Council on Collegiate Education for Nursing Publications

THE AMERICANS WITH DISABILITIES ACT:
IMPLICATIONS FOR NURSING EDUCATION

(Reapproved 2004)

Foreword

In the early 1990s, the SREB Council on Collegiate Education for Nursing Board of Directors formed a task force to develop guidelines for nursing education programs to use in complying with the 1990 Americans with Disabilities Act (ADA). The members of the task force were:

Linda Davis (chairwoman), University of Alabama at Birmingham;
Linda Bowlin, University of Arkansas for Medical Sciences;
Katherine J. Futch, Grady Memorial Hospital (Atlanta); and
Mary Hazzard, Western Kentucky University.

Even today, nursing programs request these recommendations. Based on this continued interest in the task force’s work, the CCEN is pleased to provide these recommendations here on the Southern Regional Education Board Web site.

These recommendations should not be viewed as legal advice or opinions on specific matters. The board assumes no responsibility for the implementation of the proposed guidelines, which are intended to serve as a framework for individually developed procedures.

This report is not a judicial interpretation of the ADA provisions. The task force urges nursing education programs to have the institution’s attorney review ADA compliance procedures. Because private institutions are covered by Title III of the act, compliance requirements may vary.

Background and definitions

The U.S. Congress passed the 1990 Americans with Disabilities Act (ADA) to prohibit discrimination against qualified people with disabilities. The act defines a disabled person as someone a) who has a physical or mental impairment that substantially limits one or more of his or her major life activities; b) who has a record of such impairment; or c) who is regarded as having such an impairment.

For the purposes of nursing programs’ compliance, a "qualified individual with a disability" is one who, with or without reasonable accommodations or modifications, meets the essential eligibility requirements for participation in the program. Thus, each institution may want to begin by defining the essential eligibility requirements for participation in its nursing program.

In developing the core performance standards, the CCEN task force used the definition of nursing as a practice discipline with cognitive, sensory, affective and psychomotor performance requirements. Each standard is accompanied by an example of an activity that a student would be required to perform in the typical collegiate nursing-education program. Each standard, if adopted, must be reflected in the course objectives.

Nursing programs must not base admission or continued enrollment on the standards but instead should use them to assist each student in determining whether accommodations or modifications are necessary. A student and his or her adviser should use the standards as an objective measure in deciding whether the student is "qualified" to meet requirements. Every applicant and student should have a copy of the standards.

If a student believes that he or she cannot meet one or more of the standards without accommodations or modifications, the nursing program must determine, on an individual basis, whether the necessary accommodations or modifications can be made reasonably. Reasonable accommodation is defined by the act to include:

making existing facilities … readily accessible to and usable by individuals with disabilities;
job restructuring;
part-time or modified work schedules;
acquisition or modification of equipment or devices;
appropriate adjustments to or modifications of examinations, training materials or policies; and
the provision of qualified readers or interpreters.

The school shall develop procedures for students to receive appropriate assistance and guidance if they identify potential difficulties with meeting the core performance standards.

Recommendations for nursing education programs

Institutional resources should be made available to advise and counsel applicants and students who qualify under the ADA.
The institution should provide appropriate admissions staff, faculty and administration with training on the ADA and ADA guidelines.
The core performance standards should be made available to:

all potential applicants (for example, in catalogs, application materials and materials that describe the program);
nursing faculty, staff and students;
the state board of nursing and other accrediting groups for nursing; and
agencies where educational experiences in clinical nursing occur.

The nursing program should cooperate with other institutional units to identify auxiliary aids and services, such as building accessibility and hearing devices, that may be needed for "reasonable accommodation."
There should be procedures to provide students with appropriate guidance and assistance regarding the ADA and the core performance standards.

Core performance standards for admission and progression

Issue	Standard	Examples of necessary activities (not all-inclusive)
Critical thinking	Critical-thinking ability sufficient for clinical judgment	Identify cause/effect relationships in clinical situations, develop nursing care plans
Interpersonal	Interpersonal abilities sufficient for interaction with individuals, families and groups from various social, emotional, cultural and intellectual backgrounds	Establish rapport with patients/clients and colleagues
Communication	Communication abilities sufficient for verbal and written interaction with others	Explain treatment procedures, initiate health teaching, and document and interpret nursing actions and patient/client responses
Mobility	Physical abilities sufficient for movement from room to room and in small spaces	Move around in patient’s room, work spaces and treatment areas; administer cardiopulmonary procedures
Motor skills	Gross and fine motor abilities sufficient for providing safe, effective nursing care	Calibrate and use equipment; position patients/clients
Hearing	Auditory ability sufficient for monitoring and assessing health needs	Hear monitor alarm, emergency signals, auscultatory sounds and cries for help
Visual	Visual ability sufficient for observation and assessment necessary in nursing care	Observe patient/client responses
Tactile	Tactile ability sufficient for physical assessment	Perform palpation, functions of physical examination and/or those related to therapeutic intervention (such as insertion of a catheter)

Examples of disabilities likely covered by the ADA

Physical impairments

Orthopedic, visual, speech and hearing impairments
Cerebral palsy
Epilepsy
Muscular dystrophy
Multiple sclerosis
Cancer
Heart disease
Diabetes
HIV (symptomatic or asymptomatic)
Tuberculosis
Addictions

Mental impairments

Retardation
Organic brain syndrome
Psychiatric disorders
Learning disabilities

Examples of "a record of such impairment"

History of the following:

Psychiatric illness
Addiction to drugs or alcohol
Physical illness
Erroneous diagnosis with a condition

Examples of "regarded" as having a disability

Deformity not affecting function (such as facial or trunk deformity)
Mild diabetes mellitus controlled by medication

References

Cicolino, J., G. Long and C. Spindler. "The Americans with Disabilities Act: Compliance and Complaints." Public Sector, 14(3). 1992.

Jones, N.L. The Americans with Disabilities Act (ADA): An Overview of Major Provisions. Washington, D.C.: Congressional Research Service, 1992.

Kingsley, W.E. "The Americans with Disabilities Act of 1990." Arnall Golden & Gregory Bulletin.

Marx, G.S. "The Impact of the Americans with Disabilities Act on Colleges of Nursing." A paper presented in Washington, D.C., at the 1992 meeting of the American Association of Colleges of Nursing.

National Council of State Boards of Nursing Inc. "Implications of the ADA for Boards of Nursing." Nursing Issues. 1992.

Watson, J.W. Americans with Disabilities Act: Final Rules and Information Sources. Washington, D.C.: Congressional Research Service, 1992.

For more information, e-mail Eula Aiken at eula.aiken@sreb.org.