Meloy, Faye PhD, RN; Gambescia, Stephen F. PhD, MCHES
Nursing faculty members are interested in student success. The emphasis on caring inherent in the nursing profession presents unique opportunities and challenges with the spectrum of requests from students for academic considerations or official disability-related accommodations. Throughout this article, we refer to academic considerations as the multiplicity of day-to-day decisions faculty make when students have changing and extenuating circumstances, but not official documented disability. Disability-related accommodations are those actions faculty are required to take after an official accommodation is made by professionals in the office serving students with disabilities. We refer to this office with the acronym DSS (Disability Student Services). An increasing number of students with disabilities, ranging from more visibly apparent physical impairments to chronic and episodic health conditions, to emotional and psychological issues, are enrolling in colleges as a path to a rewarding and fruitful career. In addition, as a result of the complex interplay of academic, clinical, and interpersonal challenges inherent in contemporary nursing curricula, faculty often encounter a spectrum of requests for support and special considerations from students who appear to have permanent or ongoing conditions, but who have not registered with the DSS office. Although much has been done to legalize and institutionalize academic resources and support for students with disabilities at the college level, all requests for accommodation must be reviewed on a case-by-case basis, often requiring collaboration among disability services professionals and nursing academic administrators and faculty to ensure that students with disabilities get what they need and that learning objectives are not fundamentally altered in the process.
Academic Consideration and Accommodation
This article presents contemporary examples of requests for academic consideration or notification of disability-related accommodation from nursing. It provides suggestions for best practices associated with (1) balancing commitment of faculty to reach out and assist students in need while maintaining equity among all students and high academic/clinical standards, (2) the nuances of evolving legal guidelines for students with disabilities, (3) fostering of collaborative relationships to address the wide range of student needs in an effective and timely manner, and (4) avoiding the slippery slope of setting precedent often associated with exceptions to academic policies and/or course requirements on a case-by case basis. It includes some of the challenges and pitfalls associated with making adjustments for students without official accommodations.
Demonstrating the Scope of the Problem
To demonstrate the scope of the challenge in working with students asking for academic consideration, several scenarios are presented regarding undergraduate nursing students who present requests for academic consideration, given their extenuating need (perceived or officially verified), to faculty and academic program administrators.
Scenario 1: Requests for Extended Study/Assignment Completion Time or Alternate Testing Date
Common requests from students for special assessment consideration include extensions for completion of an assignment or additional time to study for an examination. These are requests made outside the formal “students with disabilities” policy and procedures. In an attempt to be supportive of student needs, faculty will often grant the requested consideration without consultation or collaboration with other faculty or academic administrators, assuming the situation is an isolated incident. While the majority of these requests are related to 1-time issues, it is not uncommon for select students to have a recurring pattern that is not evident when faculty members view the situation from an isolated perspective. Failure to identify the emergence of a trend in such student behaviors can enable the pattern and delay needed intervention and initiation of student academic success supports to correct the underlying problem. In addition, allowing such consideration has the potential to create an unfair advantage resulting from extended study/preparation time and/or feedback from students who take the examination or submit the assignment as scheduled.
Scenario 2: Competing Priorities
It is common for students to cite competing priorities as an excuse for poor performance, failure to meet course requirements, and justification for special academic considerations. Colleges are at varying levels in the scope and formality of how to handle cocurricular activities or competing student activities. For example, how to work with student athletes may be highly developed, whereas students participating in non–school-sponsored activities and work are less rule driven. Students on athletic/military scholarships are typically monitored closely for issues related to academic performance introducing another principal involved in the priority setting of students’ academic responsibilities. Early signs of academic difficulties are often overshadowed by rigorous practice sessions, training schedules, and related extracurricular activities. It is not uncommon for scholarship recipients to develop a sense of commitment and possibly servitude to the sponsoring agency, thus relegating course-related demands to a secondary status, negotiated responsibility, and even neglect.
Conflicts associated with family and work-related responsibilities often present understandable justification for special considerations to complete academic responsibilities. These scenarios typically are the most difficult to address. As noted previously, isolated occurrences are unavoidable and are often handled at a course-specific, faculty-resolving level. However, while the requested consideration may temper the immediate academic crisis, failure to address underlying issues sets the stage for ongoing personal/academic conflicts. Well-intentioned course faculty often find themselves in the unenviable position of having to adjudicate the legitimacy of individual student requests with the complexity of a myriad of student/faculty course-related issues created by such requests.
