Selection decisions

There were a number of stages in the selection process employed by the University and the School and included standard checks of police records and health. The purpose of the selection process was to ensure that only individuals who were academically able, were physically and mentally fit to do a nursing role

and who exhibited appropriate attitudes and behavioural attributes, such as the ability to communicate clearly, were offered places on the nursing courses. The judgement to do with anticipated academic performance on the course was generally based on previous formal academic achievements. The decision about the general suitability of the person otherwise was more subjective and was left to the discretion of the admissions tutors and any accompanying representatives from clinical practice. As one admissions tutor put it:

.. we really need to be sure that they may be fit for the course, but also, at

the end of the day, we’ve got to be sure that they are fit for the purpose, which is to be a qualified nurse.” (Nicola, lecturer mental health branch)

Information about the selection process was gathered from a number of sources, specifically the admissions tutors, the School Specific Needs Officer, the

University Special Needs Officer and the published information on the University website. Throughout the selection process the applicant could disclose that they had been diagnosed as dyslexic or that they had specific problems, which might mean that they were dyslexic. The stages of the selection process were:

• The completion and submission of an application form (UCAS form if it was for the degree in nursing) by the candidate. A candidate could declare they

had a disability or specific learning need on the form.

• The admissions office supported by the lead admissions tutor reviewed the application forms to ensure the academic entry requirements had been achieved. References and any criminal record were reviewed at this point. The self-declaration health form was sent to the occupational health doctor.

• If the candidate had declared on the application form that they were

dyslexic, a copy of their application form was sent with a standard request form to the Student Support Services. The Student Support Services contacted the candidate directly and asked for a copy of the educational psychologist report and asked them to sign a Data Protection Form which would allow limited sharing of information about the student, e.g. with specific officers in the School. If they had not been assessed in the last three years a new educational psychologist report was requested.

• If the candidate had not previously been diagnosed but thought they might have a problem, they were invited to attend an interview with the

University’s Dyslexia Tutor who conducted preliminary tests. If she

discovered that the candidate had a problem she referred the candidate for formal review by an educational psychologist.

• If the person met the academic entry criteria and there were no other problems identified at the initial screening they were invited to attend a selection interview. Either a principal or senior lecturer from the branch speciality the candidate was seeking to join conducted the interview. A clinical representative, usually of senior nurse status or a second lecturer, might accompany this lecturer. A candidate could choose at this point to disclose a diagnosis of dyslexia or raise the possibility that they might be dyslexic. If this happened they were referred to the Student Support Services as described above.

• If a candidate was successful at the selection interview and had at some point disclosed they are dyslexic, the Student Support Services would set up an advisory interview with members of senior staff from the School and with the candidate to review the candidate’s needs and discuss how they might be supported on the programme.

• Once these processes had been completed the candidate was either

offered the next available date to start the course, or offered a delayed start date (if there is anything outstanding such as results from a course), or rejected.

Successful applicants received enrolment information about a month before they started the programme. Details of the Student Support Services were included in this enrolment pack. This was a further opportunity before the student began the nursing programme to disclose their specific learning need.

Students could be referred to the Student Support Services at anytime during the course. This could be self-referral or through members of the teaching staff in the School. In stage one of the study four of the seven students either self referred or were referred by their lecturers during the first year of the course.

From the University’s point of view it was desirable for students to disclose any disability or specific learning need so that additional resources and support could be put in place to assist the student. In doing this, the University was complying with the disability legislation and met the Quality Assurance Agency’s Code of Practice for students with disabilities (1999). Providing additional support and resources should increase the chances of students being successful in their studies and thus improve student retention and hence retain funding for the University.

The situation for the admissions lecturers who were required to make decisions about an individual applicant’s suitability was a little more complicated. From the interviews conducted with the eight admissions lecturers it was apparent that the lecturers were struggling to come to terms with what they saw as conflicting priorities - the rights of the individual to undertake nurse training and to receive support and accommodations to meet their needs, against the potential risk the individual may pose to patient care and whether they would be ‘fit for purpose’, i.e. able to function as a qualified nurse.

