Advancing a School of Nursing Center for Climate Change, Climate Justice, and Health.

This chapter addresses the development and advancement of the Center for Climate Change, Climate Justice, and Health (CCCCJH) in the School of Nursing at the MGH Institute of Health Professions, the first nurse-led center emerged from the overwhelming evidence of climate change and its associated deleterious health consequences. The Center steering committee developed a mission, vision, and core values as well as a logo to guide the first year of initiatives and galvanize the efforts for the future. Workshop and symposium development, implementation, and evaluation are discussed. Future directions and the importance of educational initiatives aimed at expanding nursing and interprofessional knowledge of the intersection of climate and health are discussed.

Registered nurses with disabilities: legal rights and responsibilities.

PURPOSE: The purpose of this legal case review and analysis was to determine what kinds of cases involving nurses with disabilities are typically brought to attorneys, which cases tend to be successful, and how and when a nurse with a disability should pursue legal action. DESIGN: The review used the standard legal case analysis method to analyze legal cases that have been brought by registered nurses (RNs) with physical or sensory disabilities from 1995 to 2013. The cases span the period following the enactment of the Americans With Disabilities Act (ADA) of 1990 through the ADA Amendments Act (ADAAA) of 2008. METHODS: A nurse attorney reviewed the background material to find every case involving an RN with a disability, excluding those with mental health disabilities or substance abuse issues. Case analysis was conducted using standard legal case analysis procedures. Fifty-six cases were analyzed. FINDINGS: The cases were categorized into five types of legal claims: (a) disability discrimination (84%); (b) failure to accommodate (46%); (c) retaliation (12.5%); (d) association (3.6%); and (e) hostile work environment (7%). The cases were largely unsuccessful, particularly those brought under the ADA instead of the ADAAA. CONCLUSIONS: The case analysis revealed that several cases brought by RNs with disabilities using the ADA might have been successful under the ADAAA. In addition, the case analysis has provided vital information for administrators, leaders, and clinical nurses regarding when a case is appropriate for legal action. These findings from this review will help nurses recognize when they are being treated in a discriminatory way in the workplace, what their legal rights and responsibilities are, and at what point they should pursue legal action. CLINICAL RELEVANCE: This review has relevance to all RNs working in clinical and academic settings who may have a congenital or acquired physical or sensory disability.

Transformational learning in graduate nurse education through podcasting.

AIM: To introduce faculty to podcasting, giving them opportunities for course integration in nursing. BACKGROUND: Faculty represented adult, gerontological, psychiatric, acute, and family health specialties interested in technology integration. METHOD: Faculty were invited to submit an abstract describing interest and experience with educational technology and intended use of podcasting. Each faculty received an iPod and sessions were held updating the required technical skills. Transformational learning was the conceptual framework, and faculty and students were encouraged and tutored in workshops to utilize podcast technology. Faculty launched podcasts on the university's platform, monitored students' responses, and conducted end-of-course evaluations. RESULTS: Faculty enthusiastically embraced podcasting's potential. Students' responses were mixed. Many viewed podcasts as extra work and preferred face-to-face class or written assignments. Podcasts were helpful to others, especially during commutes or for reviewing or reinforcing material. Auditory learners also preferred podcasts. CONCLUSION: Despite some technical difficulties, responses were positive. Using the theory of transformational learning and allowing students greater flexibility in obtaining knowledge, asynchronously, and at their own pace, proved beneficial.

Nurses with disabilities: their job descriptions and work expectations.

PURPOSE: To explore whether the job descriptions of registered nurses with disabilities actually match the work required by the job. DESIGN: This exploratory qualitative study used constant comparative analysis to simultaneously collect and analyze the data. METHOD: Newsletters and magazines for nurses as well as the snowball method were used to advertise for participants. Participants were asked to submit to an in-person or telephone audiotaped interview that utilized an unstructured interview guide. A coding structure was developed as themes emerged. Participant verification helped to ensure trustworthiness of the data. FINDINGS: Results confirmed findings from previous studies and found that nurses with disabilities who stay in nursing choose a job they can do, know and accept their limitations, have supervisors who are not nurses or who have a disability, and get accommodations so they can work. They rarely receive job descriptions, but it is assumed they can do the work because they are nurses. CONCLUSIONS: Nurse job descriptions are frequently not available or are inaccurate. There are jobs in nursing that nurses with disabilities can do competently and efficiently. Facilities and agencies should strive to retain these nurses and utilize their skills and expertise rather than focusing on what they are unable to do in the same way as a nurse without a disability. CLINICAL RELEVANCE: Nurses with disabilities are leaving nursing because they are not valued for their knowledge or abilities and are often prejudged because of the disability. The profession cannot afford to lose these nurses.

An exploration and comparison of the worklife experiences of registered nurses and physicians with permanent physical and/or sensory disabilities.

