Nurse Retention and the Disabled Nurse

This article is contributed by ANA California Member: Ellen King MSW BSN RN


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A little discussed topic in the nursing literature is nurses who are marginalized because of disability or acquired disability. The relevance to nurse retention relates to an aging workforce, injury on the job, and the benefit of having a diverse pool of employees, which includes disability (Gould-Werth et al., 2018; Stenhouse, 2021). Omitting inclusion of disability as a factor in loss of nurses from healthcare organizations reflects a bias that interferes with the understanding of nurse retention (McCullouh & Marks, 2015).


Disabled nurses have much to offer the nursing profession especially among nurses with long professional experience (Hudson, 2016; Neal-Boylan, 2019). Jarus et al notes that clients benefit from clinicians who model successful employment with a disability (Jarus et al., 2020). Wilson et al describes the artificially created nursing shortage when competent nurses with disabilities are shunted to either lower paying jobs through wage and employment disparities or forced out of the profession by a bias toward the able-bodied (Calloway & Copeland, 2021; Neal-Boylan, 2014; Wilson et al., 2016). The cost of discrimination is both local (the individual nursing professional) as well as the downstream loss of valuable nursing professionals to healthcare organizations and society (Barber, 2015). NSI Nursing Solutions estimated a yearly loss for a typical hospital between $3 million to $6 million for the loss of each bedside registered nurse for all causes but does not identify disability as one of the causes (NSI Nursing Solutions, 2021).


Nurse practitioners promote equitable employment for patients by certifying disability in the context of preservation of employment (Oyeleye, 2019). However, as we care for our patients, how do nurses measure up as a profession in hiring and retaining nurses who have disabilities? (Neal-Boylan & Miller, 2020). The definition of a diverse nursing workforce often does not include disabled nurses reflected in both the NSI report and the article by Shaffer & Curtin on reducing loss of nurse workers (NSI Nursing Solutions, 2021; Shafer & Curtin, 2020). With no evidence indicating inability to continue working based on disability alone, as Baby Boomer nurses work longer disability increases by a factor of 15 when comparing nurses at 25 years old versus those who are 65 years old (Avis, 2018; Sunago, 2020).


The purpose of the 2008 Amendment to the American Disability Act expanded the definition of disability to allow for enhanced access to workplace reasonable accommodation (Neal-Boylan & Miller, 2016). However, employers’ resistance to employing disabled workers is mired in misinformation, wherein those with disabilities are believed to be dangerous to customers, clients and patients or misperceived as a financial risk (Job Accommodation Network (JAN), 2021a; JAN, 2021b; Rodriguez et al., 2020). Meeks et al recently published the second edition of their book promoting inclusion of disability within healthcare professionals (Meeks et al., 2021). We owe it to our profession to dispel myths and to preserve and retain nursing jobs related to disability through reasonable accommodation as well as the wisdom of nurses with long experience who become disabled on the job.


For more information about nurses as well as other health professionals with disabilities, a sample of organizations advocating for disability within their professions are listed below.


The Association of Medical Professionals with Hearing Loss www.amphl.org

Coalition for Disability Access in Health Science Education (this is a website list of a number of organizations from various professions) https://www.hsmcoalition.org/articles


Stanford Medical Alliance for Disability Inclusion https://med.stanford.edu/smac

US Department of Labor. (2021). National association of nurses with disabilities. https://www.dol.gov/agencies/odep/alliances/previous/nond


References

Avis, P. (2018). Diversity and disability: The equality challenge. Occupational Health & Wellbeing, 70(5), 20-21. https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=141798911&site=ehost-live&scope=site&custid=s3818721Links to an external site.


Barber, C. (2015). Disability discrimination 5: How much does it cost? British Journal of Healthcare Assistants, 9(1), 30-33. https://10.12968/bjha.2015.9.1.30


Calloway, K., & Copeland, D. (2021). Acute care nurses’ attitudes toward nursing students with disabilities: A focused ethnography. Nurse Education in Practice, 51https://10.1016/j.nepr.2020.102960


Canine Companions. (2021). Who we are. https://canine.org/about/who-we-are/

Hudson, A. (2016). Nurses with disabilities. American Journal of Nursing, 116(2), 13. https://10.1097/01.NAJ.0000480478.58008.5fLinks to an external site.


Jarus, T., Bezati, R., Trivett, S., Lee, M., Bulk, L. Y., Battalova, A., Mayer, Y., Murphy, S., Gerber, P., & Drynan, D. (2020). Professionalism and disabled clinicians: The client's perspective. Disability & Society, 35(7), 1085-1102. https://10.1080/09687599.2019.1669436


Job Accommodation Network (JAN). (2021a). What does “direct threat” mean – A deconstructive series for ADA terminology. https://askjan.org/articles/What-Does-Direct-Threat-Mean-A-Deconstructive-Series-for-ADA-Terminology.cfm?csSearch=3788666_1Links to an external site.