Scenario 3: Stress and Test Anxiety Issues
Stress and “test anxiety” are increasingly cited as an excuse for poor academic performance. Student nursing programs at the undergraduate level are replete with standardized testing, including the summative licensure examination, which challenges both faculty and students to make sure students are facile at timed test taking. Students may assert their poor performance on objective testing, and evaluation parameters do not adequately reflect their mastery of course content as they ostensibly have chronic test anxiety or where negatively influenced by a harrowing personal incident. Unfortunately, given the external locus of control for said anxiety, it is difficult for the student or faculty to ameliorate the inhibiting factor, resulting in students claiming faculty are unsympathetic, if not downright suspect, of the cause and effect of the anxiety. Furthermore, it is impossible for course faculty to discern whether the student’s poor performance is a result of stress/anxiety-related potentially caused by a myriad of external factors or symptomatic of psychosocial issues, poor study skills, other intrinsic factors, or combinations thereof.
Scenario 4: Issues Related to Learning, Comprehension
The rigorous, complex nature of contemporary nursing curricula poses significant challenge for students with learning disabilities. However, federal guidelines for classification of such disorders are specific, and the subsequent requirements for diagnosis and related accommodations are very specific.1 Unfortunately, some students with previously verified academic disabilities are hesitant to proactively disclose this information because of embarrassment, insecurity, or concerns related to being unable to handle the demands of a challenging academic/clinical program. Students may also believe that the life change to college somehow obviates their need for accommodation. Without the needed academic supports, however, many of these students run into academic difficulties and retroactively request special consideration when failing an important assessment or dismissal from the program. Retroactive accommodations are not supported by the Americans With Disabilities Act (ADA)1; consequently, these students are without substantial recourse.
Faculty also encounter students who seem to have the intellectual ability to succeed academically but despite extensive personal efforts struggle with course content. These students are typically offered supplemental tutoring sessions and/or 1-to-1 mentoring from course faculty. However, these isolated time-intensive interventions may not address underlying learning disabilities, which are beyond the scope of expertise of course faculty and have the potential to delay much needed intervention/remediation and formal academic accommodations, until it is too late.
Scenario 5: Physical and Mental Health Issues
Consistent with section 504 of the Rehabilitation Act and the ADA,1 it is illegal to discriminate against individuals with disabilities in educational and employment settings. However, nursing educators are challenged with keeping students’ physical and emotional needs in balance with ultimate patient safety when practicing in actual care setting. Because of the wide scope of practice inherent in generic nursing education programs, students are required to meet all aspects of programmatic to qualify for licensure as an RN.2 While formal accommodations can assist a student in achieving these benchmarks, the standards for performance cannot be compromised. Negotiation of reasonable accommodations and compliance with technical standards inherent to ensure the safety of students, patients, and faculty must remain a foremost concern.3
Case law has clearly noted that a student’s disability does not exempt him/her from academic policies and technical standards. All students, with or without disabilities or related accommodations, must demonstrate that they are “otherwise qualified” to meet all programmatic requirements or are subject to denial of continued academic progression and even dismissal.4,5
Academic Accommodations on College Campuses
Campuses nationwide are noticing that students with disabilities are coming forward more often, seeking opportunities in higher education due in part to supportive legislation, advances in technology, and the changing rhetoric of disability. Data from the National Center for Educational Statistics reveal that 10.8% of all students who pursue postsecondary education have a disability.6 Other research shows those who do identify as having a disability in college are a small percentage of those who actually have disabilities and are enrolled in college classes. Research demonstrates that of the students previously identified as having disabilities, only 40% of them identify to their institutions as having disabilities in college.7 The small majority of students, 53%, previously identified no longer consider themselves to have disabilities at all and therefore do not identify to their postsecondary institutions. Finally, 7% do consider themselves to have disabilities but have not yet identified as having disabilities.7
Regardless of whether these students are registering with the DSS offices, they are on our campuses and in our classrooms, and we must use best practices to consistently, carefully, and caringly provide the most effective support possible. Naturally, the growth in the number of students identifying as having disabilities has implications for educational programs of all kinds, including those in the health professions. The challenge lies in allowing for enough flexibility to accommodate students with disabilities and to allow for the occasional consideration from nondisabled students while maintaining academic and patient safety standards.
Opportunities and Pitfalls When Faculty Handle Academic Considerations
Nursing faculty naturally have vested interests in student success. Nursing faculty by training take on a caring persona with students and are used to moving into a problem-solving mode, oftentimes autonomously and with confidence. However, in the area of handling academic considerations for students with no official accommodation from DSS, faculty can land in some pitfalls. Below are some common pitfalls and challenges for which faculty need to be aware.
Faculty understandably have good intentions in granting informal requests by students for academic considerations; however, single, isolated considerations could result in a student not addressing underlying issues that contribute to poor performance; help in the short term may not be help in the long term. The failure to recognize underlying patterns and trends in student behavior/performance may delay needed intervention. The issues faced by the student may escalate into more severe academic issues and concerns.
Faculty should be aware that inequities in application of standards run a risk of precipitating challenges of favoritism or unfairness from other students who “play by the rules,” despite their own personal challenges and competing priorities. Students talk liberally among themselves, and in a short amount of time, a faculty member could be asked to account for why another student was given special treatment.
