diploma in nursing. I quickly realized that, with the back injury, I was always going to have staff nursing on the floor, and I wanted to do more than that. So I started back to school and got my bachelor’s in nursing.”
“I went over to [a different unit], having never done psych. I helped open the outpatient unit, and then I brought biofeedback to the hospital, which helped them earn Magnet status. Then I got my master’s and [had] an opportunity to do research.”
Addressing Patient Safety
This comment was made by a nurse with hearing loss:
“I was on duty one night alone, and the signal light was on, and I did not hear it. I went [into a room], and I found the lady [who] had her signal light on. When I got there, she was in distress. That was such a traumatic thing for me. I just haven’t been able to go back [to work]. I just [am] so afraid this is going to repeat itself.”
Another nurse with loss of feeling in her hands said,
“I don’t believe I could start an IV now because of the feeling [loss]. Why would they hire me? I don’t think I’d be safe. I just think you have to put the patient first.”
Compensating for Limitations
“I found I really had to rearrange things in order to be able to function well and not find myself getting sick all the time.”
“I’ve always gone above and beyond, making up for what might be considered my failing.”
2. Does the RN’s perception of nursing change after he or she becomes disabled?
It is interesting to note that nurses did not change the way they perceived nursing because of their disabilities.
3. What are the barriers to the profession for RNs with disabilities?
Many themes emerged concerning barriers to the profession for nurses with physical disabilities: peer responses, organizational responses, the physical work environment, the stigma of disability, the phenomenon of the hidden disability, the lack of awareness and knowledge about how to do something for the nurse with a disability, and the nature of the work itself. Another important theme was the idea of nursing heroics or the image nurses have of themselves.
“Nobody seemed to care. The patients responded better to [me] than the nurses that [I was] working with. The nurses in my unit thought I was getting out of trying to do something.”
“That was a big downfall right there. It was like [I was] just trying to get out of floating. I [said] “No, I am not trying to get out of floating. If I could do it, I would gladly do it. But if I do, I will be calling in [sick for] the next 2 days and then taking extra pain medication.”
A nurse recruiter said,
“There is no way to promise a nurse what her workload will be on any given day.”
Physical Work Environment
“I said, ‘Why don’t you put me in cardiac care? I can sit in front of the monitors, and I can read the monitors.’ [The other nurses] just couldn’t go there. They really didn’t want me back until I could actually spend a day on my feet walking around the unit.”
One nurse recruiter said,
“They must be able to do the same things at the same speed in order to get the work accomplished.”
Stigma of Disability
“I think people [who] have disabilities [that are not] visible have a much harder time [receiving] understanding from their peers than [if] we have visible [ones].”
“I was afraid that they would decide that I was not a useful member of the team if I admitted to having any frailty. So it was really more something that I didn’t talk about because I didn’t want it to be a whole mess.”
“I hid it. There [are] times when some of us just hid it so that people didn’t know.”
Despite the fact that in some cases nurse recruiters had been interviewing nurses for many years, they rarely knew whether the nurses they were interviewing were disabled. They expressed the view that nurses should be honest and open about their physical limitations.
“It’s kind of interesting because most people come in for interviews, and [I] don’t really see whether they have a disability or not. We are not allowed to ask about disabilities, and unless the person you’re speaking with mentions it to you, there really isn’t a way [to tell] unless it’s obvious that they have a physical problem.”
Lack of Awareness and Knowledge
“There just needs to be more education, more awareness, and a focus on abilities.”
Nature of the Work
“I’m angry. The reason [is that] there is no need for this [reaction]. On their initial reviews, [the recruiters] felt as if I was an excellent employee. It appears to me that they are not willing to make accommodations, and they feel as if I’m not going to be productive for 12 hours. My job consists primarily of solving problems. I can still solve problems. [I] still have [my] mind.”
“I had to pass CPR in order to be on staff and be on the floor, and I couldn’t—I wasn’t strong enough to do it.”
“It was sort of a general work ethic of the organization that if you were asked to do more, you did more. I think there’s definitely some heroism involved in the whole nursing concept that we’re supposed to [do more]. It’s the irony of you telling your patients to do all these good things to take care of themselves, but you expect that you don’t have to worry. [Nurses think] that it doesn’t apply to [them] as far as taking time for [themselves] and not overcommitting and not allowing [the] job to overtax [them]. I’ve seen that a lot with nursing that we’re expected to go above and beyond because it’s a heroic kind of job.”
“I wouldn’t complain. I wouldn’t say anything to anybody, and I felt that [I] would be shooting myself in the head if I let on that I had some issues.”
Nurse recruiters said that they try to make accommodations for nurses with disabilities but that these accommodations often seem unfair to others and are viewed as unfair by staff.
“As much as their fellow nurses love them and are compassionate, they still resent the fact that they are not pulling their weight, and I don’t know how to get around that.”
Patient safety was a major concern for the nurse recruiters.
“You have to be able to lift. You have to be able to move the bed fairly rapidly. You have to have good eyesight to give out medications. There are impairments that would [jeopardize] the safety of the patients.”
The predominant theme in response to this question is the need for a supportive person or colleague. Another theme that emerged was the creativity of the individuals as they attempt to compensate for their limitations (as discussed previously). Nurse recruiters said that in view of the nursing shortage, something must be done to retain nurses with disabilities. According to one nurse with a disability,
“I have been fortunate. I’ve had a lot of supportive people [and] a lot of mentors who have been there at the right time to say ‘This is not the end of the world.’ ”
A common suggestion for modification was education that promotes awareness with regard to nurses with physical disabilities. Awareness is needed to show that these nurses exist and want to work as nurses although they may have hidden disabilities or choose to hide their disabilities so that others won’t stigmatize them. One nurse with a disability said,
“Making organizations aware—that would probably be the best thing. Let organizations know that you can have a physical disability and that your job would be completely unaffected. But [mention] how much better you could do at work if you had the tools at your job.”
