1. JAN is a service of the U.S. Department of Labor’s Office of Disability Employment Policy. 1 Accommodations for Health Care Workers with Motor Impairments Elisabeth Simpson, M.S., CRC, JAN Lead Consultant Lisa Mathess, M.A., JAN Senior Consultant Donna Carol Maheady, ARNP, Ed.D, Exceptionalnurse.com (800) 526-7234 (Voice) (877) 781-9403 (TTY) jan@askjan.org

2.  Labor and JAN statistics  Accommodations related to motor impairments  EEOC guidance and practical guidance  Examples  Questions Objectives 2

3. 3 Healthcare and social assistance sector  Will account for almost 1/3 of projected job growth between 2012-2022  Projected to add 5 million jobs between 2012-2022  Will become the largest industry (measured by number of jobs) by 2022 2013 data from the US Bureau of Labor Statistics Statistics

4. Job Accommodation Network Contacts  Over 10,000 calls related to healthcare.  Over 4,000 calls involving nurses with disabilities.  Approximately 1,000 calls from those working in the healthcare industry who were seeking assistance in accommodating a worker with a motor impairment. Statistics 4

5. Question 1 For medical professionals with either a hand or arm amputation OR restrictions that limit the use of one hand, what are some alternative methods for giving injections? What about placing IVs? Situation 5

6. Job Restructuring  Reallocation of marginal tasks  Performing essential functions in a different way  May require other forms of accommodation (e.g. equipment, schedule modification) EEOC Guidance 6

7. Considerations New or lifelong disability? Compensatory skills/abilities? Access to practice lab/simulation? Prosthesis? Video of Susan Fleming RN, PhD giving an injection to a newborn while wearing prosthesis. https://www.facebook.com/susanna.e.fleming/videos/o.1459841670932165/10205147220934127/?type=2&theate r Video of starting an IV with prosthesis https://vimeo.com/16298608 Foreign object removal with prosthesis https://vimeo.com/15568319 Adult CPR with prosthesis https://vimeo.com/15267253 Nursing with the hand you are given https://www.youtube.com/watch?v=d3AfRRNxLWg Disabled Nurse: Focus on abilities https://vimeo.com/20809344 Danielle’s story (nurse missing her lower arm/no prosthesis) https://www.youtube.com/watch?v=9h8y9WICHu4&feature=youtu.be Practical Guidance 7

8. Books and articles Susan Fleming (missing left hand) demonstrates donning sterile gloves in a series of photos. http://www.exceptionalnurse.com/DegreesofSuccess.pdf “Leave No Nurse Behind: Nurses working with disabilities” by Donna Maheady, Susan Fleming (nurse born missing her left hand) wrote a chapter. http://tinyurl.com/kbkgnaahttp://tinyurl.com/kbkgnaa “The Exceptional Nurse: Tales from the trenches of truly resilient nurses working with disabilities” edited by Donna Maheady, Connie Stallone Adleman wrote ‘Loving ourselves exactly as we are: Nursing after a stroke.’ http://tinyurl.com/qg9l49y http://tinyurl.com/qg9l49y “Missing a limb but not a heart” Carey Amsden, RN discussed how she practiced tasks with one arm (IVs, donning gloves) http://www.reflectionsonnursingleadership.org/Pages/Vol38_1_Maheady_Fl eming.aspx Practical Guidance 8

9. Question 2 For medical professionals who need to wear a brace or post-burn glove, how can concerns around sterility be addressed? 9 Situation

10. Direct Threat to Health & Safety  Employers may require that an individual not pose a "direct threat" to the health or safety of the individual or others, if this standard is applied to all applicants for a particular job.  Employers may comply with medical and safety requirements established under other federal laws.  Employers still have an obligation to consider whether there is a reasonable accommodation, consistent with the requirements of other federal laws. EEOC Guidance 10

11. Options to consider  Consultation with Infection Control  Employee wears a glove (perhaps a larger size) to cover the brace or burn glove  Employee wears a gown with elastic at the wrist Practical Guidance 11

