Little research exists on nursing students with accommodations in higher education. Nursing schools historically do not admit students to nursing programs with physical disabilities due to the technical requirements of being a Registered Nurse (RN). However, students choose a nursing school for a variety of reasons, and a majority of the time, it is because of a positive interaction with a nurse, sometimes due to their own engagement with the healthcare system due to a disability (Elting et al., 2020). The number of RNs or nursing students with a disability is unknown as there is oftentimes no self-disclosure due to fear of losing their job, place in the nursing program, or other discrimination (Englund & Lancaster, 2022; Marks & Sisirak, 2022; Ramluggan et al., 2020; Trujillo, 2021). Disabilities can include physical differences (visual, health, ambulation) and/ or differences in cognition (learning issues and psychiatric diagnoses) (Neal-Boylan & Miller, 2020). For the purposes of this article, the authors will focus on learning disabilities, anxiety, stress, and other emotional differences. This article will outline how to best support students with disabilities in nursing school while preparing them to become RNs.
Nursing is historically known as one of the most difficult majors in any college or university. Stress and anxiety caused by rigorous academic programs can create a disruption in the learning process (Brown et al., 2020; Ryan & Mulvogue, 2022; Wang et al., 2019). With the destigmatization of mental health concerns and the increase in diagnoses of anxiety disorders, nursing students are becoming more likely to have and utilize accommodations in the college classroom (Horkey, 2019; Morina & Orozco, 2020). The question arises of how best to support these students effectively in both lecture and practical testing while also preparing them for the National Council Licensure Examination (NCLEX) and entry to practice. The answer lies in both an integrated approach between disability support services (DSS), faculty, and advisors and individualized approaches that are cognizant of student needs. The approach is determined after a student notifies their program of the presence of a disability.
One of the major barriers in supporting any student with a disability, particularly nursing students, is creating a space in which the student feels comfortable divulging the need for support and accommodations. Particularly early in their academic career, a common narrative thread tends to develop for students with disabilities; they feel as though they are defined by their support in high school and want to make an attempt to “go it alone” in college, eschewing the accommodations that aided their previous success (Brown et al., 2020; Horkey, 2019; Neal-Boylan & Miller, 2020; Yarbrough & Welch, 2021). After struggling in coursework and, perhaps, receiving poor grades, students will then share with faculty or staff that they had accommodations in prior academic settings but did not pursue them in the college setting. At that point, it may be too late in the semester to complete the necessary requirements to receive formal support from the institution.
A similar situation can also develop with students who have never received formal diagnoses in the past, as their struggles manifest an imposter syndrome where they believe they are simply unable to keep up with the curriculum and feel shame in seeking support. A practical route to begin combatting this issue is to emphasize to students, both as a group and individually, that support resources are available and that the expectation is that students will utilize those resources rather than placing emphasis on individual hard work and sacrifice (Carroll & Eaton, 2019; Yarbrough & Welch, 2021). Acknowledging that nursing programs are difficult and that asking for help is welcome creates a space in which students feel that they can speak to their faculty and advisors about difficulties they are having. These simple statements begin the process of destigmatizing disability support and creating a rapport with students.
Beyond creating an environment of welcoming and understanding for students with disabilities, academic institutions also have the responsibility of ensuring the processes of learning about and obtaining accommodations are direct and easily accessible. The onus cannot be on a struggling student to parse through a decentered bureaucracy in order to receive the help they need. Faculty and staff can ensure this in several ways. Utilizing technology platforms to organize student resources has been hugely beneficial at the University of Delaware, where the use of the Education Advisory Board’s Success platform allows faculty and advisors to make electronic referrals directly to other offices on campus, including DSS. Once the office messages the student, the person who issued the referral is alerted that outreach has occurred. By closing this loop, administrators avoid situations where students lose contact information, are unable to reach someone or fail to do outreach on their own. Additionally, at larger institutions, the process of being evaluated and recommended for accommodations can be a lengthy and expensive procedure, delaying needed support and dissuading students from pursuing them (Stinnette Lucas et al., 2022). However, once a student has shown that they have begun the process, faculty can also coordinate with administrators in their unit to provide some basic accommodations in advance, such as providing an isolated space to take an exam.
The more difficult element comes in effectively providing support resources in the context of nursing curricula and creating an integrated network for those resources between unit administration, DSS, and faculty. Schools of Nursing can often feel like isolated entities on college and university campuses due to the unique nature of prelicensure programs and the gravity of creating nurses who will not be prone to medical errors. At the University of Delaware, there is a conscious effort to work closely with the Office of Admissions, the General Counsel’s Office, and DSS to clearly define what reasonable accommodations are for nursing students. Creating an outline of essential functions for nursing students, which cannot be accommodated, allows students who are interested in applying to see areas that are non-negotiable when it comes to accommodations (Horkey, 2019; Shilling et al., 2020; Stinnette Lucas et al., 2022). DSS has also stressed to incoming nursing students seeking particular accommodations (excessive absences, in particular) that the reasonable standard may not allow particular accommodations in the major. Delineating support services that create an environment conducive to testing and performance success from those that would create an insurmountable obstacle in the clinical work setting is important and should be expressed to the student in terms of realistic expectations of employers.
