October 29, 2020

Episode 39: Why we need more nurses with disabilities

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Podcast

Description

Today’s guest is someone very special who is working tirelessly to change the field of nursing. 

Andrea Dalzell is a registered nurse and a pioneering activist for people with disabilities. At five years old, she was diagnosed with transverse myelitis, a neurological disorder that left her unable to walk. Despite spending most of her life in a wheelchair, Andrea has been determined to make a difference, graduating with honors and receiving many awards for her advocacy work and leadership, including the Cindy Loo Disability Rights Advocate Award. 

In 2018, Andrea became not only a registered nurse, but the only nurse in all of New York City who is in a wheelchair. After the school where she was working closed down in March, Andrea heeded Governor Cuomo’s call for help and began working on the frontlines with the city’s COVID patients. 

Throughout her professional journey, Andrea has had to fight against the preconceived notions that her professors, bosses and colleagues have had about her disability. She has worked tirelessly to promote health inclusion and advocate for people with disabilities. Last month, she was awarded the inaugural Craig H. Neilsen Visionary Prize, which she’ll be using to start a foundation to encourage people with disabilities to get into the field of nursing and to ensure that nursing schools are equipped to handle students with disabilities. 

Dr. Dan speaks with Andrea about her experiences, what she plans to do next and what she wants nurse leaders and other individuals working in the healthcare industry to know. 

Links to recommended reading: 

Podcast

Transcript

Dan:
Welcome to the show.

Andrea:
Thank you for having me. I'm so excited.

Dan:
This is awesome. I've been reading a lot about your story, but I wanted to start off with just, what are you up to now? I know we've had a lot of scheduling with this and you're a busy person, but I would just love to know what you're up to?

Andrea:
Oh, man. My plate has been overflowing and it's such a blessing to be honest with you. A couple of weeks ago, the Craig H. Nielson Foundation granted me a million dollar award, a Visionary Prize for just being a nurse with a disability in getting through all of these tough times that I've had and being able to persevere throughout all of the negatives. That has kind of shifted what I've been up to. I mean, beforehand, I was a school nurse, I'd just gotten back into the school setting and also, in school for my master's degree in nursing, and that was already taking up a lot on my plate. But then this award came and here I am trying to figure out a foundation and how do I start a scholarship program? How do I ensure that other programs are going to be accessible to people with disabilities especially in healthcare, and it's just a lot of conversations, a lot of meetings happening.

Dan:
Well, first of all, congratulations. That's an amazing opportunity to just change the world which I'm all about. I'm excited to see what you'll do with that. I was reading your story and I wanted to dig into this a little bit. I was reading about your first day of nursing orientation and I think you said that the faculty said, "You can go, we don't know if you can do this." Can you tell me more about what happened on that day one of entering the profession officially?

Andrea:
There's two separate sides to that. The one that you're talking about particularly is when I actually started school. When I started school and I showed up for my first day of orientation, it was a mandatory orientation. The professors were like, "We don't know if you can be a nurse. We don't know if you can be a part of this program. You can leave for the day and we'll get back to you."

Dan:
Wow.

Andrea:
Yeah.

Dan:
I mean, I interact a lot with academia and there's some wonderful people there, but there are definitely traditions within the nursing profession in healthcare that just block our ability to see past what we've experienced and what we've known, and I think that's a lot of your stories. How did you overcome that first interaction with the people that are going to be your mentors for the rest of the two years of nursing school? How did that drive you into where you are today?

Andrea:
I wish I can tell you that I've overcome everything, but I haven't. I think ultimately what they did was prepare me for what the real world was going to express in a larger way than what they were doing in that moment. At that time, I was lucky enough to be attending a City College where we have a diversity officer on our campus. We have a disability office on our campus. I just went to the office and I was like, "This is what they're telling me and this can't be true. They already accepted me into the program. This goes against the ADA."

Andrea:
As soon as they knew that I knew the law, they were like, "Wait a minute. Stop, pause, let's figure this out. What can we do to help you? Let's talk to the program director, let's make sure that we can have things in place." I was like, "Huh, make sure that happens." But that didn't stop anything, right? My two years of college, every professor I had questioned it, they brought it up. Every clinical that I went to, it was an issue, it was a thing. I was the elephant in the room that I was constantly pointed at.

