By: Sarah Small, Consultant – Cognitive/Neurological Team
As I was driving on the interstate this past week, I couldn’t help but notice that most of the trees had lost their leaves. The beautiful reds, yellows, and oranges have slowly become bare branches. This, along with the slowly declining temperatures means one thing…winter is coming. Winter has its own excitement with the holidays and many traditions; however, at times it tends to bring with it feelings of dread. Winter means snow, ice, and for those of us in daylight savings time, shorter days. It’s easy to feel not ready and sad as the warm days leave us. But for some people, these feelings can be more intense than others.
Seasonal Affective Disorder (SAD) is a form of depression that comes and goes with the change in seasons. SAD is most common in the winter months starting in the beginning of fall and peaking in December, January, and February (Mental Health America).
Common symptoms include:
- Irritability and stress intolerance
- Decreased energy
- Changes in weight
- Difficulty concentrating
- Changes in appetite
- Decreased interest in daily activities, sex, and social interactions
- Feelings of hopelessness or worthlessness
While the cause of SAD is unknown, it is believed that the reduced level of sunlight during the winter months disrupts the body’s internal clock (circadian rhythm), as well as the body’s levels of serotonin and melatonin (Mayo Clinic). This can impact sleep patterns as well as mood.
According to the Mayo Clinic, there are certain factors that increase an individual’s risk for SAD. These risk factors include:
- Being female
- Age – onset typically between the ages of 18 and 30
- Family history of SAD
- Having depression or bipolar disorder
- Living far north or south of the equator- it is said to be rare in those who live within 30 degrees of the equator
Treatment for SAD can include prescription medications that fall within the same family of drugs that help treat depression. These types of drugs are typically non-sedative selective serotonin reuptake inhibitor (SSRI) drugs.
Another type of treatment is phototherapy. This type of therapy includes exposure to high intensity bright lights such as sun lamps or sun boxes. These forms of light are often portable and can easily be placed on a desk or table in a work area. They also can be used at home to simulate natural light and help reduce fatigue and feelings of depression.
Additional information regarding SAD as well as a variety of light products can be found at this Consultants’ Corner.
JAN also offers information on accommodating individuals with various types of depression in the workplace — Accommodation Ideas for Depression.
While the winter months can bog us down with gray skies and cold weather, make sure to find time these next few months for things you enjoy. Whether it’s spending time with family and friends, planning a ski trip, or curling up on the couch with a good book and some hot chocolate, don’t forget to take time for yourself. Spring will be here before we know it!
Mayo Clinic – Seasonal Affective Disorder (SAD)
Mental Health America – Seasonal Affective Disorder (SAD)
By: Kim Cordingly, Lead Consultant – Self-Employment
At almost every event or conference I attend, one of the questions I’m frequently asked is, “What kind of businesses do people with disabilities start?” My response to the question tends to reframe it, because almost any type of business you can imagine a person without a disability might want to start, is just as likely to be a business idea we’ve consulted about. I’m continually amazed at the creativity, vision, and resourcefulness these aspiring entrepreneurs reveal in their ideas.
Choosing self-employment or starting a small business in many cases enables an individual with a disability to build workplace accommodations into the design of their business. This ability to customize is one of its key benefits. At JAN, we can address both inquiries about the business development process, as well as specific accommodation questions.
While all information provided to JAN is confidential, and people are understandably protective of their unique business ideas, I’d like to share in general terms some of the business ideas JAN callers have contacted us about over the years. All the names used in the examples are pseudonyms.
WELDER/ARTIST – “Ken” had extensive experience in welding as a technical career, but also wanted to develop his artistic side. His plan was to contract out his welding services while also producing works of art using welding techniques and leftover metal materials.
PET SUPPORT FOR SENIORS – “Nellie” wanted to provide support services to seniors and their pets – specifically handling those tasks a senior may no longer comfortably be able to do such as walking the dog, taking the pet to vet appointments, and so on.
BOOK ILLUSTRATOR – “Angela” had extensive experience in the publishing industry, but preferred to do the work as a contractor on a project to project basis. In such a specialized field and with a background in specific types of detailed illustrations, this made for an excellent self-employment transition.
EVENT PLANNER/WEDDING SITE – “Alex” owned beautiful rural property conducive to a wedding venue, so wanted to build on this asset and develop additional wedding services to compliment the use of the site.
PROFESSIONAL SCIENCE WRITER – “Margaret” had extensive academic training in the sciences and wanted to parlay this into a professional writing career. In particular, she was interested in writing about environmental topics of importance to her.
BOUTIQUE/COTTAGE FOOD PRODUCTION – “Paul” had family recipes he felt were delicious, regionally unique, and marketable. With the growth of farmer’s markets and a focus on buying local, he believed customers would be very interested in his products.
TECH SUPPORT – “Keith” had been providing tech support to friends and friends of friends for years, but was now ready to turn it into a business where he would be compensated. He also wanted to focus on providing computer support to small businesses in his community who may not be able to afford their own IT person.
