Nurse Reporter Fall 2008 - Wyoming State Board of Nursing

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e fairly unflinching, but in fact, the NPAleaves significant room for interpretationon a case-by-case basis.First and foremost, each case must beconsidered individually to see if the licenseholder is “unfit or incompetent … topractice nursing with reasonable skill andsafety to patients.” Unfortunately, there isno national consensus on what constitutesprofession-wide competencies and skillsfor nurses, which makes legal interpretationof this statement problematic (Helms,Jorgensen, and Anderson, 2006). Thedecision of whether a nurse is unfit or incompetentmust be a joint endeavor of theregulatory agency, in this case the WyomingState Board of Nursing (WSBN), theemployer, the nurse in question, and thenurse’s health care provider.In the event of substance abuse issues,other parts of the NPA become relevant;in many instances, law enforcementagencies are also involved in gatheringevidence and reviewing the case. Currently,45 nurses are enrolled in the WyomingProfessional Assistance Program (WPAP)for treatment of substance abuse/chemicaldependency. At least that many nursesare represented in active open cases underinvestigation by the WSBN. Chemicaldependence is recognized as a disabilityunder the Americans with DisabilitiesAct (ADA); however, the ADA onlyprotects employees from discriminationif they are successfully rehabilitated andno longer abuse the substance in question(Snyder, 2008). Illegal conduct, such asuse of illegal drugs or illegal use of legaldrugs, is not conduct for which the ADArequires reasonable accommodation orpermits a disability discrimination lawsuit.This is an important point when discussioncenters around enfolding nurses withdisabilities back into the workforce; nurseswith chemical dependency must no longerbe engaged in illegal activities and must beenrolled in the WPAP (or other rehabilitationprogram) in order to have the opportunityto retain licensure and be permittedto continue practice.However, there are many disabilityissues other than chemical dependencywhen considering how disabled or health-Continued from previous pagecompromised nurses may remain in theworkforce. In just my own personal experienceas a practicing nurse and nurse educator,I have worked with nurses or taughtnursing students affected by multiplehealth issues, whether or not they fullyqualified or identified themselves as beingdisabled: cerebral palsy, congenital limbreduction, hearing impairment, speechimpediment, musculoskeletal problemscausing chronic pain and compromisinggait or movement, Type I and II diabetes,and various mental health disorders such asattention deficit disorder (ADHD), depressionand bipolar disorder. Some of thesenurses and nursing students needed specialaccommodations (special stethoscopes forIn this issue of the Wyoming NurseReporter, read the stories of nurses herein Wyoming who are struggling with thesevery questions. Ask yourself how youfeel about working with nurses who havehealth problems and/or disabilities. Considerhow each of us can provide “accommodations”for one another … sometimesas simple as offering compassion and anopen mind.hearing impairment or a particular typeof chair to support the back/spine). Mostdid not need anything other than understandingand compassionate peers andco-workers.Under specific circumstances, anemployer could attempt to raise questionsregarding a nurse’s fitness or competencyfor any of these health problems. Forexample, what if a diabetic nurse experiencedan unrecognized hypoglycemicepisode and made an error in caring for apatient? What if the nurse with a chronicback problem experienced a spasm whenmoving a patient and harmed the patientor exacerbated the injury and neededworkmen’s compensation? An employer, oreven co-workers, concerned with liabilitymay fret over any number of potential situationsand fear employing or working withnurses with health problems or disabilities,even if these employees are not asking forspecial accommodations. While employmentlaws and the ADA are designed toprotect the employee’s rights, one cannotlegislate attitudes and beliefs. The grayareas in law, regulation and even our ownpersonal beliefs leave a great deal of spacefor what course of action may be taken.In this issue of the Wyoming NurseReporter, read the stories of nurses herein Wyoming who are struggling withthese very questions. Ask yourself howyou feel about working with nurses whohave health problems and/or disabilities.Consider how each of us can provide“accommodations” for one another …sometimes as simple as offering compassionand an open mind.The WSBN is actively engaged inworkforce issues here in Wyoming. Aspart of our mission of public protection,the board is charged with regulation andlicensure of nursing professionals in thestate to ensure a robust nursing workforcefor all of the people of Wyoming.We challenge all Wyoming employersand nursing professionals to criticallyexamine the issue of including nurseswith health challenges and disabilities asvalued members of the healthcare team.We welcome your comments on this issue.ReferencesGallagher, T. (2008). Nurses in demand:Statement of the problem. Casper,WY: Wyoming Department of Employment,Research and Planning o. DocumentNumber)Helms, L., Jorgensen, J., and Anderson,M. A. (2006). Disability law and nursingeducation: An update. Journal of ProfessionalNursing, 22(3), 190-196.Snyder, E. K. (2008). Chemical dependency:Hospital not required to accommodaterestrictions re narcotics, no disabilitydiscrimination. Legal Eagle Eye for theNewsletter for the Nursing Profession,16(1), 4.Administrative rules and regulations,(2003).4 W y o m i n g N u r s e R e p o r t e r
