1. Neal-Boylan, Leslie PhD, CRRN, APRN, FAAN

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I am writing in response to the recent article "Guidelines for Response to Student Requests for Academic Consideration: Support Versus Enabling" in the May/June 2014 issue (39:3). As one who has conducted several research studies on issues related to nurses with disabilities, I am disheartened to read that misconceptions such as those expressed in this article still exist. While the article addresses several reasons why a student might require additional academic consideration, my letter will address "Scenario 5: Physical and Mental Health Issues" because physical disability is my area of expertise. First, let me call the authors' attention to the Amendment to the Americans With Disabilities Act (ADA) of 2008. The amendment has required a much broader interpretation of disability.


The discussion about students with physical disabilities should not occur in the context of academic considerations. To do so implies that someone with a physical disability is in some way impaired in his/her ability to perform well academically. It is shocking to think that nurses do not differentiate between the ability to walk, for example, and the ability to think. To suggest that students who cannot meet the technical standards should find a different career excludes all of the people with the intelligence to become nurses. After all, we constantly say that critical thinking and good judgment are what make a good nurse. Do we want to only be known by whether we can perform a skill that anyone can learn? In addition, as the population of nurses ages, the incidence of disability among us is likely to increase. Shall we disregard all nurses, regardless of their expertise, if they can no longer run down a hallway?


Furthermore, the authors include students with physical "issues" in the same scenario as students with mental health issues. This is a mistake because physical disabilities and mental health disabilities are vastly different. To lump these "issues" or concerns into 1 section may lead to the erroneous conclusions discussed in the article. My research and that of others have shown time and again that nurses with a variety of physical disabilities and chronic illnesses are able to compensate safely for what they cannot do in the traditional way. There is also ample and growing evidence that nursing students with physical disabilities are able to perform the required skills given new and emerging technologies or if allowed to perform skills in a safe but somewhat altered fashion. Moreover, the technical standards we use to measure whether a student has the physical ability to be a successful nursing student are outdated and archaic. Several nursing organizations who were represented at a recent meeting in Washington, DC, at the Office of Disability Employment Policy (Department of Labor) recommended that the technical standards be overhauled and updated to reflect realistic expectations of nursing students.


The authors contend that students with disabilities "exploit" faculty so that the disability can work to their advantage. To blatantly state that students may want to be disabled to avoid school work is insulting to people with disabilities. In addition, the authors recommend that students not be allowed to disclose their disabilities retroactively. However, it is no wonder that students might be reluctant to reveal their disability if the subsequent response is as negative as those expressed by the authors. A student who summons the courage to reveal a physical disability should be supported and encouraged to go to the university's office on disability for information and assistance, if needed.


It is clear that the authors are not acquainted with the nursing literature on this topic and have misconceptions and biases about disability, students with disabilities, and ultimately what nurses with disabilities can accomplish. It is important that nurse educators recognize that students with physical disabilities are capable of completing nursing programs successfully and of practicing as competent nurses. The Amendment to the ADA of 2008 recognized the need to prevent discrimination, and as nurses become more aware of the legislation and its impact on hiring and firing practices, the clinical sites in which we place our students for their clinical practica are likely to become more amenable to accommodating nursing students with disabilities. We must let go of the idea that every student must be able to perform every skill to become a competent nurse, particularly because there are so many settings in which a nurse can work that do not require these skills.


Leslie Neal-Boylan, PhD, CRRN, APRN, FAAN


Associate Dean and Professor


School of Nursing, Quinnipiac University


Hamden, Connecticut (