COUTURE WEDDING GOWNS – “Cathy” had over the years developed great design and sewing skills and was interested in a business making one-of-a-kind, couture wedding gowns for her clientele.
MOBILE AUTO DETAILING – “Donna” planned a business where she would go to people’s homes or businesses and detail their cars. No need to drop their car off – she would go to them.
BLUEBERRY FARMER – “Carl” was a savvy farmer who had over the years developed a blueberry bush that could withstand variable climates and soil conditions. He planned to sell them across the U.S. via mail order catalog and online.
FOOD TRUCK VENDOR – “Mike” saw a need for a food truck vendor at kids’ baseball games, local flea markets, and other community events. He wanted to offer a delicious but healthier alternative to french fries and cotton candy.
ALTERNATIVE ENERGY CONSULTANT – “Tom” had extensive experience in the alternative energy sector and wanted to consult with small businesses and homeowners on how to make their building more energy efficient and better for the environment.
RV AND CAMPSITE OWNER – “Sandy” and her family wanted to turn their property on a lake into a RV park and campground that would focus on the accessibility of the site for vacationers with disabilities.
ONLINE TUTOR – “Alice” was a former teacher with an excellent math/science background who wanted to tutor secondary school age adolescents in these disciplines. She would also help prepare students for college entrance exams.
RECORDING ENGINEER (CONTRACTOR) – With the proliferation of sophisticated computer and audio technology, “Sam” would use his skills and his own equipment to work with independent musical artists to create sound recordings.
JEWELRY DESIGNER – “Sue” designs nature-inspired jewelry and wanted to expand her business beyond her local market to include online sites such as Etsy. This would also allow her to do more specialized custom design work.
COACHING/CURRICULUM DEVELOPER – “Naomi” wanted to use her extensive oratory experience to work as a private coach for clients who had difficulty with public speaking, constructing effective presentations, and general assertiveness training in the workplace. She was also interested in developing an online training curriculum on these topics.
Job Accommodation Network (JAN) – Entrepreneurship
Office of Disability Employment Policy, U.S. Department of Labor
Self-Employment & Entrepreneurship
Making Self-Employment Work for People with Disabilities (2nd Edition, 2014)
Cary Griffin, David Hammis, Beth Keeton and Molly Sullivan
Disability.gov’s Guide to Self-Employment and Starting a Small Business
By: Melanie Whetzel, Lead Consultant – Cognitive/Neurological Team
Not only is October National Disability Employment Awareness Month, but it is also Learning Disabilities Awareness Month. JAN is joining with others such as LD OnLine and the Learning Disabilities Association of America (LDA) to bring more awareness of learning disabilities and to share information about our resources.
What does the term learning disabilities really mean? Learning Disabilities refer to a number of disorders that may affect the acquisition, organization, retention, understanding or use of verbal or nonverbal information. These disorders affect learning in individuals who otherwise demonstrate at least average abilities essential for thinking and/or reasoning.
Learning disabilities result from impairments in one or more processes related to perceiving, thinking, remembering or learning. They range in severity and may interfere with the acquisition and use of oral language, reading, written language, and mathematics. Learning disabilities may also involve difficulties with organizational skills, social perception, social interaction, and understanding the perspectives of others (Learning Disabilities Association of Canada, 2015).
In 1985, President Ronald Reagan stated the following in a proclamation. It reads in part:
“Awareness of learning disabilities is one of the most important advances in education in recent years. As more and more Americans become aware, our citizens with learning disabilities will have even greater opportunity to lead full and productive lives and to make a contribution to our society.”
Read on to see how some famous individuals with learning disabilities have greatly contributed to our society. These individuals show that although learning disabilities may present challenges, they don’t limit one’s chances for success. Having a learning disability may have in fact played an important role in helping these individuals find the determination to achieve their goals. The following partial list of prominent figures with learning disabilities can surely be a source of inspiration!
From the entertainment industry: Orlando Bloom, Tom Cruise, Whoopi Goldberg, Jay Leno, Keira Knightley, Steven Spielberg, and Henry Winkler
Sports figures: Muhammed Ali, Terry Bradshaw, Magic Johnson, and Tim Tebow
Business leaders: Richard Branson, Henry Ford, Charles Schwab, and Ted Turner
Journalist and writers: Agatha Christie, Anderson Cooper, Richard Engel, and F. Scott Fitzgerald
Scientists/Inventors: Alexander Graham Bell, Thomas Edison, and Albert Einstein
Military leaders: George Patton and Winston Churchill
If you or someone you know has a learning disability and is looking for assistance in overcoming some of the difficulties that may be present in the workplace, look no further. JAN’s resources include a newly updated Accommodation and Compliance Series: Employees with Learning Disabilities, as well as Accommodation and Compliance Series: Employees with Executive Functioning Deficits for accommodation ideas. We also have information on documentation of a learning disability, organizations, and SOAR – our Searchable Online Accommodation Resource. This tool can walk you step-by-step through the accommodation process, offer accommodation ideas, and provide product information. All of these resources can be found at Accommodation Ideas for Learning Disabilities.
