Overcoming the Odds

For most people, going to nursing school, passing the boards and working as an RN in today’s often stressful health care arena is difficult enough. But for people who have physical disabilities, pursuing the dream of becoming a nurse can be even more of a challenge.

But that didn’t stop Ernesto Fagundo, Susan Nordemo and Steve Berlan. Each has overcome significant odds to build successful careers in the nursing profession.

“I always wanted to be a nurse,” says Fagundo, who was born with multiple mobility issues. “All I needed was a chance so I could help other people.”

All three agree that for nurses and nursing students with disabilities, the keys to success are determination and an optimistic outlook. “You’ve absolutely got to have a positive attitude,” says Nordemo, who lost most of her eyesight three years ago. “You have to be willing to ask for help and you have to be willing to accept help.”

“A Sixth Sense”

Steve Berlan, BSN, RN, has never let his hearing disability get in the way of achieving his goals in life. Exposed to German measles before birth, he was born with a cleft lip and profound hearing loss.

Berlan, who is 46, was among the first wave of deaf students to go to school in mainstreamed classrooms. Whereas most deaf children used to be sent to special schools where they learned American Sign Language, Berlan learned how to speak and lip-read. He has 80% hearing loss in his left ear, 75% hearing loss in his right and wears hearing aids in both ears.

His route to nursing was a roundabout one. He worked at an iron works company for 15 years, starting out as a pipe fitter apprentice and working his way up to engineering planner. But business became slow and he was laid off in August 2001.

By then, the economy was struggling and it was not a good time to look for a job. Unsure of what he wanted to do, Berlan decided to go to trucking school–an interest he’d had for many years–and graduated near the top of his class. He soon learned, however, that the long hours of sitting required for the job aggravated his back. He needed a profession that would let him stand.

That’s when nursing came to mind. Berlan’s wife is a nurse, and though she often spoke of the challenges inherent in the job, he knew there was a shortage of registered nurses and that nursing graduates were in high demand.

So Berlan, who lives in Maine, enrolled in nursing school. In December 2005, he graduated magna cum laude from the University of Southern Maine with a BSN degree and was inducted into Sigma Theta Tau International, the Honor Society of Nursing. Before graduation, he had been hired by St. Mary’s Regional Medical Center in Lewiston, Maine, as a graduate nurse because he had not yet taken the NCLEX-RN®.

When he failed the boards, he was “devastated.” He was demoted to a certified nursing assistant. In retrospect, he says, speaking over an amplified phone, “it probably was a good thing, because now I can appreciate what a CNA does.”

Berlan passed the boards when he took them again in March. He now works as a floor nurse in a nursing home, where most of the patients are hard of hearing. They are drawn to him, Berlan says, knowing he shares their hearing loss.

A combination of special equipment, task workarounds and new health care industry regulations all help make it easier for Berlan to communicate with patients and coworkers. He uses an amplified stethoscope, which has cables that connect to the back of his hearing aids. Most of the time this works quite well, elevating the sound of a patient’s heartbeat to a level his hearing aids can detect. But if the patient is obese or machinery is running in the background, it can be hard to hear. Adjustments to his hearing aids and the stethoscope continue to make the process work better.

When Berlan first started working at the nursing home, reports between shifts were tape-recorded. “That was a nightmare for me,” he says. “I can hear a person talking on a tape recorder, but I can’t [make out] what they’re saying.”

Fortunately, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the nation’s leading standards-setting and accrediting body, recently issued a new rule that works in Berlan’s favor: Shift-change reports must now be made face to face. This is because JCAHO recognized a potential for some degree of hearing loss in the aging nurse population. (The average age of RNs is now in the mid 40s.)

The new rule means Berlan can lip-read reports. “I’m entering the nursing profession at a good time,” he says.

In addition, JCAHO now requires nurses to read back instructions phoned in by attending physicians–another policy improvement that Berlan finds very helpful. To him, people speaking through a traditional phone sound “like they’ve got the ocean mixed in with their voice.” Speakers with heavy accents are particularly difficult for him to understand, he adds.

Berlan, who has a fascination with technology, says he eventually wants to become a critical care nurse. In an ICU environment, the slightest blink of an eye or body movement may be the only way a patient can communicate. Berlan feels he could bring a higher level of care to ICU patients because he compensates for his hearing loss by observing human behavior.

“I have a ‘sixth sense’ and can tell if something is wrong,” he explains. “I can respond faster to a potential crisis than a hearing nurse, who relies on bells and whistles and other sounds.”

Discovering where his talents are best used required a fair amount of trial and error, Berlan adds. “It really requires a lot of initiative on the part of the hard-of-hearing person. Nobody’s going to roll out the red carpet for you.”

