Able Nurses and Midwives

Barbara Waters

Ex CE Skill: National Bureau for Students with Disabilities UK

Impact of anti-discrimination legislation

• Disability Discrimination in UK was made unlawful in 1995, 2001 and 2006 for students and people in employment and covers admissions, recruitment processes and policies, practices and procedures

• Can conflict with professional regulation

• Previous reliance on vague ‘fitness to practice’ screening needs to be reviewed

Culture

• Risk averse

• Barriers posed by statutory regulation

• Surfeit of requirements often vague

• Disabled people are patients not colleagues

• Focus on what is wrong with people rather than what they can contribute

Impact of nursing as a profession

• Substantial work force

• Highly rated by the public

• Public services need to reflect full diversity of society

• Wealth of skills and personal experiences that can enrich the work

• Framework of competence and conduct

• Public still protected

Evidence of risk – fact or prejudice

• Review by UK Disability Rights Commission of high profile cases where patients harmed or killed

• No evidence regulation of mental or physical fitness would have prevented criminal acts but pointers to inadequate management

• Many standards not legitimate competence standards

What is the problem with existing competence standards?

• Do not determine whether someone is competent to practice in a profession eg ‘ to be of ‘good health’ and ‘good character’

• Frequently lead to discriminatory attitudes, policies and practice

• Impact assessment will help to identify where this is happening

• Link with anti discrimination legislation and human rights act

Finding of Disability Rights Commission UK 2007

• Generalised health standards encourage a diagnosis-led approach to the assessment of risk rather than individualised approach

• No useful function in predicting future conduct or competence or in assessing risk

Do specific disabilities pose a risk?

• People with mental health difficulties are excluded without assessment/support

• Outspoken prejudice drives people underground, making work more difficult without accommodations

• ‘honest students and staff are penalised, so the unsuitable candidates are not being identified’ Nurse with mental health history

Nurses with dyslexia might make mistakes

• Being expert in the accommodations you need means better prepared

• Good use of technology for checking drugs and dosages

• People with dyslexia know they have to check

• No cases of medical mistakes recorded as caused by dyslexia, stress, tiredness and lack of attention more likely causes

Issues about disclosure of disability (Stanley et al 2011)

• Disclosure is a process rather than an event; involves a series of decisions or negotiations once on training programme for example each work placement

• Disability legislation gives people new confidence – need to build on this approach

Two distinct and different concepts of disclosure

Rational -as a transaction to share information with

employer, training institution or professional body in return for accommodations and support. Individual assess risk of exclusion and hopes to control pace and extent of the process of disclosure

Two distinct and different concepts of disclosure

A positive sense of self –

• Engaging with and owning the label of disability

• Commitment to identity eg honesty, sense of responsibility to profession and patients

• Willingness to disclose shaped by attitudes encountered on the way

These concepts are not exclusive

How to move forward

• Actively promote entry of disabled people into the profession through websites, literature, promotional events and careers services

• Provide clear information about disclosure process

• Monitor and research under represented groups and use impact assessments to identify where there are barriers

• Combat the perception that all disabled people are vulnerable receipients of care

How to move forward 2

• Make it clear why information about disability is being collected, who will see it and what use it will be put to

Create an inclusive culture: • Where there are role models• Mistakes made by disabled people are

dealt with as they would be with any student and not automatically attributed to disability

Useful reading

• Into Nursing published by Skillwww.skill.org.uk/bookshop

• Maintaining Standards: Promoting Equality, report of a UK Disability Rights Commission Formal Investigation 2007www.maintainingstandards.org

• Stanley, Nicky , Ridley, Julie , Harris, Jessica and Manthorpe, Jill(2011) 'Disclosing disability in the context of professional regulation: a qualitative UK study', Disability & Society, 26: 1, 19 — 32

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