As equality in the workplace comes under the spotlight, Lisa Hitchen talks to nurses about overcoming the odds
Ten million people with an illness or physical, mental or learning disability are considered ‘disabled’ by disability laws in Britain. Many don’t use this label and only 17% are born with a ‘disabling’ condition – most acquiring it later in life through an accident or health condition.
Bethann Siviter, a consultant nurse working with older people, is one of those 83%. She was eight months into this senior post at South Birmingham Primary Care Trust when, on 1 January 2006, she woke up with a high fever. She had developed infective discitis, a disc infection caused by bacteria. The disease damaged her back, leaving her with mobility difficulties and long-term pain.
After eight months in hospital, still with chronic neurological pains requiring regular treatment, metal rods supporting her spine, and a scooter to get around, Ms Siviter was declared fit to return to work. However, she had to wait until January 2007 until the working environment was suitably equipped for her needs. She retained her role as a consultant nurse for older people but her duties were different.
‘Before my disability, I used to spend half my time with patients and half working with staff. Now the split is 90% working with staff,’ she explains. ‘Hardly working with patients has been painful and the most difficult part of this transition,’ she adds.
Ms Siviter’s role now is mostly focused on helping nurses to improve practice and the quality of care they are able to deliver. ‘I work on projects that are all about quality improvement – our management here are very progressive in that way.
The reaction from colleagues has been mixed. Although most were very supportive, some were visibly uncomfortable about a nurse going round the wards on a scooter. Also some felt she was not as reliable as she used to be, as she still needs a week off every few months for inpatient treatment. ‘It means it is difficult for people to work around my schedule,’ she explains.
That said, Ms Siviter is very positive about the reasonable adjustments her PCT made to accommodate her disability while maximising use of her nursing skills. She has her own office for a quiet environment to use voice recognition software and space for her scooter, and disabled parking.
The PCT made an initial financial contribution but it was the Access to Work scheme, through Job Centre Plus, that picked up 80% of the costs for such adaptations – paying for a special chair to support her back and her computer headset.
As a senior nurse dealing with staff issues, Ms Siviter says her disability has made her more approachable. Nurses see that she too is vulnerable, she says.
On the negative side, she says she has less energy than she used to. ‘I’ve had days when I didn’t leave work because I was too tired to go home.’
However, Ms Siviter feels she has more patience than before and more empathy for patients. ‘I thought I understood how patients felt but, until I became disabled,
I knew nothing’ she says.
Although her interaction with patients is now very limited, Ms Siviter says the reaction of the ones she does see has been immensely helpful for both parties. One of the highlights of her nursing career is in supporting a woman in her forties who had been left profoundly disabled after a stroke. Entering the patient’s [community hospital] ward as a nurse on her scooter was a powerful demonstration that life goes on.
‘She told me when she left that I had given her hope. So maybe life was not going to be as it was but it was still life. If I’ve given her hope then it has been worth it,’ Ms Siviter says.
Having already qualified as a nurse prior to disability can be advantageous in being able to return to the profession. But what about those who already have a disability and want to come into nursing?
Sylvia Kenneth is such an individual. ‘I was born deaf and in my adolescent years I dreamt of becoming a nurse but thought it was impossible because of my disability,’ she says.
That outlook began to change, however, when Ms Kenneth became a healthcare assistant at the National Deaf Services in London. While working on the deaf services unit under St Georges NHS Trust, she was encouraged by nursing staff to apply for the Access to Nursing BTEC course, launched in the 1990s for deaf people.
After passing this, she followed it up with a diploma course in health and social care in nursing at the University of Salford.
Ms Kenneth says: ‘I didn’t experience any difficulties in applying for, or getting on this course but I did have some problems with studying. For example, if an interpreter was ill then I was unable to access the information in the lectures.’
There were 12 hearing students and three deaf students on the diploma course. ‘At the start, a few of the hearing students were a little nervous as to how the deaf students would fit in,’ she says.
‘One of our lecturers, Naomi Sharples, had British Sign Language (BSL) level 2 signing skills and was experienced in working in the deaf community. She offered the hearing students courses in basic signing skills to help communication among us,’ she adds.
During the diploma, Ms Kenneth specialised in mental health. At the end of it, she was interviewed by Rampton Hospital in October, was offered the job and started her induction in January 2006.
‘When I was a nursing student at Salford University, my personal tutor had links to hospitals with deaf patients and I opted for Rampton Hospital. I was sent there for two 12-week placements and decided to [apply to] work there.’
She was given a six-month preceptorship package and allocated a mentor by Nottinghamshire Healthcare NHS Trust, which runs Rampton. An interview with nursing managers followed to discuss performance, appraisal and training courses to develop her nursing skills.
Ms Kenneth has now been a forensic nurse on the hospital’s Connaught Ward for more than two years. She works with deaf male patients with diagnoses ranging from mental illness and personality disorder to learning disabilities.
The trust ensures she has interpreters through Access to Work and has provided further courses and training. Rampton has funded a minicom for the nurses’ office and a mobile broadband device for emergencies.
Some aspects of communication around the job are limited. Ms Kenneth cannot use the VHF radio to communicate with other wards and the hospital control room, nor can she use a telephone without an interpreter to help. She is also unable to work in other wards with hearing patients. ‘The only way that this could happen would be for the ward and myself to havean interpreter all of the time,’ she says. Emergency responses on other wards or areas are also beyond her scope. For this, all staff would require signing skills.
