Accommodation: Case Studies

Jane is a recent graduate of an Ontario university nursing program. She is requesting accommodation from the College for her processing disability, anxiety and attention deficit disorder (ADD).

Jane was diagnosed with a learning disability in her early school years. Her symptoms of anxiety disorder and ADD presented at a later age. While in school, Jane requested academic accommodation support for the theoretical portions of her program but not for her clinical placements.

During a clinical placement, Jane was unwell and voluntarily withdrew from school to seek medical treatment for her anxiety. She worked closely with her health care team and faculty to address these issues. Upon her return, she successfully completed her placement. Jane has had no further issues since this time, complies with her treatment, and sees her family physician annually. Her clinical evaluations throughout her program were exceptionally positive and her learning disorder does not appear to be an issue. Jane indicated that she monitors her practice and intends to identify experienced nurses to mentor her.

Considerations

1. Which categories of Requisite Skills and Abilities (RSAs) may be impacted in this case study?
2. How may this learning disability potentially affect the applicant’s practice?
3. What kind of supports do you think this applicant will require?
4. How may these supports translate in the clinical setting?
5. How do you think CNO proceeded with this applicant’s registration?

Outcome

The College granted Jane’s accommodation for the registration exam. She was provided a separate room and additional time. Jane passed her registration examination on the first attempt and is now a registered nurse in the general class.

Rationale

Jane demonstrates accountability and insight by her compliance with treatment and medication. She has a heightened awareness of her issues and recognizes a need for improvement.

Once registered, members are accountable to the Professional Standards, Revised 2002, whereby nurses assume responsibility for his/her own professional development and invest time, effort and other resources to improve nursing knowledge, skills and judgment.

Jason has recently completed a PN program and is applying for registration at the College. He has a diagnosis of Central Auditory Processing Disorder (CAPD); a type of processing that refers to the ability to separate meaningful messages from non-essential background noise. Deficits in this area may present as:

• misunderstanding instructions
• needing information to be repeated
• difficulty recalling information
• problems following multi-step instructions; or
• being easily distracted and finding it difficult to follow long conversations

During his clinical placements, one of his preceptors stated that Jason needed to work on his listening and organizational skills. After his clinical placement, the preceptor indicated that Jason showed marked improvement but noted he still needed work on some of his skills.

A psychiatrists’ assessment found that Jason has the necessary cognitive abilities to perform nursing duties. The psychiatrist believes employers can easily support Jason.

Considerations

1. Which categories of Requisite Skills and Abilities (RSAs) may be impacted in this case study?
2. How may this learning disability potentially affect the applicant’s practice?
3. What supports do you think this applicant will require?
4. How may these supports translate in the clinical setting?
5. How do you think CNO proceeded with this applicant’s registration?

Outcome

The Registration Committee deferred the matter. They requested staff explore an agreement (non- public undertaking) with Jason to ensure employers are aware of his learning disorder, and can provide him reasonable accommodation.

Jason obtained legal counsel and underwent a thorough comprehensive assessment of his learning disability. The assessment outlined accommodations (e.g. taking notes of client data) which his potential employer was able to provide.

Rationale

Jason demonstrated accountability and insight by his compliance with the assessment and accommodations. He has a heightened awareness of his issues and recognizes the support he requires to provide safe client care.

Once registered, members are accountable to the Professional Standards, Revised 2002, whereby nurses assume responsibility for his/her own professional development and invest time, effort and other resources to improve nursing knowledge, skills and judgment.

John is a recent graduate from a RPN program. He reported in his registration application that he had an emergency craniotomy on the back of his head, which left him unable to walk or see at first. He underwent brain injury rehabilitation and had impairments with respect to cognition, vision, speech, mobility, bowel and bladder function.

John made significant cognitive improvements since then, and is able to function using accommodation and compensatory strategies. His family physician is of the opinion is that John is cognitively and physically able to return to work at a light, sedentary level. The physician feels that John’s judgment, insight, memory and overall level of function are quite good as long as he can function in a role that allows him to sit or stand as he requires.”

