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Candy
Moore
Nursiing
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 When
Candy Moore was in high school, she got her first job working
in a nursing home. Watching the head nurse give 100% to her
patients drew Moore to the nursing profession. She never thought
much about the fact that she didn't have a left hand, and
didn't think that it caused the faculty at Walla Walla University
in Washington much concern either. They rarely mentioned it.
Looking back at her experiences at Walla Walla 27 years ago,
she can now recognize that she was treated differently than
some of the other students. She was given more opportunities
to practice on patients rather than just observe. Once, students
in her nursing class waited several days to observe a birth
in a labor and delivery unit. When a patient was finally ready
to deliver, Moore was asked to assist, while the other students
watched. The faculty would ask students, "How are you
going to do this?" Moore sees now that when asking her,
they didn't necessarily already know. For example, the faculty
taught her the Z track method of giving injections, that the
other students wouldn't learn until later, because it is usually
only used for specific medications. However, she decided to
use it for all of her injections because it only requires
one-hand.
Moore eventually went on to get her Master's in medical/surgical
nursing, specializing in gerontology. She chose gerontology
because "older people are so complex, and I would never
get bored. It was also like coming full circle, from where
I started in high school." She now has 27 years working
in various settings as a med/surg nurse and nursing supervisor.
She is also a faculty member in the nursing program at Elgin
Community College in Illinois.
Moore says she never really thought of herself as a "disabled
nurse" until recently, when she became a faculty member.
"Of course I knew I didn't have a left hand, and that
I did some things differently, but I didn't realize how others
saw me and nurses with disabilities until a prospective student
who uses a wheelchair came to visit our program. I was actually
taken aback by the reactions that she provoked," Moore
explained. Moore had always assumed that the nursing profession
would not have any issues with capable individuals with disabilities
who wanted to become nurses. "We are the profession that
is always promoting self-actualization, ... We look at the
whole person and say, how can we get through this? How can
you get through this? What are your goals? And let's go."
When Moore saw what she perceived as doors being shut on individuals
with disabilities by the nursing profession, she thought simply,
"This is not okay." She decided to take some time
to really do some research and had to learn how to articulate
that disability is a diversity issue, like race or nationality.
Now, she has written and lectured to several hospitals and
nursing associations around the country about what she has
learned.
One of the big issues that faces prospective nurses with disabilities
today that was not an issue when Moore went to school was
the formation of technical standards. Technical standards
were formed after the implementation of the Americans with
Disabilities Act in the 1990's and usually list physical abilities
that a student must have to enter a nursing program. Moore
sees this as a way to shut and lock the doors to qualified
students with disabilities.
To illustrate her point, Moore talks about a meeting she had
with the Dean of Nursing when she was beginning her nursing
program. "I had some fussing with the dean about my abilities,
but was able to convince her to give it a go. Now, a Dean
can pull out this [list of technical standards] and say 'It
doesn't matter what you think you can do, how you can accommodate,
you need to have this degree of vision, have this degree of
ability to lift, have this ability to walk, have this ability
to think, have this ability to lift 50 pounds…' and so
forth. The technical standard list can be endless. I would
have never been allowed to be a nurse, if there were technical
standards back then". "Currently, many nursing schools
are writing technical standards because the American Disability
Act allows for it. But admission criteria are very different
from technical standards. And technical standards, I think,
will cause more doors to close than to open for the perspective
nursing student because when you show that list to the person
with the disability, there's a very different perception than
showing it to someone without a disability."
One of the more practical problems with technical standards
that Moore sees is that nursing is such a varied and wide-ranging
field, each job would have very different technical functions.
For example, a poison control center nursing position may
require hearing but not lifting 50 pounds. A nurse who works
outdoors in Africa has very different job requirements than
a nurse administrator or an ICU nurse. Some positions may
require a bilingual nurse; some may not. Some positions have
more Nurse Assistants who can pitch in and help with some
of the physical requirements, some nurses work alone, such
as home health settings.