PURPOSE: To examine the worklife experiences of physicians, to further the exploration of the worklife experiences of nurses with disabilities, and to discover how the two healthcare professions compare with each other with regard to these experiences. METHODS: This study employed the research tradition of interpretive naturalistic inquiry and used constant comparative analysis to collect and analyze the data. FINDINGS: Despite the cultural and educational differences between physicians and RNs, their experiences as healthcare professionals with self-identified permanent physical and/or sensory disabilities were very similar. The research team identified five core themes. CONCLUSIONS: Healthcare professionals, including staff and administrators, need to make an effort to retain employees as turnover and predicted shortages are likely to jeopardize the current healthcare system. CLINICAL RELEVANCE: Modifications can be made within both professions to support people with disabilities and to enable them to contribute to their professions using their abilities to think critically, solve problems, and care for patients safely.

Retired RNs: perceptions of volunteering.

A qualitative study was done to explore the perceptions of volunteering among retired registered nurses (RNs) in Kansas. Participants were volunteers in formal nursing roles or were using their nursing knowledge and experience in non-nursing roles, such as church work. Regardless of the type of volunteer position, retired RNs reported that they use what they have learned as nurses when they volunteer. Volunteering benefits include enhanced self-worth, intellectual stimulation, reduced social isolation, and opportunities to help others. Increased paperwork, new technology, difficulty finding nursing-specific volunteer opportunities, resistance from health care organizations, and a lack of respect for what these nurses know are challenges and barriers to volunteering. Retired RNs have accumulated years of clinical nursing experience and can be helpful to employed nurses. Health care organizations should launch targeted efforts to recruit and utilize retired RN volunteers. Health care professionals who care for older adults should recommend volunteering as a healthful endeavor.

Nurses with sensory disabilities: their perceptions and characteristics.

A survey design was used to explore the perceptions and characteristics of registered nurses (RNs) with sensory disabilities and their risk for leaving their jobs. An earlier study found that nurses with disabilities are leaving nursing and that employers do not appear to support these nurses. Work instability and the mismatch between a nurse's perceptions of his or her ability and the demands of their work increase risk for job retention problems. This study's convenience sample of U.S. RNs had hearing, vision, or communication disabilities. Participants completed a demographic form, three U.S. Census questions, and the Nurse-Work Instability Survey. Hospital nurses were three times more likely to be at risk for retention problems. Nurses with hearing disabilities were frustrated at work. Hearing difficulties increased with years spent working as a nurse. Many nurses with sensory disabilities have left nursing. Early intervention may prevent work instability and increase retention, and rehabilitation nurses are ideally positioned to lead early intervention programs.

Failing to Fail When Disability Is a Factor.

BACKGROUND: Nursing faculty may be reluctant to fail students for a variety of reasons. Faculty may fear being viewed as discriminatory when failing nursing students with disabilities. PROBLEM: Schools of nursing may still be using technical standards that are outdated and noncompliant with the Americans with Disabilities Act (ADA) to determine eligibility for admission and may confuse essential functions with academic expectations. Lack of faculty awareness of the ADA may make faculty reluctant to fail nursing students with disabilities. APPROACH: All nursing students should be assessed based on whether-not how-they meet academic and clinical standards safely. Disability accommodations should not affect the standards that must be met. CONCLUSIONS: Faculty should base decisions on whether to assign failing grades to students on factors unrelated to a disability. Technical standards, when written correctly, should clarify whether inability or disability contributed to failure. Policies regarding failing should be clear, equitable, and accessible.

How inclusive are we, really?

Research has revealed that nurses and nursing students with disabilities experience discrimination. There are relatively few nurses with obvious physical disabilities working in clinical settings. Misconceptions abound regarding what a nurse with a disability can do. The focus tends to be on disability rather than ability. Similarly, prospective nursing students with disabilities are viewed with apprehension and caution. The overriding concern regarding nurses and nursing students with disabilities is that they will jeopardize patient safety. Nurse educators worry that students will not be able to complete the required skills and often confuse essential functions of nursing work with the academic standards required to graduate successfully. This article proposes that based on the research, we are not truly inclusive of nurses or nursing students with disabilities.

The benefits to working for retired RNs.

The population is aging leading to an increase of potential retirees. However, in light of current financial constraints, many people who might have retired may remain in the workforce. Others will nonetheless retire and may be interested in volunteering their skills and knowledge to help others. The literature is replete with discussions about how the population is aging, concerns about how to manage the health care of baby boomers, and how to handle the strain that these elders place on the community as a whole. However, there is relatively little professional literature regarding the contributions elders can make despite their wealth of knowledge and expertise or the benefits they might obtain from volunteering. Additionally, the continuing shortage of nurses is well known, as is its impact on health care delivery. Yet there is a scarcity of evidence-based literature describing how retired registered nurses (RNs) can help fill the gaps left by the nursing shortage and also contribute to their own health promotion. Research suggests that retired nurses are reentering the workforce because of financial constraints, which is likely to have a positive impact on the nursing shortage.

Having a Disability May Make You a Better Nurse.

