Think back through your nursing career. Have you ever worked a double shift to cover staffing?  Have you taken a dose of cold medicine to help you get through? Have you had very little, if anything, to eat or drink for 12 hours, which helps because then you do not need to use the bathroom? Traits like these are often viewed as badges of honor and a sign of strength within nursing but hint at something much more ominous — a professional culture where self-care is often viewed as a weakness, known as nurse heroics. Nurse heroics is “the culture nurses have created wherein one is supposed to go above and beyond what is reasonable in fulfilling one’s duties” (Neal-Boylan & Guillett, 2008, p. 165). These principles are often introduced within academic environments, pass into transition to practice programs, and follow us through our professional careers. They do not stop with frontline nursing, and many other nursing roles perpetuate the same foundation of putting your work and others before your own needs.

While we can all recognize the challenges this may cause to current and future nurses, there is a unique group for which this culture is particularly harmful: nurses with disabilities. The barriers created by nurse heroics for nurses who live with disabilities and chronic illnesses are significant and multifacted, operating at structural, individualized, and internalized levels of ableism. Ableism is the “discrimination of and social prejudice against people with disabilities based on the belief that typical abilities are superior… it classifies entire groups of people as ‘less than’ and includes harmful stereotypes, misconceptions, and generalizations of people with disabilities” (Eisenmenger, 2019, Introduction section). Structurally, nurse heroics exist due to the nursing culture and underlying principles and values held deeply within the profession (Neal-Boylan & Guillett, 2008).

Individualized and internalized barriers occur as nurses hold themselves and each other to standards beyond the actual role expectations and assign a sense of pride in neglecting personal care (Cameron et al., 2024). Nurse heroics create environments where ableism thrives through judgment, stigma, and bias from colleagues and feelings of inadequacy and exclusion from disabled nurses (Cameron et al., 2024; Lindsay et al., 2022; Thomson & Winsor Murray, 2023).

For nurses with disabilities, lack of self-care is often less sustainable. It holds consequences, such as increased recovery time, higher baseline pain levels, and extreme mental and physical fatigue (Neal-Boylan & Guillett, 2008; Thomson & Winsor Murray, 2023). This leads to a mismatch between the sustainable capacity and the spoken and unspoken expectations of the work, known as work instability (Gilworth et al., 2007). The greater the work instability, the greater the likelihood of leaving the role and the profession of nursing overall (Gilworth et al., 2007; Neal-Boylan, 2014).

Nurses who acquire disabilities during their careers and are enculturated into Nurse Heroics often feel their best option is to leave the profession (Lindsay et al., 2023; Matt, 2008). This impacts the nursing shortage and worsens the experience-complexity gap, contributing exponentially to future challenges in healthcare quality and outcomes (Westhead & Paiewonsky, 2023).

While nurses are often trained to identify and focus on what is unexpected or different and to think of that as a negative attribute, nurses with disabilities bring unique contributions to healthcare. Their exceptional critical thinking, proactive evaluation, advocacy, and creativity are invaluable (Cameron et al., 2024). By creating a representative workforce with lived experience of disability, we can support high-quality care and outcomes for all individuals, specifically for the 27% of United States adults who are currently disabled and face health disparities due to inequity in healthcare access, quality, and cost (CDC, 2023).      

Through a culture of nurse heroics, disabled nurses are being implicitly and explicitly told that they do not belong. Disabled nurses are experts at adapting, but the entire healthcare culture in the United States is too large to tackle individually. By shifting to a culture that emphasizes team-based strengths, honors individual needs, and values every person’s unique lived experiences and contributions, we can support health equity for disabled nurses and the disabled community seeking care (Cameron et al., 2024).

This shift requires each of us to examine our ableism through the biases and assumptions we each hold around what a nurse is, does, looks like, and should regularly push through, not just for disabled nurses but for all nurses. By creating a more accessible and equitable culture within nursing, it can become a profession which recruits and retains a diverse, representative workforce and leads the way for reducing health disparities, including within the disability community. 

References

Cameron, V. K., Jones, M., Lee, S., & McNelis, A. M. (2024). Barriers to retention of nurses with acquired disability: A scoping review. Nursing Management, 55(3), 8–16. https://doi.org/10.1097/nmg.0000000000000101

Centers for Disease Control and Prevention. (2023). Disability and health overview. Centers for Disease      Control and Prevention. https://www.cdc.gov/disability-and-health/about/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html

Eisenmenger, A. (2019). Ableism 101 – what is ableism? What does it look like? Access Living. Retrieved October 17, 2024, from https://www.accessliving.org/newsroom/blog/ableism-101/

Gilworth, G., Bhakta, B., Eyres, S., Carey, A., Anne Chamberlain, M., & Tennant, A. (2007). Keeping nurses working: Development and psychometric testing of the nurse-work instability scale (Nurse-WIS).Journal of Advanced Nursing, 57(5), 543–551. https://doi.org/10.1111/j.1365-2648.2006.04142.x

Lindsay, S., Fuentes, K., Ragunathan, S., Lamaj, L., & Dyson, J. (2023). Ableism within health care professions: A systematic review of the experiences and impact of discrimination against health care providers with disabilities. Disability and Rehabilitation, 45(17), 2715–2731. https://doi.org/10.1080/09638288.2022.2107086

Matt, S. B. (2008). Nurses with disabilities: Self-reported experiences as hospital employees. Qualitative Health Research, 18(11), 1524–1535. https://doi.org/10.1177/1049732308325295

Neal-Boylan, L. (2014). Nurses with disabilities: Their job descriptions and work expectations.  Rehabilitation Nursing, 39(4), 169–177. https://doi.org/10.1002/rnj.122

Neal-Boylan, L. J., & Gillett, S. E. (2008). Nurses with disabilities: Can changing our educational system      keep them in nursing? Nurse Educator, 33(4), 164–167. https://doi.org/10.1097/01.NNE.0000312194.89438.62

Thomson, A. E., & Winsor Murray, J. (2023). Mental health nurses who experience disabilities: Adapting to workplace barriers. Issues in Mental Health Nursing, 44(12), 1179–1187. https://doi.org/10.1080/01612840.2023.2266849

Westhead, M., & Paiewonsky, A. (2023). The experience-complexity gap. Advisory Board. Retrieved October 17, 2024 from https://www.advisory.com/topics/nursing/2023/05/the-experience-complexity-gap