Dan:
Yeah. That's definitely an uncomfortable place to be, and it doesn't help you with the stress of Nursing School in general. It's hard to become a nurse. It's hard when people put barriers in front of you that don't need to be there.

Andrea:
Exactly. Nursing School should just be about being a student, trying to figure out your schedule especially, for my peers who have kids or have wives or have husbands, they're there just being a student and they have support whereas I was trying to be a good daughter, trying to still work, trying to be a part of extracurricular activities, being Ms. Bush in New York at the time, as well as dealing with the stresses of, not just being a nursing student. My disability played a huge role.

Dan:
Yeah. The other piece that I think about when those kinds of assumptions that happen is, they focus so much on the task. I mean, I was reading about, "Well, could you do CPR or could you help walk a patient." These tasks that are associated with nursing that aren't really what nursing is about. Nursing is about your brain and yes, you have to do some stuff. Like you have to do a few things but ultimately it's about your brain and that's what should matter more. I mean, you ended up doing bedside clinical work. Did you ever question that choice throughout your journey? Like, "Should I just go into, I don't know, case management or," something that is not with direct patient care, did that cross your mind and how did you kind of think through that?

Andrea:
Never crossed my mind because I always hated desk work.

Dan:
I love it. Me too.

Andrea:
I hate desk work. Do not put me in front of a computer for eight hours a day. Please don't have me filing. I've already done those mundane jobs before, and I'm not discrediting anyone's job. Please, if you are a caseworker or case manager, you work filing papers, great for you. I'm glad you're happy but that for me, I cannot ever. I respect that profession. Good job. I just cannot. I have always been someone that is a go-getter, always on the move, constantly wanting to learn and absorb knowledge. The only way for me to do that in my eyes, was to be hands-on, because that's the way I learn. I'm an audio and hands-on learner. I know my learning methods. Therefore, how was I going to grow in a profession that I didn't really need to be thinking absorbently about?

Dan:
Yeah. That's a point. I mean, you followed kind of your passionate about it and that's the right thing to do. I think we both probably give that advice to our up and coming nursing students is like, "You get told a lot of things that you can't do and you can't let that drive you. You need to get in touch with your passion and where you want to go and make it happen." I think your story is exactly what all nursing students, especially nursing students with the potential disability need to hear. Tell me about, let's fast forward to today. You're in New York, the height of COVID in April and May is New York. What was your role in all of that?

Andrea:
In March, everything's shutting down, things are closing left and right. At that point I was working as a school nurse, talking to my boss about the potential of closing, and that was on Monday. Tuesday, we were still talking about the potential of closing. We're going to make a decision the next day, Wednesday comes and we decide that we're closing. Now we're closing for only 14 days at one point, and I'm packing everyone's stuff up, and then something in me said, "There's no way we're closing for 14 days. This is going to be way bigger." I prepared to have all of these kids not come back and 14 days. Hindsight is 2020 while I saw 2020 vision coming.

Dan:
2020 is the bad word, by the way.

Andrea:
It is [crosstalk 00:07:20] but with that, it was my blessing, right? I go home, Thursday I'm looking for work. I'm trying to see where is it that I can fit in? Where can I help? What can I do? I sign up for, our governor put out a call for all nurses to sign up to a registry, to come out of retirement. All nurses, they were begging for nurses to help in the hospitals and I was like, "Okay." I signed up there. I signed up in New Jersey and then another hospital system just puts out their HR number online and is like, "Please any nurse, we need nurses contact us." I contact them. I leave on message and I'm like, "I'm probably never going to hear from them." 15 minutes later, I get a call from their HR Department asking me, "Can I get credentialed by Friday?"

Andrea:
Mind you it's Thursday, so yes, I was going to show up the next day to be credentialed.

Dan:
Wow.