At Rampton, working with other staff has been a challenge with some finding it difficult to accept her because of her disability. But over time, staff attitudes have improved. The hospital offers BSL courses so employees can communicate better with Ms Kenneth and with deaf patients.
‘Communication is still the biggest issue and although staff make an effort, I know that I will never get 100% of everything that is being said – especially in general everyday conversations,’ she admits.
Rampton has a keen awareness of the issues facing deaf people. ‘If I worked in another hospital where hearing staff have not met deaf professionals before, I feel my experience would be very different,’ Ms Kenneth says.
Being the first deaf nurse to work at Rampton, she received a wonderful reception from patients. ‘They did not think that deaf people could be successful in this environment. Patients had always had qualified nurses before who were hearing, so I was the first deaf qualified nurse they had met. They are hoping that there will be more deaf nurses in the future.’
Any nurse with a disability, whether acquired on or off the job, before, during or after their working career, has their rights protected by the Disability Discrimination Act (DDA). This also puts duties on employers and helps both employers and employees to identify the ‘reasonable adjustments’ and support an individual needs in order to start or continue a training post or job.
The watchdog for the DDA is the newly formed Equality and Human Rights Commission (EHRC).
‘Nurses are no different from anybody else,’ says a spokesperson for the EHRC.
‘Employers need to allow flexible working for time off for medical appointments, for a colleague to take their work for a while or for a more desk-bound job from time to time.’
The DDA stipulates duties that public sector organisations must undertake such as the Disability Equality Scheme that must be set up in consultation with staff with disabilities. Employers’ adjustments for staff should be done on a case-by-case basis, with employer and employee working out the best measures for a particular individual.
Nursing is a wide-ranging and sometimes risky profession where the potential for developing an illness or disability through work can be high. Despite this, the NMC has only recently started to monitor how many of those who are registered to practise have disabilities.
This was picked up by the Maintaining Standards report from the Disability Rights Commission (now part of the EHRC). Published in September 2007, this explored the barriers to employment in nursing, teaching and social work for people with disabilities in Britain.
It found people with disabilities often faced obstacles both entering and progressing in many public sector roles and were being put off either applying in the first place or staying within these professions.
But change is happening. The NMC’s Disability Equality Scheme states that it is now monitoring the numbers of registrants with disabilities. Data collection began in 2007 alongside the appointment of an equality and diversity officer. The NMC is also assessing its registration and fitness to practise standards, the latter having been criticised by the DRC report as being vague.
In March this year the regulator launched a nationwide series of events under the banner ‘Have your say on Equality and Diversity’. In June it will meet with other regulators such as the General Social Care Council and the Council for Healthcare Regulatory Excellence, as well as the Department of Health, to discuss the issues around health professionals with disabilities.
Natalie Salmon, NMC head of equality and diversity, is optimistic. ‘We will feed into that meeting the responses from nurses and midwives we are gathering through our ‘Have Your Say’ events’, she says. ‘Generally, nurses, midwives and higher education institutions have shown little resistance to the idea of removing the fitness to practise standards and replacing them with some stronger and more practical guidance on reasonable adjustments.’
‘People often seem to forget that I have only one arm’
Nicola Heazell is ward sister of the community intermediate care unit at Leeds PCT. She was born at 29 weeks’ gestation, weighing just 2lb 1oz. An arterial line was inserted into her left forearm, causing a blood clot and gangrene. It required an amputation through her elbow joint at six weeks of age.
‘I had great difficulties becoming a nurse,’ she says. ‘When I applied for nursing degrees and diplomas I was asked to perform tasks such as drawing up fluid in a syringe and injecting it into an orange or putting a plaster on a doctor’s hand. I was rejected from many higher education nursing institutions on occupational health grounds, as I was assessed as not having the physical dexterity the job required.
‘Despite being very dejected, I didn’t give up and qualified as a nurse from Birmingham University in 2001. I made sure as a student I performed as many clinical skills as possible so I could practise them while being supervised.
‘Staff are often inquisitive and wonder how I will cope and manage with clinical skills but after they see me just doing my job, they are amazed at how I perform skills. People often seem to forget that I have only one arm.
‘I refuse to wear an artificial arm as I believe I manage far better without it. Whenever anybody asks me how I do things with one hand, I reply: “How do you manage with two?”
‘I often help patients who have had strokes and am very adept at teaching them how to do everyday tasks with one hand – like tying shoe laces and doing up zips and bras, for example.
‘While patients tend not to pay too much attention to my disability, occasionally relatives have been a bit offhand with me. I have had very good ward managers who have
‘In 2003 I won the NT Rising Star award for making an impact on practice and policy, through having a significant impact in the clinical setting in which I work and for being inspirational in championing the rights of people working with a disability.’
RCN Work Injured Nurses Group 0845 408 4392 and email@example.com
Disability Discrimination Act 2005 opsi.gov.uk
NMC Equality Scheme nmc-uk.org
Equality and Human Rights Commission equalityhumanrights.com EHRC helpline: 0845 604 6610
Disability Rights Commission DRC website
Department of Work and Pensions dwp.gov.uk DWP benefit enquiry line for disability benefits: 0800 88 22 00