My nursing school is setting me up for failure in 4th semester clinicals due to my disability

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation! Nurses Nurse Beth Nursing Q/A

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I'm sorry—this is a lot, but I'm at a loss. I really appreciate advice/help from anyone who has experienced this or something similar.

Background Context: I am a BSN student with disabilities in my last year. I got into healthcare after being a patient for so long, and I am very passionate about my role as a provider. Despite a lot of virtue-signaling and false promises, I have had a persistent and constant fight every semester with the school and to have accommodations and implement them successfully ecp. in any clinical setting. At the beginning of the program, they dug into my background/personal circumstances, and I was told flat-out after trying to advocate for myself and ADA needs that I should leave due to disabilities, housing status, and income status. I have worked in nurse-related roles and spent years sacrificing to make this happen, and I was not going to give up that easily.

While there are a few rarer supportive clinical scholars, instructors, and preceptors, overall, this is not the case, and it has been a hell of a battle - not because of the content, lack of skill, lack of positive feedback, or lack of interest or enjoyment of being a nurse and interacting with patients but purely from the stress of a system so profoundly rooted in the harmful systemic problem under the guise of tradition and discriminatory practices that gatekeep who should be a nurse not based on skill but income/socio-economic status, health status/disabilty, and skin color. This has profoundly impacted my health and I have developed worsening health issues that providers and loved ones alike think is most likely due to the stress caused by the school. Yet, I do and have worked in challenging jobs with the same hours and structure successfully and will be afforded more freedom than in my current field of better career paths with nursing so I know once I have the degree it is not a matter of capability. I have two semesters left and my grades are good.

Current Dilemma: After being told that they thought one of my main issues was living and driving so far away from clinicals and the school, I was repeatedly told I needed to move. I moved closer to the school. I am going into complex care, which is one of my last major rotations before my capstone, and they assigned me to the Medical-Surgical Unit I used to work near my old apartment BEFORE I moved. I have nine rotations here, 2-3 back-to-back at a time, and it is 1.5 - 2 hours away from my new place. Not only does this afford me less than 6 hours of sleep, but sleep is one of my main treatments that prevent s/s, particularly the most conerning risk of having a passing out episode while on the floor or driving my car. More so, this is also a floor I worked on that got upset when a requested some basic accommodations (an issue I have not had with other places) or at least support in getting my 30-minute break and still has management in place that got in trouble for treating the floor nurses and techs terribly ultimately leading the majority of us to leave for better work, myself included. I worked there for a while as a medical-surgical tech. Unfortunately, all of the nursing individuals with any power - manager, assistant manager, clinical educators, and a couple of others had a online meeting with staff that was a monthly meeting supposedly to work together to check in and help with improving working conditions, teamwork, and pateint care. The meeting was recorded for those of us to see if we did not make it. They forgot to stop the recording when the meeting finished and went on to say absolutely horrific things about the staff providing direct patient care - nurses and techs; and how they were not going to listen to us and laughing at the staff, naming specific people and calling them names and such. It caused an immediate up-roar and tension between the direct care workers and management. Management immediately took the recording down and blocked all staff from obtaining any recording as soon as they realized they had not turned it off and saw it was still recording - including the recording audio and transcript.

They eventually responded to the nurse uproar by firing the nursing manager BUT only to elect the assistant nursing manager who was involved as the new unit manager and keep or promote everyone else involved. I also had been involved in an accommodation request that took 6+ months to get a response after the third party "lost my record" and refiling that kept getting no response. They would not only not respond to it but kept putting me on the schedule after I was put on leave because it was unsafe to return to work, which made my co-workers and the new workers who did not know me (since they quickly were losing people) upset as they thought I was just not showing up. I tried many times at first and once again after they denied my claims to offer to be transferred to a more suitable placement within the company and told them I would be grateful for the support to do so but they refused.

My fate for nursing school now depends on my performance in this unit, and multiple subjective P/F judgments rely solely on clinical scholars, management, and preceptors' opinions. I am pretty sure all of the great team members who were direct patient care workers (nurses and PCT) I worked with left, but know those in positions involved or close to the members involved have stayed, and some of them may be judging me and my clinical educators. The school requires that we list all the specific information of past and present employment. Hence, they know I was previously employed there AND had multiple letters from providers about how forcing me to operate without adequate rest is crucial to prevention of any s/s that would interfere with my ability to perform safely.

 

I am just at such a loss and feel so powerless and hopeless. They have placements with every hospital group across the largest city in the state and surrounding cities and have the most connections (something they LOVE to brag about) of any nursing school in the state. They could have placed me literally anywhere but this unit. But nope. There is an established conflict of interest, and passing and failing is completely subjective to the person grading, regardless of how much you try to prepare as a student and how well you do with the patient.

Is there anything I can do? How in the world do I survive this? Classes start this week, and clinicals start in the next two weeks. Is it all out of my hands? Could the past 4+ years be for nothing? A few semesters ago, I contacted some legal resources for advice and received a free consultation from a lawyer who said that all my accommodations were reasonable according to ADA guidelines and supported my provider's recommendations. But I quickly found that, like most lawyers, even if they pay you back if they lose, you need a particular down payment or deposit to receive services. I am below the poverty line and cannot afford it, so I did not. But now am considering going into more debt to do it (I have about $20,000 in student loans and $2,100 in credit cards due to the cost of living versus income). Is that ridiculous?

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Specializes in Tele, ICU, Staff Development.