"The nursing profession has not captured the essence
of nursing in these technical standards. As a profession,
we need to determine what the essence of nursing is. Is it
more important to lift 50 pounds and have good manual dexterity,
or to have a passion for human life, think critically, have
a knowledge base, have good communication skills, have integrity
and responsibility towards life? These seems to more effectively
capture the essence of nursing."
As a faculty member, Moore has come to realize that faculty
are sometimes too far removed from nursing jobs to realize
how people share work and improvise. She sees that faculty
sometimes have the idea that they send out perfectly safe
and prepared-to-do-everything nurses. "As faculty members,
we don't have to do it all. [The certification exam], NCLEX
will test unsafe knowledge. Evaluations and onsite probation
test safe performance of essential functions through individual
job descriptions. The outcome needs to be met, the method
can be more flexible," Moore reasons.
"All people choose where they feel the most competent.
Nurses have always seen themselves as safety nets for patient
care after doctors go home. Nurses are the first line of defense
when there is a problem, so we take safety to heart. But this
causes nurse faculty to sometimes miss the big picture. Are
we gate keepers or are we opening the gate?"
Moore goes on to talk about the American Nurses Association
(ANA) code of ethics about protecting patient safety and the
responsibility of being aware of individual competency level.
"A skill of nursing is to know when to ask for help consultation.
Faculty will sometimes think that a nursing student with a
disability won't rely on the same code, that we have to decide
for them, above and beyond what we would do for a student
without a disability. This takes the professionalism out of
nursing, and says we don't really trust our code. This can
cause a drift from professionalism, where we have an integrity
and knowledge base, and a code of ethics. This is unfortunate
because we have worked so hard to come from the old labels
as doctors handmaidens with no independent tasks or thoughts."
Moore sees this as a double standard that treats students
with disabilities unfairly.
Another double standard that Moore sees in nursing programs
is the evaluation discrepancies between the different domains
that are assessed in nursing. For example, nurse's cognitive
skills, psychomotor skills, and effective skills are all evaluated.
However, Moore says that a higher emphasis is placed on psychomotor
than any other domain. A nursing student is required to be
100% perfect in the psychomotor domain, but may only be required
to be 75% of perfect in the cognitive domain. "No one
gets 100% on the NCLEX, but if you can do every procedure
except filling a syringe, you won't pass. Its understood that
nurses will have gaps in knowledge and that they will ask
others for assistance, but it is not acceptable to know all
the steps and safety precautions in transferring a patient,
but supervise an assistant to do the physical work."
Moore says that faculty members forget that in the real world,
nurses blend their skills all the time.
Another issue that concerns Moore is that of the NCLEX exam
itself. Currently, many students are denied reasonable accommodations
such as use of a reader, time extensions, or a scribe for
the exam. Moore says, "It doesn't make sense. You are
allowed to use the accommodations in school, you are allowed
to use them in the workplace. Why not use them on the exam?
It is just another example of a door being closed."
Moore sees an ironic difference among how nursing schools
approach the issue of students with disabilities. "Some
schools are open, some are closed. Some are supportive of
students with disabilities; some are not. They teach essentially
the same content, but have completely different philosophies.
The difference, I think, is leadership. If leaders set the
tone with fear and discrimination, faculty will follow. If
leaders set an open tone and express care for students and
the profession, things will be worked out."
Moore says that she sometimes sees nurse faculty gets in "nurse
mode". They start thinking of the student with a disability
in medical terms. They see disability is a medical condition
that is a deficit, undesirable, and in need of fixing. She
says that it is sometimes hard for medical people who are
not used to looking at a social model of disability to learn
from people with disabilities about different ways of doing
things.
She looks for answers within the profession's history as well.
She sees lessons in how, not so many years ago, married women
were not admitted to nursing schools. African American nurses
attended segregated schools and practiced in segregated hospitals.
Male nurses were unheard of. Moore believes that nursing will
grow past its intolerance of nurses with disabilities in the
future, and find value with their diversity as happened with
married, male, and African American nurses. "Valuing
a person is different than tolerating a person. Nurses especially
must learn to value people who are different from them. Nursing
surpasses toleration, it is about the human experience."
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