Introduction

JAN’s Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee’s individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Nurses

In the United States there are 2.9 million registered nurses, with 83% being employed in nursing (Center for Nursing Advocacy, 2006). Nurses employed in nursing make up 0.76% of the population in the US. The Department of Labor has predicted that the number of nurses needed in the workforce will grow by 623,000 to 2.9 million nurses by the year 2012 and that there will be a need for 236,000 new nurses per year to keep up with increasing care demands and nurse retirement (Bureau of Labor Statistics, 2006).

Nurses and the Americans with Disabilities Act

Are nurses with disabilities covered under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Nurses with Disabilities

Note: The following is only a sample of the possible accommodations available. Numerous other accommodation solutions may exist.

Questions to Consider:

1. What limitations is the nurse experiencing?

 

2. How do these limitations affect the nurse and the nurse’s job performance?

 

3. What specific job tasks are problematic as a result of these limitations?

 

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

 

5. Has the nurse been consulted regarding possible accommodations?

 

6. Once accommodations are in place, would it be useful to meet with the nurse to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

 

7. Do supervisory personnel and employees need disability awareness training?

Accommodation Ideas:

Cognitive Impairment – Cognitive impairment, as used in this publication, refers to disturbances in brain functions, such as memory loss, problems with orientation, distractibility, perception problems, and difficulty thinking logically. Cognitive impairment is a syndrome, not a diagnosis. Many conditions can cause cognitive impairment, including multiple sclerosis, depression, alcoholism, Alzheimer disease, Parkinson disease, traumatic brain injury, chronic fatigue syndrome, and stroke.

Memory Deficits:

• Allow the employee to tape record meetings and provide written checklists
• Provide type written minutes of each meeting
• Provide written instructions and allow additional training time

Difficulty Reading and Writing:

• Use speech recognition or word-prediction software if handwriting is poor or difficult
• Use a personal data assistant to help with spelling
• Seek areas of employment where charting is done by computer or in settings where reading/writing may be decreased, for example in an operating room
• Use dictation equipment and/or scribes

Motor Impairment – Motor impairment, as used in the publication, refers to limitations in motor movements such as walking, lifting, sitting, standing, typing, writing, gripping, and maintaining stamina. Many conditions cause motor or mobility impairment, including multiple sclerosis, cancer, stroke, spinal cord injury, cumulative trauma disorder, back condition, arthritis, and heart condition.

Difficulty Lifting or Transferring Patients:

• Transfer aids
• Team lifting
• Height adjustable examination tables
• Walkup changing tables that allow a child to be assisted in climbing to the changing table/examination table height

Use of One Hand:

• One-hand syringes
• One-hand IV pole
• One-handed keyboards and keyboard software

Fatigue/Weakness:

• Reduce or eliminate physical exertion and workplace stress
• Shorten work day and extend work week
• Schedule periodic rest breaks away from the unit, floor, or workspace
• Allow a flexible work schedule and flexible use of leave time
• Implement ergonomic workstation design
• Provide a scooter or other mobility aid if walking cannot be reduced

Access to Building and Work Environment:

• Install ramps, automatic doors, and internal and bathroom doors that push open
• Lower shelves and provide access to file cabinets
• Provide preferred seating during training, classes, and meetings

Maintaining Sterile Technique for Nurses Who use Wheelchairs:

• Wash and dry hands, apply clean gloves, and maneuver to area; when gloves are removed hands will remain clean
• Keep extra clean gloves in pockets
• Use a strap or belt to secure self in chair when leaning forward to assess patient, perform wound care, etc. 

Psychiatric Impairment – Psychiatric impairment, also called "mental illness," refers collectively to all diagnosable mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning (Goldman, 1999). Examples of psychiatric impairments include depression, bipolar disorder, anxiety disorder, schizophrenia, and addiction.

Depression and Anxiety:

• Reduce distractions in work environment
• Provide to-do lists and written instructions
• Remind employee of important deadlines and meetings
• Allow time off for counseling
• Provide clear expectations of responsibilities and consequences
• Provide sensitivity training to co-workers
• Allow breaks to use stress management techniques
• Develop strategies to deal with work problems before they arise
• Allow telephone calls during work hours to doctors and others for support
• Provide information on counseling and employee assistance programs

Stress:

• Allow work during shifts that are less demanding
• Adjust supervisory method
• Have more frequent meetings to discuss performance
• Develop strategies to deal with work problems before they arise
• Employer may provide sensitivity training to coworkers
• Allow telephone calls during work hours to doctors or counselors and others for support
• Provide information on counseling and employee assistance programs

Sensory Impairment – Sensory impairment, as used in the publication, is any condition that affects hearing, speech, vision, or respiration.