Andrea:
In this mindset of mine, everything has always dropped before they see me and things don't move forward. They see the wheelchair and they're like, "Hmm, maybe not." I'm here going through HR, getting credentialed and I'm like, "The ball is going to drop," and I'm talking to my preceptor and I'm like, "Something's going to drop, they're not going to want me," and she's like, "No, you better tell them to live up to their equal opportunity employment statement on their website," and I'm like, "Okay."

Andrea:
That's the confidence that I needed and she poured into me that afternoon after getting my ID badge and I reported the next morning for training, the half day orientation. No one said anything to me and I'm like, "Okay." Now, Monday evening comes and I'm about to report for evening shift. I go there, everyone's fine. They're looking at me and they're like, "Are you sure you're the nurse to help?" I'm like, "I'm here to help. What do you need?" The director of Nursing comes up and she pulls me off the floor and she says, "I don't think you can be a nurse doing this during COVID."

Dan:
Wow.

Andrea:
I think rage or something must have shown in my eyes to tell this lady, "You need to take 20 steps back."

Andrea:
She turns and she's like, "I didn't mean to offend you." I looked at her and I was like, "You didn't offend me. I just think you should talk to HR before you bring it up to me because they put me here."

Dan:
Right.

Andrea:
She was like, "Okay," and she's like, "If you need anything," and I was like, "I don't need anything." That puts so much pressure on me at the moment to excel and not mess up. Can you imagine a new grad nurse going to the floor and having already the butterflies of thinking that, "I'm a new nurse and my gosh, I don't know anything," and then there I am, me. I've only worked clinical practice. I've worked some observations stuff before but not during COVID, not during a national pandemic, not on a med surg unit, not with adults, and here I am trying to make sure that all of my I's and T's are dotted and crossed, on top of having to deal with my disability, on top of just making sure that every patient is okay by the time I leave.

Dan:
Yeah. I mean, the stress has got to be crazy. There's two things that I heard as you talked about that. The first was something that I think is an awesome leadership behavior that you have, which is holding people accountable for doing the things they say they're going to do, which I think is probably key to why you're so successful. You hold people accountable for saying, "Yes, you're going to be on that floor and I'm going to be there, and no I'm not taking no for an answer," which I love. The second piece is you're right the stress, the added drama that that puts upon you now to kind of have everyone's eyes watching for that first failure so they can take you off that unit and they can prove themselves right. It's got to be just mind-blowing

Andrea:
Oh, it's astronomical, I think I left every shift. If you're hearing the nurses talk about COVID and the emotional stress that it placed on them, now add the fact that I am also thinking about, "I can not make a mistake." Everyone triple checks their medications, I'm there 20 times checking it because I don't want any mistakes. I am in my patient's room every 20 to 30 minutes because I don't want them falling. It's just that overwhelming, "Oh, my goodness. Something can go wrong and I have to prevent that."

Dan:
How do you cope with that? What is your outlet to let the steam off, so that you can show up the next day and continue to be the awesome nurse that you are?

Andrea:
In that moment, I had no outlet. I just had my dog.

Dan:
Well, there's a [inaudible 00:11:50] pet therapy, right?

Andrea:
Yes. There is pet therapy. I had my dog who allows me to just cuddle her and smush her to death, so that was about it. During the peak, there was no time off, right? We were going 12, 14, 15 hours a day, four or five, six days out of the week. There was no real time to outlet then, aside from my pet therapy.

Dan:
This is something that we did a study on. We asked about 1500 nurses, do you feel supported in your mental wellness, specifically during COVID and 95% said, "No." Was there any resource given to you or any of the nurses to help support debriefing or stress or even just a phone number to call to cry into, was there any support that you felt was given as you were kind of in the peak of the COVID work?

Andrea:
No. That doesn't go against the institutions either but I think the way New York City hospitals were slammed, there was so many different outlets for other hospitals and then smaller hospitals. I think it's all budget related, but I won't throw my institution under the bus. But at the same time I do realize that things were happening at such a rapid rate. There were a lot of things that were forgotten and they were major things that were forgotten, especially when dealing with nurses and their mental health during all of this.