JAN’s consultants on the cognitive/neurological team are available to help answer your questions about the accommodation process, disclosure, and information that can help you in your specific situation. Please feel free to contact us.
Learning Disabilities Association of Canada. (2015). Official Definition of Learning Disabilities. Retrieved October 27, 2015 from http://ldac-acta.ca.
Famous People with the Gift of Dyslexia, retrieved from http://www.dyslexia.com/famous.htm October 27, 2015.
Success Stories: Celebrities with Dyslexia, ADHD, and Dyscalculia, retrieved from https://www.understood.org/en/learning-attention-issues/personal-stories/famous-people/success-stories-celebrities-with-dyslexia-adhd-and-dyscalculia October 27, 2015.
By: Sheryl Grossman, Consultant – Motor Team
One of the most positive things about more people surviving breast cancer, and cancer diagnoses in general, is that life after a diagnosis goes on, including one’s work life. Many are able to continue working through treatment, while others choose to focus on treatment and then return to work. Often less recognized is that while a clinical diagnosis is made on a specific date, and various treatments are done on specific dates, the side effects may linger on for weeks, months, and sometimes years.
Cancer, as many oncologists say, is a lifelong, chronic condition. For some this may be a direct result of the disease process, while for others it may be the result of side effects from necessary, but often potent, treatment protocols.
Just like with any other chronic condition, people who have had breast cancer can be fantastic employees. Some return to work and continue on as they did prior to their diagnosis. Others may need accommodations to be the best employee they can be.
The following are some potential areas of accommodation that may assist someone who has had a diagnosis of breast cancer:
Need for ongoing medical treatment, follow-up appointments, and monitoring:
- Allow for a flexible schedule
- Allow employee to telework
- Allow for additional leave time
Need for an ergonomically adjusted workspace due to lifting restrictions, pain management, and so on:
- Provide workspace adjustments to desk height, monitor height, chair, arm support, and reach ranges for equipment and materials
- Provide ergonomically appropriate tools
- Allow for breaks from repetitive tasks
- Modify workspace layout to avoid tasks done over the head
- Allow time for physical movement to help circulation
Need for supports with cognitive processing:
- Allow for self-paced workload
- Adjust supervisory method to allow for prompting, adjusting instructional or management method, breaking large tasks into smaller tasks
- Allow for one task to be completed before the next is presented
Need to manage fatigue:
- Allow for periodic rest breaks
- Allow for a modified schedule
- Redesign workspace to bring all necessary materials within easy reach range
- Limit physical exertion required
- Move workspace closer to door, break room, or restroom
- Provide personal mobility device to maneuver around workspace without exerting more effort
- Allow telework from home and remote access to meetings
While wearing pink brings awareness to the needs of those who are living with or have survived breast cancer, providing accommodations concretely changes the lives of those who are affected, as well as strengthening the business as a whole.
For more information:
Accommodation Ideas for Cancer
EEOC Fact Sheet: Questions and Answers About Cancer in the Workplace and ADA
By: Tracie DeFreitas, Lead Consultant – ADA Specialist
Inclusion. Equality. Fairness. Respect. It’s reasonable to say that all of these words have significant meaning to everyone, particularly at work. All employees should be able to participate in, and contribute to, the progress and success of an organization by being included, by being afforded equal rights, and by being treated fairly and respectfully. However, sometimes employees feel they cannot be themselves at work and will not fully engage as part of the team if they don’t believe these basic human rights can be realized – if the workplace is not inclusive of all employees or the culture is not forward-thinking. This can be especially true for individuals who transition from one gender to another, or who identify as a different gender than what they were assigned at birth.
JAN receives inquiries from employers seeking information about ways to include transgender employees in the workplace. Transgender is a term for people whose gender identity, expression, or behavior are different from those typically associated with their assigned sex at birth (NCTE, 2015). For example, a transgender man may have been assigned female at birth, but identifies as a man. Many of the inquiries JAN receives related to transgender issues come from employers who have an employee who has been employed for some time and is known as one gender, but is transitioning to a different gender. Our discussions with employers and others often center-around supporting the employee’s transition and making modifications at work that ensure that transgender employees are able to work in a manner consistent with how they live their daily lives, based on their gender identity.
The Americans with Disabilities (ADA) does not apply to situations involving workers who are transgender because being transgender is not considered a disability under the ADA. However, more and more businesses are recognizing the need to establish policies related to accommodating transgender workers – without an established federal mandate to do so. The accommodation process can be similar to that applied to workers with disabilities. When a transgender employee makes the employer aware of his or her transition and identifies work-related needs as part of the process, it’s time to have an open dialogue with the employee to discuss the employee’s needs, work-related barriers, and solutions for overcoming those barriers. Ask how the environment or means of communication can be adapted to promote inclusion and make the effort to maintain a supportive work environment that enables the individual to be him or herself. It’s also critically important to educate human resource personnel, supervisors, and managers about respectfully discussing transgender issues with employees.
