In 2017, Ailey and Marks published a landmark article highlighting the barriers posed by technical standards for admission to nursing programs. The article was significant, timely and appropriate to the Rehabilitation Nursing journal because rehabilitation nurses are champions of inclusion for people with disabilities. The term "technical standards" refers to nonacademic admission requirements. Marks and Ailey discussed the increasing emphasis on inclusion in nursing and explained that technical standards are an example of how students with disabilities are frequently ignored in conversations and decisions regarding inclusion.
Ailey and Marks made the key point that technical standards are not equivalent to the essential functions of nursing employment. The former should refer to nonacademic requirements such as critical thinking, cultural competency and professionalism. However, they frequently include requirements such as behavior, communication and motor ability, among others. The essential functions of nursing work refer to employer-determined requirements to fulfill the job, such as lifting fifty pounds and the ability to push or pull. The authors reminded us that nurses work in a variety of settings that require different essential functions. A discussion of the history of technical standards highlighting legal cases and barriers to students helped the authors illustrate why poorly written technical standards are non-compliant with the Americans with Disabilities Act (ADA; 1990).
Nursing faculty typically counter that it is challenging to place students with disabilities in clinical sites. However, hospitals and other healthcare facilities must also comply with the ADA. The authors stated that the ADA stipulates that we provide reasonable accommodations. In reality, this often means that anything short of financial ruin or closing a program is considered "reasonable." Faculty also concern themselves with patient safety. Ailey and Marks pointed out that medical errors are typically caused by "faulty systems, processes, and conditions rather than the characteristics of individual clinicians or recklessness or the actions of a particular group" (p. 250). Safety is not a valid argument for excluding students with disabilities.
The American Association of Colleges of Nursing (AACN) baccalaureate (AACN, 2008), masters (AACN, 2011) and doctor of nursing practice (AACN, 2006) Essentials documents are based on concepts students should know and understand before they graduate. These documents that guide nursing education do not list tasks, such as lifting and pushing. Rather, they speak to the ability to apply technology, improve patient outcomes, conduct research, ensure patient safety and generally perform as a professional nurse or advanced practice nurse.
Ailey and Marks (2017) differentiated the task from how one accomplishes the task. A nurse with a hearing impairment can auscultate lung sounds using a special stethoscope. Lifting patients can be performed using mechanized lifts and the assistance of other people. The focus should be on what has to be done rather than on how to do it. The authors proposed using Reichgott's (1998, p. 79) technical standards: 1) acquiring fundamental knowledge; 2) developing communication skills; 3) interpreting data; 4) interpreting knowledge to establish clinical judgement, and 5) developing appropriate professional attitudes and behaviors (Ailey & Marks, 2017, p. 250).
Although three years have passed since this landmark article, little has changed with regard to the use of essential functions as technical standards for admission. A quick Google search of technical standards in nursing programs reveals that many schools still use the term "essential functions" within their technical standards documents. Many also still list tasks rather than concepts and highlight motor, sensory, mobility, endurance and strength as essential abilities. It is safe to assume that these technical standards still present barriers to prospective students with disabilities.
It is interesting to note that in this article, Ailey and Marks (2017) cited their own work from 2014 (Marks & Ailey) when stating that disability is rarely discussed when nurse educators discuss diversity. This was the case in 2014, 2017 and today in 2020. Conversations around diversity typically focus on race, ethnicity, religion and gender identity. The message to students with disabilities is that people with disabilities are not worthy of inclusion or of reasonable accommodation.
Rehabilitation nurses remain the unrivaled champions of people with disabilities. It is up to us to fix this, once and for all. Having recently experienced the COVID 19 pandemic, we've learned that high quality teaching can occur in virtual and online environments. While no substitute for direct care experiences, students can learn using simulation and a variety of virtual programs. Those of us who work in academic settings should educate our colleagues. Nurses who precept students should educate the students and the faculty who evaluate them. Many rehabilitation nurses return to school for further education. Use your expertise to educate your peer students. People with disabilities are as diverse as people of different races, ethnicities or gender identity. In this age of increasing technology, the previous rationales for excluding prospective students with disabilities no longer hold water and are, in fact, violating the ADA.
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