What are Reasonable Accommodations for Anxiety and Mental Health Issues While in Nursing School?

The recent news story of a nursing student suing her university because she was not given accommodations for her anxiety has nurses and nursing students everywhere talking. I can see multiple sides to this issue and am interested in how the whole ordeal will play out. I know that nursing school is a stressful and anxiety-filled time. I would even argue that many of my experiences in nursing school were far more stressful than most of my days working on the floor. However, it does bring me to ask the question: 

What are reasonable accommodations for anxiety and mental health issues while in nursing school?


Mental Health Issues in the Nursing Profession

The nursing profession is not without it’s anxiety. According to MentalHealth.gov, 1 in 5 American adults experience mental health issues. With 20% of the US population experiencing mental health issues. it’s easy to assume that 20% of the nursing population and nursing student population are also experiencing mental health issues.  It’s difficult to speculate on what types of disorders and severity 20% of the nursing population might have, but we can’t pretend there aren’t nurses practicing with mental health issues. So, in my opinion, having a mental health issue doesn’t mean you can’t be a nurse.


Anxiety and Mental Health While In Nursing School

Nursing school was one of the most stressful periods of my life. I can’t imagine anyone going through nursing school without some level of anxiety.  The tests in nursing school are like no other. Every answer is right. Most students are competitive. When I was in nursing school, many of my instructors were cold and callous about the fact that many of us would not pass and they had little sympathy for that. However, there’s good reason for many nursing students to not pass. Nursing is a tough job and you have to be tough to do it.

However, I don't think that anyone would argue with that fact that nursing school is a stressful time. Student who generally handle stress well have struggled with the intensity of curriculum and the near insanity of some of the tests. If you aren't a nurse or nursing student I can give you a little context. Imagine the anxiety you'd experience if a 10 question math test could end your entire career. It happens. A decimal can end your future as a nurse.


Accommodations for Anxiety and Mental Health in Nursing School

Craig Erickson, nurse blogger and vlogger at Keep It Real, RN, has done the research on whether anxiety falls under the Americans with Disabilities Act. In a post in the Nursing community on Next Wave Connect, he cites this passage from the ADA:

“The ADA defines “disability” as: (1) a physical or mental impairment that substantially limits one or more of the major life activities of such individual; (2) a record of such an impairment; or (3) being regarded as having such an impairment. Generally speaking, a documented and diagnosed anxiety disorder will meet this definition.”

If a nurse presented his or her anxiety disorder in writing to their nursing school administrators they would have to make reasonable accommodations for their disability.  According to the news report for the incident in question, Jennifer Burbella took the course in question twice. She was given “a distraction-free environment and extra time for her final exam when she took the class a second time, but [the professor] didn’t respond to telephoned questions as promised, creating even more stress.” Were these reasonable accommodations? Did the school not meet their end of the agreement? 


Reasonable Accommodations for Anxiety and Mental Health

The biggest question, in my opinion is what are “reasonable accommodations for anxiety?” If we could agree that a distraction free environment, extra test time, and phone/email access to instructors are reasonable accommodation, could they be abused? Would the nursing instructor, who did not return phone calls, be held liable for not meeting these accommodations? Is there a limit to amount of calls per semester, month, week, or even day that student could make? Is this fair to the other students?


In Jennifer Burbella’s Case

Jennifer Burbella, image via ABC NEWS

Jennifer Burbella, image via ABC NEWS

I don't know the answers. I can only speculate on details of this particular nursing student’s case. However, despite what I know or don’t know about her situation, I do empathize with her. Nursing school is hard. Living with anxiety is hard. Going through nursing school with anxiety is understandably harder.  The best nurses I know were C students in nursing school. Just because a person struggles doesn't mean they wouldn't make a good nurse. Sometimes, however, despite our best efforts, a career in nursing may not be in the cards for us. This may ultimately be the fate for young Jennifer Burbella. Even if she manages to re-enter nursing school, graduates, and pass the NCLEX, she is going to have a difficult time finding a job with the media and attention she has brought to herself and her mental health issues.


The Stigma of Mental Health Issues

Although 20% of the population and 20% of nurses struggle with mental health issues, almost no one is talking about it. There’s a stigma that appears to be unshakable. It’s going to be hard for most hospitals and healthcare organizations  to ignore this and the media attention she has received. It is seen as a weakness and is therefor a deal-breaker for many. Even if she becomes a nurse, it will likely be difficult for her to ever find work as a nurse.