Having gender transition guidelines available for human resource personnel and supervisors and managers will prepare staff to appropriately communicate with transgender employees and manage accommodation situations. The Human Rights Campaign (HRC) offers practical information and examples of gender transition guidelines that can be adapted and implemented to promote a transgender-inclusive business. To learn more, see HRC’s Workplace Gender Transition Guidelines. For examples of guidelines implemented by national corporations, see Chevron’s Gender Transition Guidelines and Ernst & Young’s Gender Transition Guidelines.
There are many ways to support transgender workers. The following suggestions will be useful to businesses trying to promote a transgender-inclusive workplace:
- Educate staff about what “transgender” means. A transgender person is someone whose sex assigned at birth is different from who they know they are on the inside. This includes people who have medically transitioned to align their internal knowledge of gender with their physical presentation and those who have not medically transitioned (HRC, 2015).
- Train management staff to lead by example by treating transgender workers respectfully and fairly, and by becoming part of the individual’s support team.
- Respect the name a transgender person is using. During the transition process, an individual will often change his or her name to align with their gender identity.
- Use the individual’s preferred pronoun and encourage others to do so. For example, when an individual presents as female, use feminine references like she, her, hers. When a person presents as male, use masculine references like he, him, his. In uncertain cases, use the person’s first name (GLAAD, 2015).
- Talk with the individual about ways to communicate his or her transition to others they must interact with at work – if the employee would like others to be informed. Ask if he or she wishes to inform their manager, co-workers, clients, etc. on their own, or if he or she prefers that this be done by the employer. Learn what information the employee would and would not like to share with others.
- Remove gender-specific rules from a dress code or grooming policy.
- Permit employees to use the restroom facilities that correspond with their gender identity. Employers may also establish single-occupancy gender-neutral (unisex) facilities or allow use of multiple-occupant, gender-neutral restroom facilities with lockable single occupant stalls. The Occupational Safety and Health Administration (OSHA) has issued transgender inclusive restroom access guidelines. For more information, go to Best Practices: A Guide to Restroom Access for Transgender Workers.
- Allow a flexible schedule and permit the use of leave for medical procedures.
- Discuss if there is a preference to remain in his or her current position or to consider reassignment to another position during transition.
- Update name and gender designations for human resource and administrative records once an employee has officially transitioned. Also, update employment-related photo identification.
- Finally, respect the individual’s privacy and allow him or her the right to be who they are.
National Center for Transgender Equality. (2015). Transgender Terminology. Retrieved June 19, 2015 from http://transequality.org/issues/resources/transgender-terminology
Human Rights Campaign. (2015). Reporting About Transgender People? Read This. HRC’s Brief Guide to Getting It Right. Retrieved July 31, 2015 from http://www.hrc.org/resources/entry/reporting-about-transgender-people-read-this
Human Rights Campaign. (2015). Workplace Gender Transition Guidelines. Retrieved July 17, 2015 from http://www.hrc.org/resources/entry/workplace-gender-transition-guidelines
GLAAD. (2015). GLAAD’s Tips for Allies of Transgender People. Retrieved July 31, 2015 from http://www.glaad.org/transgender/allies
By Daniel Tucker, Consultant — Cognitive/Neurological Team
October 10th is World Mental Health Day. Originally celebrated in 1992 as an initiative of the World Federation for Mental Health, its objectives included raising awareness of mental health issues throughout the world; encouraging individuals to educate themselves about mental health; and searching for ways to provide greater supports. With this in mind, we wanted to draw attention to the prevalence of mental health conditions, common misconceptions, and steps employers can take to foster a supportive and inclusive work environment.
According to a National Institute of Mental Health (NIMH) survey, approximately 43.8 million adults experience some form of mental health condition in a given year. That’s 18.5 percent or nearly 1 in 5 of all adults in the U.S. It’s a common misconception that mental health impairments affect a small number of individuals. These statistics show that mental health conditions as a whole are actually relatively common.
Given these statistics and the number of individuals employed or seeking employment with mental health impairments, employers may want to consider steps they can take to raise awareness in the workplace. With October being National Disability Employment Awareness Month, it’s a good time to consider providing disability awareness training where topics relevant to mental health can be discussed. By bringing attention to the fact that mental health conditions are common, and only one part of a person’s identity, employers may help reduce the still pervasive stigma around mental illness, and make employees feel more comfortable and supported in the workplace.
In terms of disability etiquette, it’s important to know how to talk about mental health in a way that is respectful rather than offensive. For example, the terms “mental defective,” “afflicted,” “victim of,” and “sufferer of” are generally antiquated and offensive. The terms “mental health impairment” and “psychiatric impairment” are generally accepted, and individuals may have a personal preference as to what terms they prefer. Also, it’s generally better to use person first language – focusing on the person first, not the disability. For example, “an employee with bipolar disorder,” as opposed to “a bipolar employee.” When speaking with an employee that has disclosed a mental health impairment, it may be helpful to listen for the words they use to describe themselves, and to ask whether they have a preference about what terms you use.