12. Question 3 Are there alternatives to taking a leave of absence during flu season for medical professionals who are not able to receive the flu vaccine? 12 Situation

13. Leave  Can’t force employees to stay at work if FMLA-eligible  Can’t force employees to take ADA leave instead of accommodations to enable stay-at-work  Can’t force employees to take leave until the interactive process is complete (most situations) EEOC Guidance 13

14. Hardship Flu season can be lengthy in some areas, so a leave of absence may not be possible Alternatives  Allow employee to wear a mask/personal protective gear  Reassign employee to non direct patient care position  Modify flu shot policy (depending on state laws)  Allow extended leave and reassignment to vacant position on return Reference “Vaccinating the Health-Care Workforce: State Law vs. Institutional Requirements” Public Health Rep. 2010 Jul-Aug; 125(4): 615–618 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882617/ Practical Guidance 14

15. Question 4 When a limited schedule is needed (e.g., 10-hour shift in place of a 12-hour shift), would allowing this for one nurse on a unit really be a hardship for the other nurses working? 15 Situation

16.  Modifying Schedule  Adjust arrival/departure time  Limited scheduling  Adjust break times  Modifying Policies  Attendance  Eating & Drinking EEOC Guidance 16

17. Hardship  In most situations, a limited schedule change for one nurse would be a hardship  Often, nurses are working with limited staff  Adding additional work can be problematic  Safe staffing ratios are critical to patient care outcomes Alternatives  Modify eating and drinking policies  Allow periodic breaks  Reallocating certain functions to other staff  Reassignment Practical Guidance 17

18. Question 5 What about client caseload standards for those in positions like a clinical social worker? If someone is expected to maintain a certain number of patients but is unable due to a medical condition, what can be done? 18 Situation

19.  Productivity Standards  Don’t have to lower qualitative/quantitative standards that are applied to those in same position  Do need to consider accommodations that would help employee meet standards  Telework  Equipment/Devices EEOC Guidance 19

20. Help meeting caseload standards  Reassignment of some tasks  Scooter to make rounds (decrease walking, fatigue)  Assignment to cases in a certain geographic area  Dictation software (decrease typing/writing) Practical Guidance 20

21. Question 6 How can a medical professional who uses a cane or mobility device address concerns around sterilizing the device? 21 Situation

22.  Purchasing or Modifying Equipment or Products  Making Worksite Accessible  Accessible entryways  Parking  Accessible restrooms, break rooms, etc.  Safety Concerns EEOC Guidance 22

23. Infection control: Cane or mobility devices  Consultation with Infection Control  Use two wheelchairs (keep one in sterile area, employee switches chairs in designated area)  Wheelchair tire covers  Wheel into room with one pair of gloves, change to new gloves before touching patient  Umbrella bags could be used to cover a cane Practical Guidance 23

24. Question 7 When a patient lifting device is not available, what are some alternative options that a medical professional with a lifting restriction could consider? 24 Situation

25.  Job Restructuring  Lifting techniques  Task reallocation  Patient safety  Reassignment  Temporary Accommodation  Unit transfer  “Rules” for reassignment. EEOC Guidance 25

26. Patient Lifting  Assistance from another staff member  Lift teams/lift buddies  Consideration of team members’ body size and strength (different contributions when lifting)  Ambulation gait/transfer belts Practical Guidance 26

27.  Videos  Books  Articles  JAN publications  EEOC’s Questions and Answers about Health Care Workers and the Americans with Disabilities Act at http://www.eeoc.gov/facts/health_care_worker s.html http://www.eeoc.gov/facts/health_care_worker s.html General Resources 27

28. http://askjan.org/media/eaps/EducatingWorkplace.doc 28 Employer Resource

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30. JAN (800) 526-7234 (V) (877) 781-9403 (TTY) AskJAN.org jan@askjan.org (304) 216-8189 via Text janconsultants via Skype Special thanks to Dr. Donna Carol Maheady exceptionalnurse@aol.com @ExceptNurse www.ExceptionalNurse.com 30 Questions?

31. Questions? AskJAN.org 31 Job Accommodation Network