Job Accommodation Network (JAN). (2021b). What does “undue hardship” mean? – A deconstructive series for ADA terminology. https://askjan.org/publications/consultants-corner/Leave-Undue-Hardship-Under-the-ADA.cfm?csSearch=3788667_1Links to an external site.


Krawczyk, M. (2017). Caring for patients with service dogs: information for healthcare providers. OJIN: The Online Journal of Issues in Nursing, 22(1). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-22-2017/No1-Jan-2017/Articles-Previous-Topics/Caring-for-Patients-with-Service-Dogs.html


McCulloh, K., & Marks, B. (2015). National organization of nurses with disabilities asks: What would you do? American Nurse, 47(1), 11. https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=101140969&site=ehost-live&scope=site&custid=s3818721Links to an external site.


Meeks, L., Jain, N., & Laird, E. (2021). Equal access for students with disabilities: The guide for health science and professional education 2nd edition. Springer.


Neal-Boylan, L., & Miller, M. (2020). How inclusive are we, really? Teaching and Learning in Nursing, 15(4), 237-240. https://10.1016/j.teln.2020.04.006


Neal-Boylan, L. (2014). Nurses with disabilities: Their job descriptions and work expectations. Rehabilitation Nursing, 39(4), 169-177. https://10.1002/rnj.122


Neal-Boylan, L. (2019). Having a disability may make you a better nurse. Workplace Health & Safety, 67(11), 567-568. https://10.1177/2165079919860541


Neal-Boylan, L., & Miller, M. (2016). The ADA and its amendment. Insight: The Journal of the American Society of Ophthalmic Registered Nurses, 41(2), 29-31. https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=114544419&site=ehost-live&scope=site&custid=s3818721Links to an external site.


NSI Nursing Solutions, Inc. (2021). 2021 NSI national health care retention & RN staffing report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdfLinks to an external site.


Oyeleye, O. A. (2019). The nurse practitioner's role in assisting clients with disabilities to receive reasonable accommodation under the americans with disabilities act. Journal for Nurse Practitioners, 15(7), 474-478. https://10.1016/j.nurpra.2019.03.005


Rodriguez, J. N., Marini, I., Chen, R. K., & Tanguma, J. (2020). An exploratory factor analysis: Factors influencing employers' disposition to hire and retain persons with disabilities. Journal of Vocational Rehabilitation, 52(1), 89-100. https://10.3233/JVR-191062


Shaffer, F. A., & Curtin, L. (2020). Nurse turnover: Understand it, reduce it. American Nurse Today, 15(8), 22. https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=145226098&site=ehost-live&scope=site&custid=s3818721Links to an external site.


Stenhouse, R. (2021). Understanding equality and diversity in nursing practice. Nursing Standard (Royal College of Nursing (Great Britain) : 1987), 36(2), 27-33. https://10.7748/ns.2020.e11562


Sunago, M. (2020). Strategies for nursing leaders on recruiting and retaining a diverse workforce. Creative Nursing, 26(1), 17-22. https://10.1891/1078-4535.26.1.17


Gould-Werth, A., Morrison, K., & Ben-Shalom, Y. (2018). Employers’ perspectives on accommodating and retaining employees with newly acquired disabilities: An exploratory study. Journal of Occupational Rehabilitation, 28(4), 611-633. https://10.1007/s10926-018-9806-6


Wilson, B. L., Butler, R. J., & Butler, M. J. (2016). Employment and wage disparities for nurses with activity limitations. Journal of Nursing Scholarship, 48(6), 608-615. https://10.1111/jnu.12253


Biographical Note:

Ellen King MSW BSN RN has been a deaf/hard of hearing nurse for more than 30 years working in areas such as critical care, public health, home health and psychiatric nursing. In addition to other reasonable accommodations, she has a Hearing Dog who goes with her to work (Canine Companions, 2021). Although there are several articles related to healthcare for patients with service animals, little or no literature exists regarding healthcare professionals with service animals (Krawczyk, 2017). The reason for this is most likely due to privacy issues. However, from personal experience, she has communicated with nurses with service animals who work in clinical and community nursing, including inpatient roles. She serves on the board of directors of the Association of Medical Professionals with Hearing Loss and is a former member of the Legislative Committee for Disability Rights California. She currently works for a large psychiatric hospital outpatient program in Sacramento, California. She is currently enrolled in the DNP-PMHNP program at the University of San Francisco. She can be reached at esking@usfca.edu.