The Employer Assistance and Resource Network (EARN) offers employers numerous resources for creating a more inclusive workplace including information on disability etiquette.
JAN also offers a wide variety of resources to support the successful employment of individuals with mental health impairments.
If you have a specific situation or question you’d like to discuss with a JAN consultant, we encourage you to contact us directly or visit AskJAN.org.
Any Mental Illness (AMI) Among Adults. (n.d.). Retrieved October 7, 2015, from http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml.
Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-49, HHS Publication No. (SMA) 14-4887. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
by: Kelsey Lewis, MSW, LGSW
This past summer, I attended a session at the National Alliance on Mental Illness (NAMI) conference entitled “Borderline Personality Disorder: Demystified and Destigmatized” led by Dr. Alan Fruzzetti, a Professor of Psychology at the University of Nevada, Reno. As a featured speaker, he opened the session by sharing the most up-to-date research on individuals with Borderline Personality Disorder (BPD). In his presentation, Fruzzetti focused on the concept of emotional dysregulation as a central process in BPD.
Emotional dysregulation (ED) is characterized by quick and frequent mood swings that are beyond the control of the person with the problem (New Harbinger Publications). ED can also be associated with fear of negative emotions, difficulty concentrating, impulsive behavior, low self-esteem, and fear of abandonment. Although heightened in individuals with BPD, such feelings are shared by many individuals with or without a diagnosed mental health condition. These dysregulated emotions may significantly affect an individual’s relationships, both personal and professional, in and out of the workplace.
Fruzzetti explained that when an individual reaches a heightened state of emotion, he or she is more inclined to think in rigid terms — black or white, good or bad. It’s during these periods of emotional arousal that dysregulation may occur, particularly for those with BPD. In order to function happily and effectively in any relationship, we must first accept the ambiguity of the other person’s intentions, including the constant change of expectations and preferences. But how is this possible when one is thinking in such a polarized way?
Fruzzetti suggests learning to take a step back – giving yourself a breather – and then addressing the situation more tactfully so, as he explains, you learn to interact healthily, express yourself and your needs when your arousal has lowered. This will help you express yourself more accurately and appropriately. Instead of reacting when your coworker or supervisor has acted in a way you perceive as offensive, you instead walk away until you have reached a point of calmness, and then readdress the situation. You can now explain that the interaction did not sit well with you instead of blaming, calling someone names, or potentially overreacting in a way that will make you feel embarrassed later on. He emphasized that the more accurately you explain your feelings, the easier it is for the other person to understand and validate your experience. This does not necessarily mean that the other person will be able to fully understand why you feel this way, or even agree with your position, but at least this opens the line of communication that will enable you to feel heard and respected.
Fruzzetti believes that if people do not feel validated in their feelings, their arousal will not drop. For employers, this can mean that employees with BPD may not be able to work effectively, without distraction, if they feel unsupported in their workplace. Instead of moving on from a negative event or encounter, they may alternatively believe their feelings aren’t safe in their workplace. Although difficult at times, particularly if an employer is unfamiliar with BPD, validation can change this frame of reference and potentially lead to a more productive employee.
According to Fruzzetti, the tricky part is learning to differentiate between validating “false” perspectives versus emotions regarding the matter. This means that you don’t necessarily want to validate an employee’s perspective if it could cause more harm, but instead validate the feelings attached to this perspective. For example, if an employee wrongfully believes that her supervisor is singling her out, it would cause more harm to agree with this perspective. However, you can still express your understanding that she is upset over feeling this way. This interaction can help the employee feel supported while also providing a different viewpoint on the situation.
Relationships can be challenging — especially with our work colleagues and supervisors with whom we interact during a large portion of our days. But in trying to relate to each other through validation and respect, these relationships can provide many benefits that will enrich our workplace lives. Particularly for those with BPD, this relational strategy can make a huge difference in both morale and productivity. Through simple but new levels of understanding, we can allow our professional relationships to provide collaboration, inspiration, motivation, and a new perspective on life.
For more information on Accommodation Ideas for Mental Health Impairments, JAN publications offer a variety of suggestions. JAN consultants can also provide one-on-one consulting to discuss a specific workplace situation.
By: Elisabeth Simpson, Lead Consultant – Motor Team
In this final segment of the 2-part Blog on accommodations for healthcare workers with motor impairments, JAN Lead Consultant Elisabeth Simpson, MS., CRC, in collaboration with the founder of the non-profit resource network Exceptional Nurse, Dr. Donna Carol Maheady, continues the discussion on some of the more complex accommodation questions JAN Motor Team consultants are fielding. Seven questions were directed to Dr. Maheady. This month we will be looking at the remaining four questions and offering resources and information on the topic.
1) When a limited schedule is needed (e.g., 10 hour shift in place of a 12 hour shift), would allowing this for one nurse on a unit really be a hardship for the other nurses working?