Accommodations for nursing students have expanded over the last few years thanks to technological advances. There are numerous ways to aid students with accommodations for a variety of reasons. For example, technology makes it possible for students to use virtual reality in simulated scenarios in order to practice in a safe environment before going into the clinical setting (Brown et al., 2020; Carroll & Eaton, 2019; Horkey, 2019; Neal-Boylan & Miller, 2020). Overall, meeting students where they are is the most important aspect of working with students who have some type of disability. Faculty members must be educated and aware of processes within their setting to help students navigate this difficult time as they transition to becoming an RN. Nursing students may not feel comfortable sharing information, but faculty can be the first point of contact to help students become successful in their program of study. Consider these key points when you find yourself in the position to help students become successful in their program of study:
- Early Identification
- Empathy and Sensitivity
- Building Trusting Relationships
- Guidance and Support
- Knowledge of Rights and Laws
- Referrals to Appropriate Resources
- Equal Treatment of Students
- Reasonable Accommodations That Meet Student Needs
- Getting Student Input
- Monitoring Progress
References
Brown, J., McDonald, M., Besse, C., Manson, P., McDonald, R., Rohatinsky, N., & Singh, M. (2020). Anxiety, mental illness, learning disabilities, and learning accommodation use: A cross-sectional study. Journal of Professional Nursing, 36(6), 579-586. https://doi.org/10.1016/j.profnurs.2020.08.007
Carroll, S.M., & Eaton, C. (2019). Accessible simulation: A necessity in nursing education. Journal of Nursing Education, 58(11), 619-621. https://doi.org/10.3928/01484834-20191021-01
Elting, J.K., Avit, E., & Gordon, R. (2021). Nursing faculty perceptions regarding students with physical disabilities. Nurse Educator, 46(4), 225-229. https://doi.org/10.1097/NNE.0000000000000940
Englund, H.M., & Lancaster, R.J. (2022). Differences in marginality between nursing students with and without disabilities. Journal of Nursing Education, 61(8), 429-438. https://doi.org/10.3928/01484834-20220602-03
Horkey, E. (2019). Reasonable academic accommodation implementation in clinical nursing education: A scoping review. Nursing Education Perspectives, 40(4), 205-209. https://doi.org/10.1097/01.nep.0000000000000469
Marks, B., & Sisirak, J. (2022). Nurses with disability: Transforming healthcare for all. Online Journal of Issues in Nursing, 27(3), 10. https://doi.org/10.3912/OJIN.Vol27No03Man04
Moriña, A., & Orozco, I. (2020). Facilitating the retention and success of students with disabilities in health sciences: Experiences and recommendations by nursing faculty members. Nurse Education in Practice, 49, 102902. https://doi.org/10.1016/j.nepr.2020.102902
Neal-Boylan, L., & Miller, M. (2020). How inclusive are we, really? Teaching and Learning in Nursing, 15(4), 237-240. https://doi.org/10.1016/j.teln.2020.04.006
Ramluggan, P., Jackson, D, & Usher. K. (2020). Supporting students with disabilities in preregistration nursing programmes. International Journal of Mental Health Nursing, 30(2), 353-356. https://doi.org/10.1111/inm.12793
Ryan, C., & Mulvogue, J. (2022). An evaluation of professional development for staff working with nursing students in distress. International Journal of Mental Health Nursing, 31(3), 677-686. https://doi.org/10.1111/inm.12987
Shilling, S.D., Lucas, L., Silbert-Flagg, J., & Nolan, M.T. (2020). Federal, state, and institutional regulations regarding a nursing student with a service ani-mal. Journal of Professional Nursing, 36(6), 454-457. https://doi.org/10.1016/j.profnurs.2020.03.004
Stinnette Lucas, L., Silbert-Flagg, J., & D’Aoust, R.F. (2022). Nursing students with disabilities: A guide to providing accommodations. Nursing Clinics of North America, 57(4). 671-683. https://doi.org/10.1016/j.cnur.2022.06.012.
Trujillo Tanner, C. (2021). With all due respect: Paving the way for nursing students with disabilities. Journal of Professional Nursing, 37(6), A3-A5. https://doi.org/10.1016/j.profnurs.2021.09.001
Wang, A.H., Lee, C.T., & Espin, S. (2019). Undergraduate nursing students’ experiences of anxiety-producing situations in clinical practicums: A descriptive survey study Nurse Education Today, 76, 103-108. https://doi.org/10.1016/j.nedt.2019.01.016
Yarbrough, A.E., & Welch, S.R. (2021). Uncovering the process of reasonable academic accommodation for prelicensure nursing students with learning disabilities. Nursing Education Perspectives, 42(1), 5-10. https://doi.org/10.1097/01.NEP.0000000000000666