Speech Impairments:

• Word prediction computer software
• Text telephones (TTY or TDD)

Vision Impairments:

Monitoring Vital Signs

• Talking thermometers
• Talking scales
• Talking blood glucose monitors
• Talking blood pressure monitors
• Talking watches

Reading/Documentation

• Provide signage in large print and Braille
• Text-enlargement computer software
• Hand or stand magnifiers for printed material
• Closed-circuit television (CCTV)
• Reduce glare via glare guards on computers and adjust lighting or blinds
• Electronic note-taking devices with speech or Braille output

Deaf/Hard of Hearing:

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

One-on-One Communication

• Written notes
• Email, instant messaging, speech recognition software
• Interpreters
• Augmentative communication devices
• Basic sign language training
• Text telephones (TTY or TDD)

Group Communication

• Assistive listening devices
• Communication Access Realtime Translation (CART) services
• Computer-assisted note taking
• Tape recording meetings
• Video conferencing

Telephone Communication

• Amplification (enhancing volume)
• Clarity (adjusting sound frequency)
• Headsets; HATIS manufactures the only headset available that is specifically designed for use by individuals with a moderate to profound hearing loss and who wear behind the ear (BTE), t-coil equipped hearing aids. For more information regarding HATIS products, go to http://www.hatis.com.
• TTY or TDD

Responding to Fire or Emergency Alarms

• Vibrating pagers
• Lights hard-wired to alarm system

Allergies/Multiple Chemical Sensitivity:

• Modify or create a fragrance-free workplace policy
• Provide an air purification system
• Modify the workstation location
• Have an air quality test performed by an industrial hygiene professional to assess poor air quality, dust, mold or mildew accumulation, VOC concentration, etc.

Situations and Solutions:

A nurse with bilateral hearing loss has been using an amplified stethoscope that requires her to take her hearing aids in and out. She called JAN seeking a stethoscope that will work with her hearing aids in.  JAN referred the nurse to a company who makes a stethoscope that can be used with a direct audio input port. The stethoscope was purchased.

A nurse with fibromyalgia syndrome working in a county health clinic experienced a great deal of fatigue and pain at work. The nurse typically worked evening shifts but her doctor recommended a schedule change so she could regulate her sleep patterns. Accommodations suggestions included changing her shift from evening to day, restructuring the work schedule to eliminate working two consecutive twelve hour shifts, reducing the number of hours worked to part time, and taking frequent rest breaks.

A nurse with drug addiction was restricted from dispensing medication after she was caught using illegal drugs. Her employer had a policy allowing employees to participate in drug rehabilitation and return to work with a last chance agreement. When the nurse returned to work after rehabilitation, she was reassigned to a job that did not require her to dispense medication and given periodic drug tests.

An operating-room nurse with chronic fatigue syndrome had difficulty rotating schedules. She was accommodated with a permanent day schedule.

A resource nurse with multiple sclerosis needed changes to her workstation and schedule. The employer made the workstation wider and added an adjustable keyboard tray. The employer also allowed periodic rest breaks and moved the employee closer to the restroom and break room to help reduce fatigue.

A psychiatric nurse with cancer was experiencing difficulty dealing with job-related stress. He was accommodated with a temporary transfer and was referred to the employer's employee assistance program for emotional support and stress management tools.

A nurse with insulin-dependent diabetes and hypoglycemia was having problems regulating her condition (specifically, eating regularly while at work). Her schedule was altered by eliminating the evening rotation until her blood glucose levels could be controlled on a consistent basis. The employer reported this as a very effective accommodation. Cost of accommodation: none.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

Bureau of Labor Statistics.  (2006). November 2004 national occupational employment estimates for registered nurses. Retrieved June 19, 2006, from             http://data.bls.gov/oep/servlet/oep.noeted.servlet.ActionServlet?Action=empoccp

Center for Nursing Advocacy.  (2006). Retrieved September 6, 2008, from http://www.nursingadvocacy.org/faq/rn_facts.html

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act.  Retrieved September 6, 2008, from http://www.jan.wvu.edu/links/ADAtam1.html

Updated 06/22/06