The accommodation of a schedule modification, as well as modifications of a workplace policy regarding scheduling, are a couple of types of accommodations an employer would need to consider providing, absent undue hardship. The EEOC’s Enforcement Guidance on Reasonable Accommodation and Undue Hardship under the Americans with Disabilities Act (ADA) offers guidance on this area of accommodation that might be useful for an employer or individual to review.
According to Dr. Maheady, in some cases an employer may be able to limit an individual’s schedule without it posing a hardship. However, in most situations, nurses are working with limited staff and adding additional work can be problematic for various reasons. Safe staffing ratios are critical to patient care outcomes and allowing a nurse to leave early or come in late could impact safe staffing ratios.
Alternative options could be to consider accommodations that would enable an individual to work the hours required. This could include periodic breaks, modifying policies around eating and drinking, providing equipment, or restructuring a job to reallocate marginal functions. Reassignment may be necessary if accommodations would not be effective or would pose a hardship. This type of accommodation may also be necessary if an individual needs to limit hours to the extent at which they would be working part time rather than full time.
2) For medical professionals with upper extremity limitations, what are some alternative ways to place a catheter (male or female)? Is maintaining a sterile field ever a concern?
It depends on many factors (age of patient, patient’s condition, etc.). For males, in some instances, it is appropriate to have the patient assist while placing the catheter. Also, if teaching the patient to self-catheterize (or a family member), this is part of the teaching/learning process.
What would work best is to have a second person, possibly a nurses’ aid or family member, don gloves and assist. Then the individual can don gloves, clean the meatus, and insert the catheter. Dr. Maheady notes that, in her experience, many nurses ask for assistance, disabled or not.
3) How can a medical professional who uses a cane or mobility device address concerns around sterilizing the device?
In these situations, Dr. Maheady recommends that the Infection Control Department or designee should always be consulted. There may be specific infection control issues related to a facility or unit. Collaboration with all parties in determining effective solutions can help to speed up the process and ensure that policies and procedures around sterilization are kept in mind.
Concerns around cane or wheelchair use in sterile medical environments can be addressed by:
- Having two wheelchairs available and keeping one chair in a sterile area. The individual could switch chairs in a dedicated area.
- Using wheelchair tire covers.
- Wheeling into the room with one pair of gloves and changing to a new pair of gloves before touching the patient.
- Surgical gowns could also be used to cover exposed areas of the chair.
- A long narrow plastic bag (like ones for wet umbrellas) could be used with a cane and taped around the cane to secure. Bags could be changed as needed.
It is important to note that in general patient care areas, nurses do not sterilize their shoes, sneakers or clogs. An employer would not want to unnecessarily impose more stringent rules or requirements for employees with disabilities as this could be a violation of the ADA.
4) When a patient lifting device is not available, what are some alternative options that a medical professional with a lifting restriction could consider?
This is another situation where job restructuring may be the most effective form of accommodation for individuals who have lifting restrictions and are working in healthcare positions that require them to lift. Job restructuring can be an adjustment in how and when a job is performed, including reallocating or eliminating marginal functions of a job. However, the EEOC has indicated that an employer is not required to reallocate essential functions of a job as a reasonable accommodation. Although an employer is not required to reallocate essential job functions, it may be a reasonable accommodation to modify the essential functions of a job by changing when or how they are done.
While there may be a common or typical way a job function is performed by healthcare workers, such as patient lifting techniques, individuals with a disabilities should be given the option to perform the same job task in a manner that works best for them while keeping patient care and safety in mind. For example, an individual could be permitted to ask for assistance when lifting a patient. Team lifting, or lift buddies, can also be a solution. However, there will still be risks associated with lifting patients and injuries can occur with any employee, not just those with restrictions. It is important to remember that team members have different strengths and body sizes and may contribute differently when lifting a patient.
Ultimately, if an individual is not able to lift patients even with accommodations, reassignment would need to be considered. Reassigning the individual to another unit (e.g., pediatrics, newborn nursery) where there is a vacant position could be explored.
JAN and Elisabeth would like to extend our appreciation to Dr. Maheady for her assistance in answering these common, but difficult questions related to healthcare workers with motor impairments. For assistance in determining accommodation options for individuals with motor impairments, JAN consultants are ready to assist!
By: Kim Cordingly, Lead Consultant – Self-Employment Team
Over the years, JAN consultants have fielded questions from aspiring entrepreneurs with many different types of disabilities and every conceivable variation of business idea. Frog farm – we’ve heard of it. Opera singer and teacher – how wonderful! Used automobile sculptures – why not? Many of the business ideas we hear about are absolutely brilliant – inspired – practical – imaginative – marketable – and feasible. But to get from here to there takes lots of good information and support, and on the part of the individual wanting to start a business, both knowledge and practical skills.
Many so called “soft skills” cannot be emphasized enough as being critical to the success of both planning and operating a small business or self-employment. Soft skills are frequently characterized as those that encompass proficiency with verbal and nonverbal communication, a positive attitude and enthusiasm, teamwork and networking behaviors, problem solving and critical thinking skills, and acting with professionalism. The very process of researching and planning for a business requires skills that will be necessary in the start-up and operations stages of business development. As a result, these are skills we try to focus on from the outset — either as best practices or in the context of accommodations — and encourage JAN customers to develop further both in how they interact with us, as well as those they reach out to with other programs and services in their local areas.