Taking the First Step

Susan Nordemo, RN, has been a nurse for more than 40 years. But it wasn’t until she lost most of her eyesight that she knew how badly she wanted to remain in the profession.

Several years ago, cataracts started robbing her of her sight. (A former heavy smoker, Nordemo is convinced that the habit made her more prone to cataracts.) As her eyesight worsened, she had to stop working as a hospital nurse. Her Reiki and hypnosis business began to suffer.

Nordemo says she was depressed, though she didn’t realize it at the time. She would go for days without talking to friends or family. She had no passion for her business. Then one morning, she woke up and knew she could no longer ignore the source of her malaise.

She called the New Hampshire Department of Education’s Division of Adult Learning and Rehabilitation Services for Blind and Visually Impaired and asked for help in finding a job. It was a crucial step, she says.

Her call brought a state employee to her house the next day to install ZoomText, software that magnified the text on her home business computer screen to a size she could see. In the next day’s mail, she received a flier seeking nurses to work for Alicare Medical Management, a health care cost management company whose services include providing telephone triage to patients around the country. Nordemo could no longer do traditional bedside nursing, but a job fielding medical questions would be a perfect way to still utilize her decades of nursing experience.

The same day, an acquaintance who helps people with disabilities find jobs came over to help her revamp her resume.

Nordemo’s considerable experience and a fair amount of moxie got her the triage job. She didn’t say anything about her low vision until she was offered the position the day after the interview. Surprised at first, the company still hired her, and Nordemo went through training to learn the job’s juggling act: simultaneously talking on the phone to patients, typing in their questions, following medical guidelines and recommending appropriate care.

Three years later, the company has loaded ZoomText on four computers and has also hired two other people with different disabilities. Nordemo is very happy with her job. “It’s using all my nursing skills and I don’t need to have perfect vision,” she says. “They’ve accommodated me every step of the way. They’ve been very good to me. But I had to take that first step, and that was a challenge.”

Her Reiki and hypnosis business, Healing Crossways Hypnosis Center in Nashua, N.H., is thriving as well. In fact, Nordemo believes her vision loss has helped make her more aware with her other senses–an approach that benefits the healing therapies she provides.

“I’ve always been blessed,” she concludes. “Things have always worked out.”

Finding a Way

Ernesto Fagundo, RN, has a lot of empathy for his patients: He knows what it’s like to live with pain.

Born in Cuba in 1970 with completely malformed legs, he endured a long process of casting and multiple surgeries. As a youngster, he used crutches, a walker and a wheelchair (from which he worked as a shoeshine boy). Yet he refused to think of himself as permanently disabled.

At the age of 10, Fagundo learned to balance his body and walk on his own. He came to the U.S. with his father when he was 15, picking strawberries on the West Coast during the day and studying at night. After graduating from high school, he moved to Miami, where he got a job doing billing posting at a clinic. He slept on the clinic floor at night.

For all of his early struggles, Fagundo believes his biggest challenges came while he was a nursing student at Broward Community College. He had a full scholarship and says he endured discrimination by fellow students who resented his success. But despite these obstacles, Fagundo did well in his courses and clinical evaluations. He graduated from the program in December 2005.

“When there is a will, there’s a way,” says Fagundo, who shares his inspirational story on request with Miami-area groups. “I just needed to find a way, because I already had the will.”

Nursing students with disabilities should know what accommodations the law requires colleges and employers to make for them, Fagundo emphasizes. He also advises having a doctor evaluate your condition and make recommendations for accommodations. To give Fagundo relief from chronic pain when he was a graduate nurse, a doctor recommended that he sit down (rather than stand) at the nurses’ station while writing his reports during clinical–a simple thing, but it required a shift in staff attitude. At the facility where he was working, only full nurses were afforded the luxury of being able to sit.

Today Fagundo, who passed the NCLEX-RN in May, works at Nursing Education Center, Inc., a Florida Board of Nursing-approved continuing education provider. He is also an American Heart Association community training instructor and operates his own AHA training site. He eventually wants to become a home health nurse “to help the elderly. Nobody listens to them.”

Living with chronic pain since birth, Fagundo says, gives him a special empathy for patients who are suffering. He understands the need to be treated with dignity and respect and he gives his patients room to grieve and come to terms with their conditions.

“There is something that nurses with disabilities can bring to the profession, and that is heart,” adds Fagundo, who continues to deal with pain as well as fibromyalgia. “Let’s not forget: we’re not disabled people. We’re people with disabilities.” He also offers this advice for nurses and students with disabilities: “Get all the help you can, because there’s a lot of help out there.”