Faculty members who get too engrossed with meeting every academic consideration without some general knowledge and guidance can expect increased workload by creating multiple examinations, monitoring outstanding assignments, disruption of course, and so on—all cause for distraction of efforts from course-related student responsibilities. There can be much effort in dealing with “problem students” that faculty energies are diverted from course-related priorities and needs of the general student population; flexibility need not be at the expense of any single group.
In giving academic consideration to students, faculty place themselves in the position of both judge and jury of reasonable versus unreasonable requests. Students may exploit acts of flexibility by taking their pick in seeing the faculty member as supportive, enabling, or a barrier to their academic progress.
Faculty working without some thoughtful consult will have a hard time determining where to draw the line in for academic considerations. Each request seems to be different as the students’ issues seem to involve such varied extenuating circumstances. The variance is uncanny. This creates a slippery slope for inadvertently encouraging students who seek academic considerations, and the faculty member’s litmus test becomes more liberal.
Giving a student academic considerations could be opening the door to other less desirable, legal complications, in the future. For example, if a professor gives academic consideration of some kind to a student but then later tries to take it away or discontinue it for some reason, the student may say you originally gave the consideration to them because they have a disability. Technically, the students could make the case that you have regarded them as having a disability, and under the ADA, those who are regarded as having disabilities are protected from discrimination. In addition, students who register with DSS offices go through a rigorous process in order to request and receive accommodations. Should a student go through that process and be denied only to find out another student without a disability received the same flexibility through the professor without an official accommodation, one can expect the issue to become legally charged.
Communicating Student Expectations
Universities promulgate a large body of policies and procedures, standards, and expectations for students. Faculty and academic administrators should be aware of the many sources or authorities for these expectations and the need to help students know where to find, read, and interpret the expectations. As one can imagine, these expectations can be dizzying to students on college campuses as there are many, and they are unlikely to be assembled in one place, even in the era of electronic communication. Furthermore, students who have an officially verified disability needing accommodation or students who may potentially need some type of accommodation (officially verified or episodic to a particular academic activity) may find some of these expectations challenging. They need to be more vigilant about knowing what is expected. Therefore, academic administrators need themselves to be vigilant on the clear rationale for, communication of, and implementation of all student expectations.
Legal Guidelines/Purpose of the DSS Office
In 1973, section 504 of the Rehabilitation Act1 made history as the first piece of disability-specific legislation to protect students with disabilities from discrimination. Nearly 20 years later, in 1990, the ADA1 went into effect and clarified that people with disabilities are not only to be protected from discrimination but are also eligible for reasonable accommodations in order to fully and equally enjoy the goods, services, facilities, privileges, advantages, or accommodations of an entity. In order to be eligible for accommodations at the college level, it is the student’s responsibility to register with the DSS office and (depending on the procedure at the given institution) ensure that an accommodation notice is provided to each professor in a reasonable amount of time before the accommodation is to be used. It is the responsibility of the college to ensure that all reasonable accommodations are provided for students with disabilities.
A Systems Approach to Student Requests for Academic Consideration and Accommodation
A first step in a systems approach in handling requests for academic considerations is to ensure persistent communication with students of the need for them to be responsible for their academic outcomes and for them to reach out for support or ask questions when having concerns. There is a range of reasons why students do not reach out for help, such as avoiding the remedial label, mistaken capacity of being high on the self-efficacy scale for a certain standard, or sociocultural reasons. Faculty and academic administrators cannot possibly anticipate and be facile in handling every conceivable academic consideration or formal accommodation. Furthermore, administrators should feel confident that faculty members generally use their good knowledge and experience in making decisions to give students academic considerations. It is important that all students hear often and consistently the message that they will be held to an uncompromising standard, and standards will not be tempered arbitrarily or capriciously given any consideration or official accommodation.
Clinically focused professional education programs such as nursing are faced with the challenge of supporting student learning in the context of public safety, mandated program outcome standards, and licensure requirements.3 Another important step in a systems approach is communicating to prospective students and parents and to current students that academic accommodations are not intended to lower program outcome standards. It is important for both faculty and students to understand the important distinction that all students are held to the same academic standards and program outcome requirements. Correspondingly, technical standards/essential functions are established for the continuum of students’ participation in the nursing program from admission, to graduation and practice as an RN. Individuals who are unable to meet such technical standards, with or without reasonable accommodations, are not permitted to complete the nursing program and should be counseled to pursue alternate careers. Faculty and academic administrators should be prepared to answer students’ and often parents’ complaints that not lessening the standard or not making an accommodation is antithetical to the caring nursing profession or the philosophical commitment to treat students as individuals.