Dan:
Yeah. I think you're right. There's a lot of reactivity and it was crisis mode and so things dropped. That story about the nurse leader that pulled you aside and said, "This won't work, I know it because I'm the nurse leader that's been here for X many days, months, years, whatever." What advice would you give to nurse leaders to just not do that? I mean, not do that is the advice but what are some tactics that could better approach you? If they have concerns, how can they better approach someone with a disability and actually converse about it rather than jumping to their conclusion?

Andrea:
It really starts with whoever the hiring manager is at first, right? Someone has to be able to get in the door, and getting in the door for me wasn't exactly hard. It was actually just getting the position. I realized that with any nurse, with any disability, any visible disability, just getting in the door is a roadblock. You're automatically deemed unable to do something without being given the opportunity to, whether that opportunity is coming directly from an HR perspective or if that is coming at the next level when you're meeting with the unit manager. The point is to give the person a chance. You don't know what they're able to do and the thing is, nursing school prepares us. It's not like we're just going in and looking at a screen or we're just taking a test. We are in clinical practice. I had clinical practice before even getting to the floor. If you're willing to give new grads a chance, why not give a new grad with a disability a chance?

Dan:
Yeah. I think that's a great point. I mean, it's not like you could skirt around all the skills, checklists and tests and knowledge. You pass Nursing School which, like we said it's super hard and that's a baseline to get started and if you can make it through that I don't know. I feel like clinical practice is easier than Nursing School.

Andrea:
I mean, Nursing School is difficult, but I don't want to compare Clinical Nursing School to that of what nurses do at the bedside every day. There's definitely two different worlds going on there. However, it's not what you're looking at on Grey's Anatomy. Okay. Nurses are not running to do CPR every two seconds. We are literally doing assessments to ensure that our patient is going to be okay throughout our shifts. If a patient does decide to code, also remember that nursing is not an individual job. You are a part of a team. You're looking at me from the seated position as someone who cannot stand up and saying automatically, "Oh, she can't do CPR." Well, what about a nurse who's pregnant? Or what about a nurse who maybe, broke her wrist a couple of months ago and is in a brace? Or what about a nurse who just has back problems and can't do CPR for 20 minutes at a time?

Dan:
Right. There's an obvious bias there. They don't think of those other examples that you mentioned as the limiter automatically, but as soon as they see you in a wheelchair, that's limiting all the things that they associate with nursing.

Andrea:
Right.

Dan:
How do you become aware of those things as a leader and then kind of check yourself so that you're not making those assumptions?

Andrea:
Take a Diversity and Inclusion course. I mean, let's be real about this. These Nursing Schools themselves are turning away students with disabilities. Okay. If you're going to have the audacity to turn away students that are actually coming to you with the grades to be in your program, then what does that say about what's going to happen in the actual profession? It's going to be the same thing. I'm not the first nurse in a wheelchair. I probably won't ever be the last so therefore, change needs to start at the educational level because if Nursing Schools are going to start turning out nurses with disabilities and that's all different types of disabilities, right? Not just someone who has a physical and visible disability.

Andrea:
Disabilities come in all shapes and forms, so if they can get through Nursing School, then why aren't the professions giving them the chance, right? Then we forget that there's so many different facets to nursing. We know case management is one of them. We know that desk work is another. We know that even just triaging over the phone is another. But unless you can decipher or single out like, "Okay, this person did clinical so we can give them a chance in a clinical setting. Or this person only did paperwork and knows book knowledge, so we can give them a chance here." They're not going to do that.

Dan:
Yeah. Right. I think you bring up a good point. The nursing is so diverse that, from a job perspective, that there's so many avenues you can go that physical limitations, mental limitations. There's a spot for you in some place and I think people just associate nursing and new grads having to do this clinical experience piece or this clinical care which isn't always the case. I think we need to do better about prepping people for all the other jobs that happen in healthcare that are outside the hospital and now with technology, there's so many more, the tele-health and phone triage and informatics and all these other things that are possibilities for all nursing students, they're just not exposed to it in Nursing School.

Andrea:
Right. That's what changes the narrative. When education is the one to say, "No, we know that these people can do the job."

Dan:
Yap. I think what a loss for the organization to not have these highly intelligent amazing people to bring a different viewpoint, not only to relate to patients, but to just enhance the entire workforce. What advantages do you see to having a diverse and inclusive workforce?

