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Introduction
How many nurses with disabilities are working today?
According to the Bureau of Labor Statistics, there were nearly three million registered nursing jobs in the United States in 2016. The Department of Labor has predicted that the number of nurses in the workforce will grow by 15% in the next 10 years, which is much faster than average. If disabilities affect one-fifth of all Americans (Census Bureau, 2012), then close to 600,000 registered nurses could be in need of job accommodations. This number doesn't include nurse practitioners, midwives, anesthetists, and licenses practical and vocational nurses and nursing assistants.
With the high standards nurses are held to, along with the myriad skills they are required to master and the tasks they accomplish on a daily basis, those in the nursing profession with disabilities may need reasonable accommodations to effectively perform their jobs. They may need accommodations related to cognitive, mental health, motor, sensory, and other disabilities.
Are nurses with disabilities required to disclose their disability to their employers?
It depends. The ADA regulates when employers can ask medical questions of job applicants, new hires, and employees. During the application stage, employers are not allowed to ask medical questions and applicants are not required to disclose their disabilities unless they need an accommodation. Employers are required to provide accommodations for job applicants with disabilities to participate in the application process, but only if they know about the disability and need for accommodation (EEOC, 1992).
Once an employer makes a job offer, but before the new hire actually starts working, employers can ask any medical questions they want as long as they ask all new employees in the same job category the same questions. At this stage, the new hire must disclose a disability if asked (EEOC, 1992).
Once working, employees only need to disclose their disabilities if they want to request an accommodation (EEOC, 1992).
Can an employer ask nurses with disabilities to submit to a medical examination?
Yes, if the need for the medical examination is job-related and consistent with business necessity. Disability-related inquiries and examinations of employees must be “job-related and consistent with business necessity.” According to the Equal Employment Opportunity Commission (EEOC, 2005), the federal agency charged with enforcing the ADA, a medical inquiry or examination is job-related and consistent with business necessity when:
- an employer has a reasonable belief, based on objective evidence, that an employee’s ability to perform essential job functions will be impaired by a medical condition; or
- an employer has a reasonable belief, based on objective evidence, that an employee will pose a direct threat due to a medical condition; or
- an employee asks for a reasonable accommodation and the employee’s disability or need for accommodation is not known or obvious; or
- required in positions that affect public safety, such as police and fire fighters.
Accommodation Ideas:
Accommodations vary for nurses with cognitive, motor, and sensory impairments. The following provides an overview of accommodation ideas that may be helpful:
- Cognitive impairment, as used in this publication, refers to disturbances in brain functions, such as memory loss and problems with organizing and concentrating. Cognitive impairment is a syndrome, not a diagnosis. Many conditions can cause cognitive impairment, including multiple sclerosis, depression, alcoholism, Alzheimer's disease, Parkinson's disease, traumatic brain injury, chronic fatigue syndrome, and stroke.
- Motor impairment, as used in the publication, refers to limitations in motor movements such as walking, bending, lifting, sitting, standing, fingering, grasping, and maintaining stamina. Many conditions cause motor or mobility impairment, including multiple sclerosis, cancer, stroke, paraplegia, quadriplegia, cumulative trauma disorder, back condition, arthritis, and heart condition.
- Mental health conditions, also called "mental illness," refers collectively to all diagnosable mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood, and/or behavior. Examples of psychiatric impairments include depression, bipolar disorder, anxiety disorder, schizophrenia, and addictions like alcoholism and drug addiction.
- Sensory impairment, as used in the publication, is any condition that results in hearing loss, deafness, speech impairment, vision loss, blindness, or respiration.
Limitations and accommodation ideas specific to the nursing environment include:
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Difficulty Lifting or Transferring Patients
Use of One Hand
Maintaining Clean Technique for Nurses Who use Wheelchairs
- Wash and dry hands, apply two pairs of clean gloves, and maneuver to area
- Remove exterior pair of gloves
- Use a strap or belt to secure self in chair when leaning forward to assess patient, perform wound care, etc.
Monitoring Vital Signs
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Monitoring Vital Signs
- Blood pressure monitors with displays showing pulse and blood pressure
- Graphic auscultation systems
- Equipment with digital displays
- Vibrating alert to signal a monitor’s alarm
Difficulties with Documentation
- Speech recognition software
- Steno system
- Screen reading software
- Writing/editing software
- Smart Pens
Memory Deficits
Difficulties with Focus and Time Management
Additional Resources:
- For additional information, see Enforcement Guidance: Disability-Related Inquiries and Medical Examinations of Employees under the Americans with Disabilities Act (ADA).
- For additional information on testing accommodations, see JAN's A to Z: Testing Accommodation Topics.
- For case studies from the health care fields, see: Accommodating Employees in Health Care Fields.
Situations and Solutions:
The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.