Based on our experience, I’ve highlighted below some “Dos and Don’ts” that frequently come up with our customers. Often they seem small or common sense, but they frequently have huge implications in how seriously one’s ideas will be taken by others, and whether an individual is perceived as committed to a business idea and the development process.
Tip 1: Be Specific
You’ve requested information from a program or agency and they’ve responded to you by preparing information based on your request. You have follow-up questions. What do you do?
DO: Review the information they sent to you carefully. If you need support to do this, let an appropriate person/service provider know. I cannot emphasize this enough. If they’ve prepared the information for you, take the time to review it thoroughly.
DO: Once you’ve reviewed the information, write down (or prepare somehow) follow-up questions that reference as specifically as possible the material you received. This communicates to the person or agency that you value their time; this also makes it more likely they will be able to respond appropriately to your questions, as well as be willing to network with you in the future.
DON’T: Ask extremely general questions – ask questions that show you have reviewed the information and reference it. This demonstrates good critical thinking and communication skills – you are sharing the concrete steps you’ve taken to review the information and follow-up if applicable. Again, if accommodations are needed, JAN consultants can assist with this.
An unhelpful question tends to be very general – “I don’t understand the information you sent to me. Could you explain it?”
A helpful question is more specific – “On page 3 of the information you sent to me you talk about Social Security work incentives and self-employment. This is confusing to me. I wonder if you could explain more clearly how these rules work. If you need more information about my specific situation, I’d be glad to share this information.”
Tip 2: Always Be Professional, Even When Irritated
You’re in the process of putting together your business plan and are following up with business development organizations to schedule an appointment with a counselor. Some agencies you’ve contacted have not called back in a timely manner, so you’re feeling frustrated. What do you do?
DO: Keep a good record of the dates and times you’ve contacted an agency and cite this information when you call back. If they have not called back in a reasonable amount of time (I usually say a few days unless they’ve said it will be within another time frame), call back and let them know you called earlier, left a message (if you did), and have the date/time information ready.
DO: Make sure you are (and sound) assertive, not agitated. If you’re not sure, take a break before contacting them. Don’t make the call until you are in a calmer state of mind.
DO: Write down what you want to say beforehand. Being prepared in this way tends to present clarity on your part and lessen anxiety.
DON’T: Never take out your frustration on the individual you finally get to talk to whether it’s a receptionist or the counselor. While it’s perfectly understandable to feel frustrated when you’ve made repeated calls, you don’t know why there was a delay in getting back to you. Now that you’ve gotten ahold of the person you want to speak with, use this opportunity wisely.
REMEMBER: You are building social capital with every contact you make. How you present yourself in each conversation — even in these initial steps — is setting the groundwork for your future plans. People always remember when they are treated kindly and respectfully. You can’t control how other people behave, but you can always be professional from your end, even if you decide not to work with that person or agency.
Tip 3: Be Reliable
You have scheduled a meeting with your vocational rehabilitation (VR) counselor and a small business counselor. You’ve been trying to schedule this meeting for many weeks. Due to unforeseeable health issues, you need to reschedule the meeting. What do you do?
DO: As soon as you know you will not be able to make the meeting, let both parties know. Let them know by the means you know they are most likely to receive the message. If not sure, contact both by email and phone.
DO: If possible, try to reschedule the meeting during that conversation. Let them know you are committed to meeting and regret having to reschedule.
DON’T: Unless appropriate, don’t feel you need to give explicit details about the medical reasons for the cancellation unless it is relevant to your relationship with that individual and the issues at hand. In other words, they don’t need to know all the details, just the parts that are relevant based on the type or relationship you have and the purpose of the meeting.
REMEMBER: We all have unforeseen things happen when we may need to cancel meetings. The important part is to be courteous and timely in the cancellation process. Unfortunately, we hear too often that individuals simply do not show up at the meeting and call afterwards to apologize. This makes it much less likely these persons will want to work with you again.
Office of Disability Employment Policy (2012), Skills to Pay the Bills – Mastering Soft Skills for Workplace Success. Retrieved from http://www.dol.gov/odep/topics/youth/softskills/softskills.pdf
By: Elisabeth Simpson, Lead Consultant – Motor Team
According to the Bureau of Labor Statistics (2013), the health care and social assistance sector will account for almost a third of the projected job growth between 2012 and 2022. With 16,971,800 healthcare workers employed in the United States in 2012 (Bureau of Labor Statistics, 2013), accommodations for those with disabilities working, or planning to work in, the healthcare field is a timely topic to be discussing.
With the over ten thousand calls JAN has received related to accommodations in healthcare settings, JAN consultants can offer a wealth of experience with accommodation situations. For healthcare workers with motor impairments such as carpal tunnel, back conditions, leg impairments, or arthritis, certain job duties – tasks such as lifting, carrying, moving, transferring, standing, walking, manipulating extremities, and positioning individuals for activities of daily living or physical therapy – may be difficult to perform without accommodations.