Considerations

1. Which categories of Requisite Skills and Abilities (RSAs) may be impacted in this case study?
2. How may this physical disability potentially affect the applicant’s practice?
3. What supports do you think this applicant will require?
4. How may these supports translate in the clinical setting?
5. How do you think CNO proceeded with this applicant’s registration?

Outcome

The College explored an agreement (non-public undertaking) with John to ensure his health care providers continue to monitor his health and that he complies with treatment. John is registered as an RPN in the general class with no reported issues regarding his practice.

Rationale

The letter from John’s physician outlined he has made significant progress. Despite some impairments, John is independent and does not require medications,

John demonstrates accountability and insight by understanding his abilities, compliance with treatment and motivation for recovery. He has a heightened awareness of his issues and recognizes the supports he requires to provide safe client care.

Once registered, members are accountable to the Professional Standards, Revised 2002, whereby nurses assume responsibility for his/her own professional development and invest time, effort and other resources to improve nursing knowledge, skills and judgment.

Rebecca is applying for registration as an RN in the general class. In 2014, she was diagnosed with Bipolar Disorder II and admitted to hospital. Rebecca is currently stable and compliant with medications. She has not required readmission since 2014.

Rebecca describes in detail the affects her low moods had on her life. She was unable to deal with day-to-day activities because she felt overwhelmed by everything. Rebecca describes her “high moods” as being capable and focused but was irritated with people who could not keep up with her train of thought.

Rebecca indicates that she asked herself before every clinical shift if she was ready and confident to care for her patients. She indicates that she is fully aware when she is unable to provide care and has informed her instructor or preceptor on those shifts. Rebecca does not attempt to provide care when she feels depressed. She has implemented several strategies to minimize her mood swings.

Rebecca’s clinical evaluations indicate she builds effective therapeutic relationships with her patients and works well within health care teams.

Considerations

1. Which categories of Requisite Skills and Abilities (RSAs) may be impacted in this case study?
2. How may this physical disability potentially affect the applicant’s practice?
3. What supports do you think this applicant will require?
4. How may these supports translate in the clinical setting?

Outcome

The College explored an agreement (non-public undertaking) to ensure that Rebecca’s health care provider continues to monitor her mood stability over time and that she is compliant with the prescribed treatment plan. The Registration Committee deferred this matter and after several months of stability, Rebecca was registered.

Rationale

Rebecca demonstrates insight with regard to her personal circumstances. She understands how her disability may potentially affect her practice. Rebecca demonstrates compliance with treatment and motivation for recovery. She also acknowledges the strategies she has implemented to balance her moods. However, given the time between initial diagnosis and recent stability, a deferral by the Registration Committee was necessary to ensure compliance over an extended period.

Once registered, members are accountable to the Professional Standards, Revised 2002, whereby nurses assume responsibility for his/her own professional development and invest time, effort and other resources to improve nursing knowledge, skills and judgment.

Candace is in her final year of her nursing program. She recently applied for registration with CNO. Someone notified her school of a post she made about nursing on her social media account. The post alluded to her lying to professors and to clients during her clinical experience. Candace also referred to her clinical preceptors in a derogatory manner.

Considerations

1. Which categories of Requisite Skills and Abilities (RSAs) may be impacted in this case study?
2. How should the school respond to this conduct?
3. How do you think CNO should proceed with this member’s registration?

Outcome

The Executive Director met with Candace and decided to refer the matter to Registration Committee. The Registration Committee deferred this matter until Candace completed a review of practice standards and met with a Regulatory Expert at least once to discuss her conduct and review relevant practice standards and application to future practice.

To date, Candace has not provided the necessary documentation as outlined by Registration Committee’s order.  She has not registered with the College.

Rationale

The Registration Committee directed Candace to provide additional documentation to assure the Committee of her ability to practice with decency, honestly, with integrity and in accordance with the law.

Once registered, members are accountable to the Professional Standards, Revised 2002, whereby nurses assume responsibility for his/her own professional development and invest time, effort and other resources to improve nursing knowledge, skills and judgment.

Members are also accountable to the Ethics practice standard, where nurses demonstrate the standard by sharing the value of truthfulness.