Andrea:
I mean, when you have representation in your workforce then the people that you're treating are definitely going to feel more respected and heard. I say that from a patient standpoint, I've had doctors tell me things that I would never tell a patient today. I've had nurses look at me like, "Wow, Oh my goodness moment," and I'm like, "What? This is my everyday life. Why are you looking at me like I'm some trophy." The narrative is just so demeaning to someone with a disability and saying like, "Okay, you have to only be home eating bonbons. [inaudible 00:19:17] that's not how this works.

Dan:
No. Exactly. Yeah.

Andrea:
Technology has advanced to the point where we are not just wheelchair bound. We're wheelchair movers, we're innovators, we're thinkers. We're the ones that are problem solving everything that's going to change for someone else. We just look at it as though, "Oh, that's nice. That's good for you." No, I don't need your pity. I need you to see me and respect me as someone who can do the job.

Dan:
Exactly. Someone who now has a million dollar foundation to go change the world, right? You're doing more than a lot of people which is amazing and so cool that you've taken it to the next level because you could continue your clinical career and be awesome, and you've taken that step to do the next level stuff, to change the profession, to change the foundations, to give a different experience to people who are coming through a similar situation as you have done. That's just awesome. Congratulations to that. I would love to help in any way I can because it's just so cool. I mean, I'm all about change the world, so anything I can do to do that. What are some of the useful accommodations that may help people with disability be able to practice to the top of their abilities in nursing?

Andrea:
Okay. Here's where it gets a little tricky. Everyone's disability is different. What I'm able to do at my level of injury, someone else may not be able to do, and that's okay. The point is just being able to have an open mind and allowing them to see what works and what doesn't, and that's it. I think when you really want to talk about accommodations. We're really looking for a Band-Aid like, "Okay, we can give you this accommodation to get this job done." Accommodations are supposed to equal the playing field. It's supposed to allow a person to be able to do the job without having to worry about it being looked at as accommodation.

Dan:
Yeah.

Andrea:
Right? When you're talking about an educational standpoint, have your programs accessible, is your website accessible for someone to actually apply to your program? What about your texts? What about the videos you show in the classroom? Are they captioned so someone can read it instead of having to hear it? These are all things that transfer into the profession as well. Can things come in braille? Can a nurse or a doctor use a stethoscope that they can actually look at instead of actually listened to? These are all technologies that are out there in the world but we're not implementing them in our own practices and we're thinking it's a luxury and it's not a luxury anymore.

Dan:
I totally agree with that. I'd like to say that healthcare is about 20 years behind the rest of the world in implementation of tools that would help people do their job better. It starts with the medical record which we won't even get into but the fact that we're still using stethoscopes is kind of archaic, there're ultrasounds where you can see everything and it's handheld, it plugs into a phone. You don't need to listen anymore. You can see the stuff, there's the imaging, there's all these other things that you can use to have better information to make better clinical decisions yet we kind of hold ourselves to these traditions that may need to be disrupted. I think, thinking about it from an inclusive standpoint and then also just, how do you get information to people better? There's a ton of different ways that can happen and it doesn't have to happen like we did it 40 million years ago.

Andrea:
Right. Because 20 years ago or 30 years ago was when the ADA was passed, and the ADA is still outdated in comparison to where we are today. When you want to think about how the medical field actually translates over to the disability world, the medical field is what actually downgrades what disability is, because we put this bubble around it like, "Oh, no, this can't happen," because we're not implementing those technologies.

Dan:
Yeah. Which is so goofy because healthcare should be the first one to be accepting and inclusive because we preach that in every single school, nursing, medicine, whatever clinical track you take, that it's the foundation of it and then we just don't practice it which is kind of disheartening, which is more to the reason why I'm excited that you are going to do something about it.

Andrea:
I'm trying.

Dan:
All right. Tell me, what's your vision now that you won this award, you got this funding. You're going to start a foundation. What do you see as the future of nursing? What changes do you hope? What's your vision for that?