There are a variety of accommodation options that can be implemented in order for an employee to perform the essential functions of the job. Proper lifting techniques, lowering adjustable exam tables and equipment (low-lipped showers), ergonomic layouts for equipment (cranks and handles on beds and carts) and supplies (storing items at waist height, lowering bed rails when attending to patient needs, etc.), and team lifting are beneficial work site and procedural changes.
Still, accommodation situations in healthcare settings can be tricky or complicated. When this is the case, JAN consultants might turn to other experts in the field for assistance so that those contacting us for guidance are provided with the most beneficial and accurate information. For this two part blog, I collaborated with the founder of the non-profit resource network Exceptional Nurse, Dr. Donna Carol Maheady, to discuss some of the more complex accommodation questions JAN Motor Team consultants are fielding. Seven questions were directed to Dr. Maheady. This month we will be looking at the first three questions and offering resources and information on the topic.
1) For medical professionals with either a hand or arm amputation OR restrictions that limit the use of one hand, what are some alternative methods for giving injections? What about placing IV’s?
According to the Equal Employment Opportunity Commission (EEOC), a reasonable accommodation must be provided to enable a qualified employee with a disability to perform the essential functions of a job currently held. In general, an accommodation is any change in the work environment or in the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities.
Job restructuring may be the most effective form of accommodation for individuals who have limited or no use of one hand and are working in healthcare positions that require them to perform injections, place IV’s, etc. Job restructuring can be an adjustment in how and when a job is performed, including reallocating or eliminating marginal functions of a job. However, the EEOC has indicated that an employer is not required to reallocate essential functions of a job as a reasonable accommodation. Although an employer is not required to reallocate essential job functions, it may be a reasonable accommodation to modify the essential functions of a job by changing when or how they are done.
While there may be a common or typical way a job function is performed by healthcare workers, such as placing an IV, an individual with a disability should be given the option to perform the same job task in a manner that works best for them while keeping patient care and safety in mind. Time to practice clinical skills or tasks may be needed as part of the accommodation.
A number of videos and articles are offered as an additional resource to support the work of those with motor impairments in healthcare settings:
Foreign object removal with prosthesis
Adult CPR with prosthesis
Nursing with the hand you are given
Disabled Nurse: Focus on abilities
Danielle’s story (nurse missing her lower arm)
A sequence of photos demonstrating the donning of sterile gloves with one hand can be found within the article: “Nursing with the Hand You Are Given”
Articles and Book Chapters
In the book Leave No Nurse Behind: Nurses Working with Disabilities by Donna Maheady, Susan Fleming (nurse born missing her left hand) wrote a chapter about her journey.
In the book The Exceptional Nurse: Tales from the Trenches of Truly Resilient Nurses Working with Disabilities, edited by Donna Maheady, Connie Stallone Adleman wrote a chapter called “Loving Ourselves Exactly as We Are: Nursing after a Stroke.”
In the article “Missing a Limb but Not a Heart,” Carey Amsden, RN, discussed how she practiced performing certain job tasks with the use of one arm, such as starting an IV, and donning a sterile glove in nursing school and has been able to successfully work in the field of nursing.
2) For medical professionals who need to wear a brace or post-burn glove, how can concerns around sterility be addressed?
An employer may require as a qualification standard that an individual not pose a “direct threat” to the health or safety of the individual or others, if this standard is applied to all applicants for a particular job. Additionally, employers may comply with medical and safety requirements established under other Federal laws without violating the ADA.
However, an employer still has an obligation to consider whether there is a reasonable accommodation, consistent with the requirements of other Federal laws, which would not exclude individuals who can perform jobs safely. In situations where sterility is a concern, alternatives to standard practices should be explored with the individual.
One option could be for the employee to wear a sterile glove (perhaps a larger size), gown or drape over the brace or glove. In doing this, sterility would be addressed to the same standard that others would be held to.
It is also recommended that the Infection Control Department or designee be consulted. There may be specific infection control issues related to a particular facility or unit to consider.
3) Are there alternatives to taking a leave of absence during flu season for medical professionals who are not able to receive the flu vaccine?
Flu season, in some areas, can last a while and a leave of absence may not be feasible or could pose an undue hardship to the employer. Alternative options for accommodating those who are not able to receive the flu vaccine can include: allowing the employee to wearing a mask or protective gear, reassigning the employee to a position that does not require direct-patient contact, considering flu shot alternatives, modifying a policy if applicable and depending on state law, or allowing an extended leave and offering reassignment to a vacant position upon return. For more information, see the following article: “Vaccinating the Health-Care Workforce: State Law vs Institutional Requirements.”
Next month we will be exploring schedule modifications and specific work tasks, so stay tuned!
Monthly Labor Review (2013). Bureau of Labor Statistics. Retrieved from http://www.bls.gov/opub/mlr/2013/article/industry-employment-and-output-projections-to-2022-1.htm