Although a nurse with a disability is likely to experience discrimination in the workplace, they may be a better nurse because of their disability.

Killing Me Sovereignly: The Quiet Demise of the Americans With Disabilities Act.

PURPOSE: The aim of the study was to make rehabilitation nurses aware that the Supreme Court has limited some of the protections afforded by the Americans With Disabilities Act (1990) on the basis of "sovereign immunity." METHODS: The authors use the case review method to analyze Supreme Court cases and alternatives for people with disabilities discriminated against because of the state in which they live. FINDINGS: Sovereign immunity makes it more difficult for a disabled person to bring a lawsuit against a state government (as an employer or provider of a public service) under the Americans With Disabilities Act. CONCLUSION: The extent to which disabled Americans can fully participate in their communities should not depend on where in the country they live. CLINICAL RELEVANCE: As patient advocates, rehabilitation nurses are in an ideal position to educate patients and families and have a duty to make their voices heard to persuade lawmakers to strengthen legal protections for disabled Americans.

The Nurse With a Profound Disability: A Case Study.

Nurses are at significant risk for work-related injury, and ultimately disability. The purpose of this intrinsic single-case study guided by Yin's and Stake's iterative analytic processes was to examine one case of a registered nurse with a profound disability to determine whether this experience aligned with previous research and to examine whether a nurse with a profound physical disability could remain working in a clinical setting. The case study subject (a nurse with a profound physical disability) and the participants (people who knew, worked, and cared for the subject) were interviewed using a semi-structured interview guide. Interviews were transcribed and analyzed using Yin's mental framework and iterative analytic process. Participant verification, whereby the researcher confirms the data with each participant, was obtained. The results were aligned with previous studies and support the need to provide environments that utilize and retain nurses with physical disabilities. Nurses with physical disabilities can practice safely in patient care settings, provided there is a supportive culture and willingness to make accommodations. Occupational health nurses have the expertise to take the lead in educating nurses and managers to provide this supportive culture.

Integrating Climate Change Topics Into Nursing Curricula.

BACKGROUND: Health professionals have a key role in addressing the health impacts of climate change at several levels: direct patient care, client and community education, health professions education, and through advocacy and health policy development. METHOD: Recognizing that nurses are the first line in health education, nursing faculty at the MGH Institute of Health Professions developed the first nurse-led Center for Climate Change, Climate Justice and Health (CCCCJH). RESULTS: A steering committee of nurse climate change scholars and interested faculty developed a mission, vision, core values, and a strategic plan for the CCCCJH and are working on integrating climate change topics into nursing curricula at all levels. CONCLUSION: Nurses are in the ideal position to lead the way to increase awareness among health professionals and students about the health impacts of climate change. Curricular integration of climate change topics at all levels will prepare our students to meet the needs and challenges of the future. [J Nurs Educ. 2019;58(6):364-368.].

Nurse Author: Who Me? Yes, You!

BACKGROUND AND PURPOSE: Potential nurse authors may find writing a challenge, including managing the publication process from getting started through submission to revision of the work and its acceptance. This special article presents strategies to help inexperienced writers develop and hone skills for journal publication. POTENTIAL PUBLICATION STRATEGIES: Tips discussed here that may lead to manuscript acceptance include selecting a topic of interest, using motivational self-talk approaches and structuring time to write, choosing coauthors, targeting a journal for submission, writing strong sentences in active voice, developing a structured abstract, using correct citation and reference formats, understanding reviews and resubmitting the manuscript, and keeping momentum to produce continued writing results. Practical writing hints are also suggested for inexperienced writers. RELEVANCE AND CONCLUSION: These strategies can help guide nurse writers in planning, navigating the system, and finding success as a published author.

Nurses with disabilities: can changing our educational system keep them in nursing?

A recent qualitative study revealed that registered nurses with physical disabilities experience discrimination in the workplace and frequently leave their jobs and the profession. In light of these findings, it is vital that nursing faculty begin to inculcate students with an appreciation for collegial support before they enter the workplace as registered nurses. The familiar refrain "nurses eat their young" is apparently also true of nurses who have physical limitations. This article will discuss the findings from a qualitative study and offer recommendations for how nurse educators can educate students to help prevent the loss of nurses with disabilities from the profession.

Work experiences of RNs with physical disabilities.

Registered nurses who consider themselves to be physically disabled were interviewed regarding their experiences. Nurses who interview other nurses for hire were also interviewed. Participants were gathered from Virginia, Maryland, and Maine. Data collection and analysis were conducted using a qualitative methodology. Findings indicated that nurses with physical disabilities are leaving the workplace, and employers are not typically making accommodations to permit nurses to work safely and effectively in the patient-care setting. Nurses often hide their disabilities because they fear being rejected for employment and being stigmatized by colleagues. Rehabilitation nurses are in an ideal position to lead the way to reduce discrimination against nurses with disabilities. Many themes emerged from the study and are discussed in this article.