Rose Rennell, RN, MS, COHN EmployeeHealth Nurse, Campbell County MemorialHospital, Gillette, Wyo.A Rose is Not Just a RoseRose Rennell, RN, MS, COHNI am a nurse. I have always been a nurse.Even in childhood, when playing withneighborhood friends, I was the nurse bandagingimaginary wounds. I officially beganmy nursing career as a licensed practicalnurse in 1978. I moved to Gillette, Wyo., in1980. I had to wait for the associate degreenursing program to come to the Gillettecampus to continue towards my goal ofbeing a registered nurse. By the time theprogram was ready to accept students, mycredits were too old to transfer. I was ableto earn credits by challenging many of thecourses and clinical requirements, but I stillhad to repeat some classes. As a mother oftwo growing children, maintaining full timeemployment with benefits was essential, soI completed most of the courses by takingnight classes. I enrolled in one or twoclasses a semester until I was accepted intothe associate degree program in January of1989.It was during fall break, Octoberof that year, that my children (now youngteenagers) and I went to Rapid City tospend time with my family. We started ourreturn to Gillette on Sunday evening. Theweather turned colder, forming black ice onthe highway. As we passed the exit of Sundance,Wyo., my little Chevy S-10 pickuptook a sudden slide sideways, landed in theditch, and rolled over onto the roof. I wasthrown partially out of the window. Thetruck rolled across my chest and dumped meface down in the ditch. This shattered myT4 and fractured T5 and T7. Thankfully,my children sustained only minor injuries.At that point, only two months fromgraduation, my world changed. I had a newname, T4 complete paraplegic.My co-workers, fellow students,instructors and friends never wavered intheir support. My rehabilitation includedmore than the physical preparation for mynew life. I was determined to finish my RN.With the help of a fellow nursing studentsending me typed lecture notes weekly andGillette campus instructors creating clinicalrotations, I did finish and graduated May1990. My focus on completing my nursingdegree kept me looking forward.The hospital where I had workedfor nine years did not know what to do withme. The idea of an RN in a wheelchair wasthinking way outside the box, and I kepthearing terms like “patient safety” and “bedsideaccessibility.” Our Infection Controlnurse, always the visionary, stepped forwardand proposed a new position called EmployeeHealth nurse. This would be a nursewho concentrated on meeting the healthand safety needs of the staff and has knowledgeof the Occupational Safety and HealthAdministration (OSHA) and Centers forDisease Control and Prevention (CDC)requirements. I continue to hold this position,and it has proven to be challengingand extremely rewarding. I now take care ofthe staff that took care of me. Believe mewhen I say there is nothing “cushy” about a“desk job.”I continued my education thanksto the support and encouragement frommy manager. I completed my Bachelor ofScience Degree in Nursing through the Universityof Wyoming’s RN to BSN programin 1997 and my Master of Science Degreealso from UW in 2002. I achieved nationalcertification in Occupational Health Nursingin 2001.Along the way, I met a mixture of supportand resistance for nursing from a wheelchair.Stereotypic attitudes are like blinders, preventingthe person from being seen beyondthe disability. I mostly ignore the doubtersand work around them. I have confidencein what I can do and know my limitations.The real beauty of nursing is the vast careerfields that are available. Bedside nursing isnot the only game in town.My disability has given me an insight tothe long lasting effects an injury can haveon the individual, the family, and financialstability. Workplace safety and preventionof work-related injuries is one of the mostimportant functions of my position. Whenan injury does occur, job accommodation isa viable option to keep the valued, skilledworker on the job. This is better for theemployer and the employee. If nothing else,I want to be living proof that working with adisability can be a win-win situation.
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Nurse Reporter Fall 2008 - Wyoming State Board of Nursing

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