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 constitutespr<strong>of</strong>ession-wide competencies and skillsfor nurses, which makes legal interpretation<strong>of</strong> this statement problematic (Helms,Jorgensen, and Anderson, 2006). Thedecision <strong>of</strong> whether a nurse is unfit or incompetentmust be a joint endeavor <strong>of</strong> theregulatory agency, in this case the <strong>Wyoming</strong><strong>State</strong> <strong>Board</strong> <strong>of</strong> <strong>Nursing</strong> (WSBN), theemployer, the nurse in question, and thenurse’s health care provider.In the event <strong>of</strong> substance abuse issues,other parts <strong>of</strong> 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 <strong>Wyoming</strong>Pr<strong>of</strong>essional Assistance Program (WPAP)for treatment <strong>of</strong> 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, <strong>2008</strong>). Illegal conduct, such asuse <strong>of</strong> illegal drugs or illegal use <strong>of</strong> 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 <strong>of</strong> thesenurses and nursing students needed specialaccommodations (special stethoscopes forIn this issue <strong>of</strong> the <strong>Wyoming</strong> <strong>Nurse</strong><strong>Reporter</strong>, read the stories <strong>of</strong> nurses herein <strong>Wyoming</strong> who are struggling with thesevery questions. Ask yourself how youfeel about working with nurses who havehealth problems and/or disabilities. Considerhow each <strong>of</strong> us can provide “accommodations”for one another … sometimesas simple as <strong>of</strong>fering compassion and anopen mind.hearing impairment or a particular type<strong>of</strong> 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 <strong>of</strong> 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 <strong>of</strong> 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 <strong>of</strong> spacefor what course <strong>of</strong> action may be taken.In this issue <strong>of</strong> the <strong>Wyoming</strong> <strong>Nurse</strong><strong>Reporter</strong>, read the stories <strong>of</strong> nurses herein <strong>Wyoming</strong> who are struggling withthese very questions. Ask yourself howyou feel about working with nurses whohave health problems and/or disabilities.Consider how each <strong>of</strong> us can provide“accommodations” for one another …sometimes as simple as <strong>of</strong>fering compassionand an open mind.The WSBN is actively engaged inworkforce issues here in <strong>Wyoming</strong>. Aspart <strong>of</strong> our mission <strong>of</strong> public protection,the board is charged with regulation andlicensure <strong>of</strong> nursing pr<strong>of</strong>essionals in thestate to ensure a robust nursing workforcefor all <strong>of</strong> the people <strong>of</strong> <strong>Wyoming</strong>.We challenge all <strong>Wyoming</strong> employersand nursing pr<strong>of</strong>essionals to criticallyexamine the issue <strong>of</strong> including nurseswith health challenges and disabilities asvalued members <strong>of</strong> the healthcare team.We welcome your comments on this issue.ReferencesGallagher, T. (<strong>2008</strong>). <strong>Nurse</strong>s in demand:<strong>State</strong>ment <strong>of</strong> the problem. Casper,WY: <strong>Wyoming</strong> Department <strong>of</strong> Employment,Research and Planning o. DocumentNumber)Helms, L., Jorgensen, J., and Anderson,M. A. (2006). Disability law and nursingeducation: An update. Journal <strong>of</strong> Pr<strong>of</strong>essional<strong>Nursing</strong>, 22(3), 190-196.Snyder, E. K. (<strong>2008</strong>). Chemical dependency:Hospital not required to accommodaterestrictions re narcotics, no disabilitydiscrimination. Legal Eagle Eye for theNewsletter for the <strong>Nursing</strong> Pr<strong>of</strong>ession,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 <strong>Nurse</strong>, 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 <strong>of</strong>ficially 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 <strong>of</strong>being 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 <strong>of</strong> thecourses and clinical requirements, but I stillhad to repeat some classes. As a mother <strong>of</strong>two growing children, maintaining full timeemployment with benefits was essential, soI completed most <strong>of</strong> the courses by takingnight classes. I enrolled in one or twoclasses a semester until I was accepted intothe associate degree program in January <strong>of</strong>1989.It was during fall break, October<strong>of</strong> 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 <strong>of</strong> Sundance,Wyo., my little Chevy S-10 pickuptook a sudden slide sideways, landed in theditch, and rolled over onto the ro<strong>of</strong>. I wasthrown partially out <strong>of</strong> 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 <strong>of</strong> 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 <strong>of</strong> 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 <strong>of</strong> the staff and has knowledge<strong>of</strong> 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 <strong>of</strong>the staff that took care <strong>of</strong> 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 <strong>of</strong>Science Degree in <strong>Nursing</strong> through the University<strong>of</strong> <strong>Wyoming</strong>’s RN to BSN programin 1997 and my Master <strong>of</strong> Science Degreealso from UW in 2002. I achieved nationalcertification in Occupational Health <strong>Nursing</strong>in 2001.Along the way, I met a mixture <strong>of</strong> 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 <strong>of</strong> 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 prevention<strong>of</strong> work-related injuries is one <strong>of</strong> the mostimportant functions <strong>of</strong> 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 pro<strong>of</strong> that working with adisability can be a win-win situation.