Last week, in the midst of National Nurses Month, we announced what we hope will be an impactful grant opportunity for nursing faculty. Disability Inclusion in Nursing: A Grants Program to Advance Innovation and Systems Approaches for Nursing Education and Practice, launched with the support of the Robert Wood Johnson Foundation, would not be possible without the expert guidance of our Advisory Committee. Brigit M. Carter, PhD, RN, FAAN, Lauren Clark, RN, PHD, FAAN, Brandy Jackson, MSN, MBA, RN, and Bonnielin K. Swenor, PhD, MPH, provided critical leadership throughout the development of this award and will also serve as members of a larger reviewer committee. In this month’s Macy Notes, they share their perspectives on the rationale for the Disability Inclusion in Nursing grant and their hopes for its impact.
Given that the Americans with Disabilities Act (ADA) was enacted more than 30 years ago, why is a grant program intended to promote and advance equity and inclusion for nursing students with disabilities still needed?
(Brandy Jackson) For years, there have been misconceptions surrounding the impact of the ADA on nursing and nursing students. Some have assumed that nurses with disabilities are unable to fulfill the necessary nursing responsibilities, a notion that was widely accepted. Despite the ADA being three decades old, it’s only recently that nursing has started to recognize the need for a deeper exploration of these misconceptions. I believe that the nursing profession holds a unique position to challenge and dismantle ableism.
(Bonnielin Swenor) Although the ADA was passed more than 30 years ago, disability rights, equity, and justice efforts are lagging, especially in health care and academic environments. This grant program from the Macy and Robert Wood Johnson Foundations elevates the need to prioritize the inclusion and belonging of disabled people in nursing programs and provides the much-needed support to catalyze such change.
(Brigit Carter) As with many initiatives within nursing, education on historical barriers and development of critically needed strategies to advance an inclusive environment for nursing students in academia and current nurses within health care systems. Highlighting the importance of recognizing people with disabilities in conversations about equity and inclusion will help to generate the development of meaningful approaches that can be generalized to nursing programs across the nation. Inclusion is an intentional action; therefore, our goal should be to move beyond the dialogue and implement concrete actions that have a positive impact on increasing access for students and nurses with disabilities.
(Lauren Clark) The main reason, for me, is that we’re missing a critical talent pool. We need nurses with lived experience of disability to join us in making critical improvements in nursing. Without them, we have struggled to implement care with universal design in mind. We lag in designing hospital and clinic accessibility policies for nurses with temporary and permanent disabilities. And we absolutely need disabled nurses in faculty roles. Altogether, we can do better in terms of universal design for instruction, accommodations in the clinical learning environment, and preparation of all nurses in culturally competent care related to disability.
Is it accurate to assume that, in a health care setting, biases against nurses with disabilities—whether expressed or not, conscious or not—can be easily shrouded in concerns about quality of care, patient safety, etc.? What are the most effective options for countering such biases among patients, faculty, or care team members?
(Ms. Jackson) It is accurate to assume there are biases in health care; research has indicated such biases exist. However, no evidence exists that suggests patients cared for by nurses with disabilities experience adverse outcomes. I believe countering biases involves listening to concerns, meeting individuals where they are, having meaningful conversations, and working to dispel myths. However, innovative ideas and research are essential to support meaningful change.
(Dr. Clark) The Institute of Medicine (IOM) found no evidence that nurses with disabilities are responsible for more errors in clinical settings than anyone else. Beth Marks’s paper talks about disabled nurses’ safety and reminded me that the IOM attributes errors to faulty systems, processes, and conditions in the health system. Let’s reframe this question and note that people with disabilities have experienced more than their share of errors in health care settings. Sometimes our errors cause harms that are not reversible, and people live with those outcomes as disabilities. Other times, our callous treatment of disabled people repels them from seeking timely care. Having disabled nurses in our profession will help us reflect on disabled patients’ care and safety and do better work on their behalf.
(Dr. Carter) Nurses who have a disability are extremely capable of providing safe, high-quality patient care, but must be provided equitable resources to support the needs required by the disability. Implicit and explicit bias, physical barriers, and attitudes are some of the more common challenges nursing students and nurses encounter, which prevent them from achieving their highest level of ability and potential.
The goal for mitigating biases is to create concrete actions that will confront and dismantle discriminatory actions in the admission and retention of students in the academic environment and the hiring of nurses in the health care setting. It is the responsibility of leaders to ensure that we design structures within academic and health care environments to support the needed accommodations and create an environment that is free from discriminatory behaviors.
(Dr. Swenor) We are facing a critical nursing workforce shortage. Yet, people with disabilities face formidable barriers across nursing education and careers, resulting in an avoidable loss of nursing talent. A paradigm shift is needed. Nursing programs have the power to address ableism and biases against people with disabilities—as patients and as providers—through what they teach and whom they include.
What kinds of programs do you hope will emerge from or change as a result of the funded demonstration projects?
(Dr. Carter) The optimal projects would address system-level innovation as well as organization- and individual-level barriers. Systems that have policies and practices that support ableism need to be redesigned or dismantled (e.g., technical standards used to prevent access to nurses with disabilities). The clinical learning environment should be designed so that it supports nurses with disabilities and enhances equitable, high-quality care for patients with disabilities. I also hope to see projects that will educate and increase awareness of the discrimination and prejudice that defines nursing students and nurses by their disability.
(Dr. Swenor) I hope this funding opportunity will lead to programs that dismantle ableism using top-down and bottom-up approaches. This includes revising nursing curricula; cultivating a culture of disability inclusion and belonging among students, faculty, and staff; supporting the career growth of disabled people into nursing leadership roles; and holding nursing leaders accountable with data and transparency.
(Dr. Clark) There’s plenty of room for new ideas that leapfrog to creative solutions to build disability-inclusive nursing capacity. For example, we could see clinical partners come forward with projects that create seamless pathways to employment for nursing students with disabilities. Students with disabilities could experience fully accommodated clinical rotations at the hospital, for example, and then transition to a new graduate nursing internship at the same hospital. It’s a win-win-win for nursing students, schools of nursing, and clinical agencies. In the end, the clinical setting and the partner school build expertise in clinical accommodations alongside one another, and then retain the talent of recent graduates with disabilities in their workforce.
More commonly, I expect we will see incremental change proposals, like programs that tackle outdated technical standards for admission. Or proposals that build stronger partnerships with the campus accessibility office to better accommodate students in didactic, clinical, simulation, and skills areas.
(Ms. Jackson) I am filled with anticipation for the change that will result from these projects. My hope is for these projects to propel nursing forward, fostering inclusivity for nurses and nursing students with disabilities to be openly welcomed in the profession. I would love to see projects that foster a collaborative approach to create inclusive clinical learning environments for nursing students with disabilities.