The ADA requires institutions to designate a compliance officer to oversee compliance issues, student disability qualification processes, and accommodation determinations and serve as a subject matter expert for consultation with faculty and program administrators.1 Close collaboration among nursing program administrators, faculty, academic support services, and disability officers is essential. Faculty and academic administrators are not expected to be expert in these areas of the law but will be held to the responsibility of referring all students who disclose a disability to the designated DSS office. While disability officers, legal counsel, and their respective staff are content experts in disability law and generally accepted academic accommodations, they often lack the professional insight and expertise to adapt generic academic adjustments to clinical coursework and related clinical experiences.3 Early warning measures should be established to identify students at risk for excessive considerations or students who may need further evaluation by the office of disability services.
Using the Concept of Universal Design With All Students
It is well recognized all students learn and work differently. However, when one thinks of the myriad of requests faculty receive for academic consideration, it is interesting to contemplate how many of the requests may actually arise because the student is not getting the type of instruction or the degree of flexibility that really complements their learning styles and needs. Most faculty would agree that there is a certain degree of flexibility that is reasonable and anything beyond that would be an alteration of the learning outcomes. But how do they know when they come to that line? It is helpful to remember (so as to be fair to all students) that the degree of flexibility available to one student should be available to anyone who requests it. If it is reasonable for one student to receive flexibility requested based on personal circumstance, it is fair all students with reasons of personal circumstance be afforded the same consideration. When this logic is used proactively, the method can be called Universal Design (UD). UD is the effort to make the environment as accessible and usable to the greatest number of individuals as possible, regardless of age, disability, or other factors.
Handling Complaints/Grievances When Students Are Not Satisfied With an Academic Consideration
A corollary responsibility of the academic program or college in keeping students informed of the many expectations is to let them know that there is a formal system in place if they have a complaint or grievance with the granting or not granting of an academic consideration. The college should have in place a circumspect student complaint/grievance/appeal process. The nursing program administrators should know the lead person who handles student issues for the college. They should become familiar with the process and develop a good working relationship with the lead person. A healthy approach and philosophy for the college to follow given a student complaint/grievance is that before a student seeks recourse from the formal grievance/appeal process, he/she should first exhaust the immediate means of resolution between the parties involved. Stakeholders within an academic community deserve an opportunity to resolve a student issue within their respective areas of responsibility, and quite simply, good organizational practice holds that those closest to, most invested in, and most familiar with a problem are in the best position to solve the problem.
Although official student accommodations have strict policy and legal directions, the majority of issues faculty face will be in the less formal academic consideration category, for which there are few proscriptions. Nursing administrators should call for formal briefing sessions with the official who handles student issues and involve all stakeholders to devise a fair, reasonable, and defensible academic consideration for a student. Similarly, such sessions should follow to discuss appeals or potential appeals made by students who are displeased with the consideration or feel that the consideration had a negative effect on their performance in an assessment. Students should be made aware that a system is in place to hear their complaints and due process is ensured. Certainly patterns of student behavior emerge from which faculty and nursing program administrators will know the next steps; however, a more practical school of thought in working with student issues is that each student issue tends to be unique. The policy and procedures review is often the least complex, whereas the review of a best practice in the decision or the student’s extenuating circumstance makes the review nuanced.
An important distinction in a review of student issues in these cases is to first determine if you are working with a student who has an official student accommodation. Does the student have notice of accommodation from the DSS office? If so, a representative from DSS should be consulted during the student issue review process. The nursing program administrators should develop a close working relationship with that representative so each party can educate the other on the nuances of students needing accommodations. A common request from students is to ask for accommodation retrospectively after a poor assessment. The legal guidelines for working with students with disabilities are clear that request for accommodation must be student initiated and cannot be granted retrospectively. A system should be in place to maintain records of such complaints/grievances/appeals and their resolutions. Furthermore, the information becomes a valuable resource to work to develop educational and student/faculty development programs that foster best teaching/learning practices.
Summary and Conclusions
This best practice article makes a unique distinction between consideration, the multiplicity of day-to-day decisions faculty make when students have changing and extenuating circumstances but not related to documented disability, and accommodation, that is, those actions faculty are required to take after an official accommodation is made by professionals in the office serving students with disabilities. Nursing faculty by nature approach student issues in a caring manner but have to balance academic considerations with risk of pitfalls, perceived or real, in giving students preferential treatment. Furthermore, enabling students to rely on the good nature of faculty consideration may delay or mask much needed academic support including official accommodation by the DSS office. Campuses nationwide are noticing that students with disabilities are coming forward more often, seeking opportunities in higher education due in part to supportive legislation, advances in technology, and the changing rhetoric of disability. Faculty members are not expected to be expert in handling the sundry of issues related to student considerations and accommodations. Thus, a systems approach is needed to give students needed consideration and accommodation while protecting the academic rigor and technical standards of the nursing program and maintaining administrative order when handling student issues.
© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.