Americans with Disabilities Act-related considerations when an alcoholic nurse is your employee: when is a nurse legally considered a "direct threat" to patient safety?

Abstract

When contemplating the legal and ethical issues surrounding employment of an alcoholic nurse, nursing administrators are challenged with recognizing and upholding the Americans With Disabilities Act (ADA)-related civil rights of their employees while ensuring the quality of care provided by the practitioners in their facility. The "direct-threat" exception to disability accommodations relieves employers from making accommodations for a disability if those accommodations would necessitate lowering patient care quality standards. According to the ADA's direct-threat exception, a healthcare facility may legally terminate a nurse with the disability of alcoholism if that practitioner poses a threat to the safety of its patients. This article provides an informative overview of alcoholism as a disability in the context of nursing. A nurse administrator could use the information provided to objectively and competently make a determination of direct threat. The focus is on the importance of making an objective and unbiased assessment when determining if an alcoholic nurse meets the direct-threat" criteria that eliminates the requirement for making reasonable accommodations for a disabled employee. General ADA guidelines are provided, but the assessment must be individualized based on the patient care setting, the requirements of the position, and the nurse's present ability to safely perform the essential job functions.