Andrea:
Well, for one, I want everyone, whether they acquire a disability or born with a disability to feel like they can be accepted in the healthcare world as a professional and not just as a patient, right? We know the patient side of it like the back of our hands. We know what the doctors are going to say. We know what the tests are going to say. We know our bodies better than anyone can ever tell us about. But then when you turn on the professional side of it, now you know how to really get what it is that you need, so why not become a professional? Why aren't those doors open for those who have any type of disability, to become the professionals in what they already know? They already know it, they're experts and who better than to be the doctor, the nurse, the sonographer, the respiratory therapist, and someone who is already going through what you're going through.

Andrea:
You want someone to be able to connect to, especially in a hospital and you know what I realized during COVID? When all of these patients are going through their worst times of their lives, when they saw me, they knew I already knew their struggle. They already knew that I empathize with them in that bed. I've had a lot of patients tell me, "Wow, you're one of the best nurses I've ever had." Not because I did anything extraordinary, but because I already knew what I would have wanted when I was in that hospital bed. It's the little things that people overlook that I see clearly because I was a patient, I've had 33 surgeries. Why not employ those people who have disabilities, who acquire disabilities in those same professions that we're here already working in?

Dan:
Yeah. I think that's exactly where we need to be and to leverage that expertise as well, and puts you in situations where you can be that light at the end of the tunnel for people and to have the real conversations about what's going to be like, and there's just so much opportunity for us to do great things by putting the right person in the right situation with the right patient. You said it really great. Tell me a little bit about the foundation, what your vision is for the foundation that you're setting up. What do you hope to achieve? What's the end goal for that?

Andrea:
I don't know what the end goal is yet, but the beginning really needs to start with, like I said, education. I have been reaching out to nursing programs and trying to discuss what does accommodations look like from the very beginning? Because if you can figure out what those accommodations are from the beginning, when someone starts into a program, then the profession will figure it out and be able to transition well, because those nurses and those nursing students that are going to school with those people who have disabilities, are going to be now, "Okay, wow, this person can do it," and when they become a nurse manager, they're going to be more inclined to hire that person.

Dan:
You set up a cycle?

Andrea:
Right. You set the cycle. My foundation is really going to be one to encourage students, those with disabilities to applying into healthcare roles, into STEM roles, because STEM is where I fell in love with nursing. I want others to feel like they can't be downplayed in those roles because they have a disability. The second part of that is to ensure that the nursing programs are well-equipped to be able to handle students that have different abilities so that when they go into the professional world, that cycle can grow.

Dan:
Yeah. I think that's awesome. It's totally needed. I think we just need a different cohort of people to jump into nursing. We don't have enough nurses and so we should be the most inclusive profession out there and we can make such a huge impact, all four point whatever million nurses there are. We can just amplify that even more by bringing in the best talent possible and so I'm excited to see how you do that. We'd like to end the show here with handing off that one nugget of information to our listeners. What would you like to hand off to our listeners?

Andrea:
For those that are struggling? I feel like this message is for them. For those that are struggling, they don't know whether or not nursing is for them. They don't know if they're going to be able to get through Nursing School. They're feeling burnt out in whatever situation they're in, in their profession right now. Reevaluate your passion, understand why you're in health care, why you're a nurse, why you're a doctor, any healthcare profession that you're in that you're feeling like you're struggling, re-evaluate your passion, understand why you're doing what you're doing because there's always going to be hard days but if those hard days are never ending, this is not worth it. Reevaluate it, embrace it, find where your voice is and run with it or roll.

Dan:
I love that. What a great message. I want to echo that, you need to find your passion and go 100% towards it. The work is not worth it if you don't do that. Thanks for being on the show. Really appreciate it. Where can we find you online? Where is the place to interact and learn more about all the awesome stuff you're doing?

Andrea:
Oh, the number one spot is Instagram. I am The Seated Nurse.

Dan:
I love it. Check out the Instagram, The Seated Nurse. Thanks so much for being on the show and we're excited. We'll put that in the show notes for you to link into, and just really appreciate the conversation today. Thank you so much.

Andrea:
Of course. Thank you so much for having me.

Thank you and welcome to the Trusted Community!
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