I'm sorry you're going through this—your situation sounds incredibly challenging and unfair. Navigating a nursing program is tough enough without the added stress of fighting for your rights and health. Your resilience and dedication to your education are admirable.

Here are some potential steps you could take:

Document Everything

Keep thorough records of all your interactions with the school, clinical sites, and any healthcare providers regarding your accommodations. This includes emails, letters, and notes from conversations.

Document your symptoms, how the lack of accommodations affects your health, and any negative experiences you have at your clinical site.

Contact Disability Services

Re-engage with your school's disability services office. Make sure they are fully aware of your situation and request a formal meeting to discuss your accommodations.

If they deny your requests, ask for a written explanation. This could be useful if you decide to pursue legal action.

Escalate Within the School

If disability services or your instructors aren't responsive, consider escalating the issue to higher levels within the school, such as the Dean of Nursing or even the university president.

Present your case clearly, highlighting the school's legal obligations under the ADA to provide reasonable accommodations.

Seek External Support

Contact disability rights organizations for advice or advocacy. They might offer resources or legal support at little to no cost.

Some organizations, like the ADA National Network, may offer guidance or connect you with resources in your area.

Legal Consultation

Consider contacting your local Legal Aid Society or a non-profit organization that provides legal assistance to low-income individuals. They may offer free or reduced-cost legal services.

If possible, revisit the idea of seeking a lawyer. Some lawyers work on a contingency basis, meaning they only get paid if you win the case.

Consider an Alternative Plan

If your current school remains unresponsive, you might explore transferring to another nursing program, though this would be a last resort, given your progress. Some schools might be more accommodating or offer more supportive environments.

Mental Health and Self-Care

Your health is paramount. Continue to prioritize your well-being. Seek support from friends, family, or a therapist if possible.

Practice self-care and stress management techniques to help mitigate the health impacts of this stressful situation.

Reflect on Legal Action

Taking legal action is a significant decision, especially when financial resources are limited. It can drain energy, be time-consuming, and keep you in a negative state.

However, if you genuinely believe that your legal rights are being violated, that's a different ballgame, and it may be worthwhile to pursue legal action.

I wish you the very best in your decision,

Nurse Beth

kbrn2002 said:

 You knew about this clinical placement before you moved so you really should have addressed this as soon as you moved if not sooner.  The placement was close to your home before your move, which is likely why you were placed there in the first place. By not addressing your other issues with this placement as soon as you were assigned there and then not raising concerns about the location's distance from your home promptly when you moved the school may have no responsibility to change your clinical site to accommodate any disability.

 

I can see why you read it the way you did, but fairly sure what the poster is saying is that they were told that they lived too far away and this distance was blamed for things related to OP disability. So...OP moved closer to the school. Then the school assigned a rotation right near OP's previous place. 

To the OP:

I say this with all due sensitivity, as a word of caution. 
 

It sounds like your former work place is a trashy place where horrible behavior is allowed. I would not want to go back there either. Maybe you shared all of that just so Nurse Beth could understand some background. I am not a lawyer but have a feeling you would be wise to keep your previous experiences at that place completely out of discussions about ADA accommodations. The only situation where it *might* (but not necessarily) be wise to commingle the two issues would be if your former workplace had received some kind of sanction related to not complying with their ADA responsibilities in relation to your disability in the past. 
 

Otherwise, it is possible for people to ask whether the real problem is that the school is purposely not complying with their own suggestion related to your disability (that you live closer)……or.....that you mostly don't want to go back to that place because they're generally horrible (as no one would).  You don't want them accusing you of muddying the waters over an undesirable clinical site. 
 

Have you tried just approaching the person in charge of setting up rotations in a friendly and professional manner and stating something along the lines "I understand what a huge job this is and am guessing this clinical site may have been planned for me when I lived in that area, but I have had to move closer to the school to accommodate my disability and now will need a site closer to this area.” Or maybe start with disability services at your school and say the same kind of thing, giving them a way to gracefully do the right thing. 

Hope you get it all worked out ~

Specializes in Geriatrics, Dialysis.
JKL33 said:

I can see why you read it the way you did, but fairly sure what the poster is saying is that they were told that they lived too far away and this distance was blamed for things related to OP disability. So...OP moved closer to the school. Then the school assigned a rotation right near OP's previous place. 

Yeah, I can see that. However, I've never heard of a program that assigns clinical rotations with little notice. Hopefully, there will be enough time to talk to the powers that be in the program about changing sites. I agree that OP should focus solely on the distance from OP now lives and not bring up the more negative aspects of working there.  However, depending on program rules having a clinical rotation at a facility and unit that formerly employed the OP may not even be allowed.  In which case bringing up the employment history without going into the negative experiences OP had there could also be a valid reason to change clinical sites.

 

Specializes in Geriatrics, Dialysis.

Have you talked to the instructor who schedules your clinical rotations? If nothing else assigning you to a clinical site so far from where you live if closer sites are available is not conducive to your success. I'm sorry you are having so much stress over this. 

Is there an option to change clinical sites with the clinical rotation starting soon? You knew about this clinical placement before you moved so you really should have addressed this as soon as you moved if not sooner.  The placement was close to your home before your move, which is likely why you were placed there in the first place. By not addressing your other issues with this placement as soon as you were assigned there and then not raising concerns about the location's distance from your home promptly when you moved the school may have no responsibility to change your clinical site to accommodate any disability.