Nurses’ Thoughts on the Topic

The Nursing community on Next Wave Connect has an engaging discussion about this “Nursing Student Who Failed Class Twice Sues Her University.”

A nurse questions accommodations for anxiety that a workplace can provide, but doesn’t want to take a side because there is more to the story:

I am just wondering how the workplace could provide sufficient accommodation to mitigate anxiety. Whenever I read similar stories in the press, my mind goes into “objective mindset” and I always want to hear more before I react or take a side. The truth is often in the middle. I do think that failure to return a phone call(s), while disappointing, doesn’t rise to the level of a lawsuit.- Beth Hawkes MSN, RN-BC, HACP nurse blogger at Nurse Code

A nurse highlights the bigger picture and mentions her fragile grades prior to the test in question:

It is a bit difficult to find any details – other than what is outlined in the lawsuit – which is one side of the story. Apparently, the crux of the complaint is that she was placed in another building, yet another student with disabilities was in the same building as her other classmates. She is claiming she was not afforded that same accommodations as the other student. Therefore, she is asking to take the test again. What concerns me more is that if her grades going into the exam were that fragile, then there is likely a bigger issue – maybe she is just not cut out for nursing or at a place in her life where she can finish school successfully. The lawsuit is going to come down to what is “reasonable accommodations”…and we all likely have differing opinions on reasonable. Definitely gets you thinking…and talking! – Joan Spitrey nurse blogger at The Nurse Teacher

A nurse questions the difference between employment and education:

I’m wondering if her being a student is a different situation than her being an employee in regards to the ADA? Also, it will be interesting to hear where the burden of proof lies in this case. What is the reasonable expectation a student can have of their instructors whether they have a challenging situation or not? Unlike employees that can be referred to the company’s EAP program, do colleges have the equivalent type of services students can access to help them with their personal challenges? – David Greene, nurse blogger at Pathfinder’s Living Healthy Blog

A nurse mentions that you have to be tough to be a nurse:

I have mixed feelings. If the nursing student is flipped out over nursing instructors not returning her call, what will she do on a busy unit, with alarms going and a load of anxious patients? What will she do when a patient dies? What will be her reaction when a doc screams at her? Sorry, not buying it. You have to be tough to be a nurse. – Kate Loving Shenk, nurse blogger and podcaster at katelovingshenk.com

A nurse educator shares her opinions:

As a nurse educator, I have seen some students that are so desperate to succeed they will do anything… despite the fact that they are clearly not safe to practice as a nurse. The courts have seen lots of these cases and almost ALWAYS defer to the University. Highly anxious students are constantly emailing and calling instructors at all times of the day, and instructors are not required to answer all questions whenever a student beacons. Her not passing the course is most likely due to her not being able to master the course content as tested on exams…This may or may not be related to her extreme anxiety/depression, but perhaps it is related to her not being able to master the content and practice safely, hence why she failed the course. – Janet Reed, contributor at Nurse Journal

A mental health nurse practitioner states:

Without more information, it is difficult to form an opinion on this specific case; however, anxiety and depression can certainly be exasperated by school. Maybe a case like this will raise more awareness of mental illness in college age individuals, and more programs will be implemented to help students receive the help they need. –Melissa DeCapua, MSN, PMHNP-BC, blogger at melissadecapua.com

Nursing Disability Expert Weighs in

Donna Maheady, ARNP, EdD is an advocate for nurses who have disabilities. Her Exceptional Nurses website and blog provides resources and support for nurses who struggle with disabilities. Her thoughts on the topic summarize the situation well:

Oh how I wish I had more information from the faculty perspective! As many of you know, I am an advocate for nurses and nursing students with disabilities….but that doesn’t mean that I think every student with or without a disability should be a nurse. I don’t think comparing her accommodations to another student’s accommodations will fly. The other student’s disability, request for accommodation and implementation of a reasonable accommodation is an individual (confidential) case…just like hers. This just may not be the right time for her to be in nursing school. If she does complete the program, she could possibly find a less stressful position—find her own niche. There are so many alternative career paths….

Share Your Perspective

Join the Nursing community on Next Wave Connect and give your perspective on reasonable accommodations for anxiety and mental health issues while in nursing school.