Education is needed concerning what nurses can do and how accommodations can assist them to keep their jobs and use their experience and expertise to the benefit of their patients. In addition, as nursing students are educated about diversity and caring for patients from diverse cultures, students also need education regarding the needs of nurses with disabilities, because they are also a diverse population.
The need for organizational flexibility was another predominant response to this question. Nurses with physical disabilities need flexibility in scheduling and understanding from colleagues and administrators that, for example, someone experiencing fatigue related to chronic illness cannot work night shifts but can be well utilized during the day. Part-time scheduling, such as 2- or 4-hour shifts, job sharing, and opportunities to sit when it is still possible to handle job tasks, can help keep a nurse on the job. Many job descriptions include heavy lifting, but this task might not be necessary in a particular work environment. One nurse described another nurse she knew who had only one hand: “She went to get the job, and they actually threw an IV bag at her to see if she could catch it.”
It is interesting that during the course of the unstructured interviews, nurses remarked that they had never had an experience related to their disability that caused a patient or staff member harm or injury. Nurse recruiters could not recall any injuries that were caused by a nurse’s disability.
Reconfiguring (physical modification) of the work environment was also highlighted. Modifications could include increasing the space between patient beds, reducing the length of long hallways, or placing workstations with seating halfway down a long hall.
Finally, the suggestion was made that a national resource center be made available to nurses who have or acquire a disability. Nurses could contact the resource center and provide information about their educational backgrounds, work experience, expertise, and geographical locations and get assistance to find work that they can perform within the limits of their disabilities. RNs interviewed recognized that it is unreasonable to expect to be able to perform in all settings because patient safety is paramount and might be jeopardized by employing nurses who cannot perform in certain ways. However, nurses also expressed a love for nursing and spoke of grieving the loss of the ability to practice nursing because of their disabilities. A national resource center could use these nurses and thus prevent further drain of nurses.
One nurse said,
“I can see how valuable an occupational health nurse is in identifying what disabilities are, how they can be worked around, and helping people identify what their strong abilities are and then finding a niche for that ability within the organization. It might not be floor nursing. It could be a totally different direction within the organization but [still] keep that person [as] a viable member of the organization because they bring with them the skills and the knowledge. A [workplace] community is very important to people, and I think it helps send the message to everyone that we take care of our own, and we’re not going to let you go unless you really want to leave us. We care about you.”
A significant limitation of the study was that the sample was not sufficiently diverse in ethnicity and gender. Each sample had only two people who were not Caucasian and only two males.
The findings from qualitative studies cannot be generalized; however, the variation in the samples with regard to age, nursing experience, geographical location, and educational background help to demonstrate that, despite the variability, nurses shared the same perceptions and experiences of being disabled. It is interesting to note that the researchers received calls from nurses from all over the country requesting to participate after word of the study reached them. Only nurses from the Washington, DC, area and Maine were included.
Conclusions and Implications
Clearly, RNs with physical disabilities are a population that needs further study. In light of the nursing shortage, it is imperative that we retain these nurses. To retain them, the nursing field needs to acknowledge the nurses’ value based on their education, experience, and expertise and make the commitment to help nurses with disabilities retain or find jobs that they can do despite their limitations. A national resource to help nurses with disabilities is imperative.
An atmosphere of recognition, acceptance, and support of colleagues who are disabled can help retain nurses that the profession cannot afford to lose because of outdated expectations of a nurse’s role or the idea that nurses are heroes and must work at a level above and beyond that of other human beings. It is important to review job descriptions to see if they are archaic and require abilities that might not actually be necessary or could be modified. We should be role models for each other. As one nurse said, “We are nurses; we represent good health.” Nurses with disabilities should not have to feel compelled to hide their disabilities from employers in order to work, and nurse recruiters should be able to offer suggestions for work that these nurses could do. The nursing profession is losing nurses with skills, experience, and expertise. Workplaces must find ways to accommodate them or help them find other jobs better suited to them.
Education in the workplace is vital to creating an atmosphere of acceptance of people with disabilities. Rehabilitation nurses are in the ideal position to educate others and to be role models with positive attitudes toward nurses with disabilities. Rehabilitation nurses might set the standard for how nurses treat each other in the work environment. They can lead the way to change, according to one participant, by designing and posting a “bill of rights” for people with disabilities. In addition, in-service education led by rehabilitation nurses should lend the curriculum credibility. Rehabilitation nurses could sponsor proposals to add seating halfway down long hallways or to increase spaces between beds as well as to make other accommodations to the physical environment. Support from the administration is integral to proposing and making these changes. Rehabilitation nurses have the credibility required to convince administrators and managers that an investment of time and money is worthwhile to retain quality nurses in the profession.
Further research is necessary to explore the employment experiences of nurses with disabilities across the country. A research study to review nursing job descriptions is another avenue to explore that might change the paradigm of nurse hiring.
About the Authors
Leslie Neal-Boylan, PhD RN CRRN FNP-C, is an associate professor of nursing at Yale University, New Haven, CT. Address correspondence to her at firstname.lastname@example.org.
Sharron E. Guillett, PhD RN, is associate professor of nursing at Marymount University in Arlington, VA. Address any correspondence to her at email@example.com.
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