“Some people with very severe dyslexia it’s whether we could put stuff in place to ensure safety of patients and that has still got to be our first priority. It they really can’t write and if there are other things going on as well that we need to look into...so I don’t think it should be automatic that because they’ve got dyslexia we have to put all these support things in place. It has to be the whole package, are they suitable to be a nurse, can they sustain all the other things that we require. And are they competent at the end of the programme. And if they become ward managers, can they do the job? Are they fit for practice and purpose.” (Angharad, lecturer adult branch)

7 think people who are dyslexic should have the chance to become a

nurse. But I’m also mindful that the public need protecting and if there is a difficulty with dyslexia... I’m mindful that there is a potential for danger in a sense. If I was on the other side of the coin and I was a patient and there was a student who had difficulties with dyslexia in terms of writing reports and missing information, I’m not sure if I’d be comfortable with that. ”

This second quote illustrated the fear that the admissions lecturers had about the potential risk to patient safety from poor record keeping, which is a legal

responsibility of all nurses. The interviewees did not cite evidence of the danger in terms of researched facts or statistics, it was couched more in terms of a general underlying feeling the person had.

The admission lecturers viewed themselves to be ‘gatekeepers’ for entry into the profession and were aware of their professional responsibilities when selecting candidates. Reluctance or a sense of caution on the part of admission lecturers to select someone with a learning difficulty reflects historically the nursing

profession’s resistance to the idea of accepting individuals into the profession with long-term problems, illnesses or disabilities. As one of the admissions lecturers observed, it was only recently that someone who is a well controlled epileptic or diabetic had been allowed to enter training. The lecturers agreed that a person must be ‘fit for purpose’ and ‘fit for practice’, i.e. able to meet the requirements for registration and carry out the role and functions of a nurse. What seemed to be debated was whether ‘fit for purpose’ and ‘fit for practice’ meant the person must be free from illness and disability. There was some confusion about making accommodations to a person’s work environment, whether accommodations should be made at all and at what point do you stop.

“/ think it would be useful to know at what point we... the cut off point with

disability realty, in terms of nursing, within the profession where people have to be fit for purpose... Because we are becoming too precious as a profession and we really don’t want people with disabilities and we really have to have a proper open debate about what disabilities can be

accommodated in nursing...” (Nicola, lecturer mental health branch)

In trying to work through this tension of individual rights, regulator requirements and potential risk to patient safety, one view put forward was that in making

selection decisions about students who have learning difficulties or disabilities the focus should be on the person’s potential with support, rather than what they cannot do. In the following quote the admission lecturer refers to moving from a medical model of disability, that sees the disabled person as the problem, to a social model of disability that focuses on potential, as the underpinning philosophy that should be adopted in selection.

“So sometimes the person with a specific need we focus far too much on what the person cannot do, as opposed to... the social model. You know

you have the medical model where the person has got some deficit and you could argue that the social model where OK let's optimise what the person, if provided with a level of support, can do." (Youseff, lecturer mental health

branch)

Youseff s argument was that part of the problem for individuals entering the nursing profession was that they were being subjected to discrimination because the majority of nurses were thinking within a medical model, rather than a social model of disability. The student nurse who was dyslexic was not being seen as an individual with potential with specific needs to be met, but as a problem and a potential threat, which some felt should bar them from entering the profession.

It should be noted at this point that the eight admissions lecturers and the School and University support officers all referred to the fact that students should not be barred from becoming a nurse purely on the grounds that they are dyslexic.

However, comments by some of the students suggested that some other lecturers they had encountered did think that individuals who are dyslexic should not enter nursing as a profession.

“When I was diagnosed I brought back my results to my personal tutor and to the co-ordinator, and I was called into the office asking...well the first question they asked was, how I got on the course. So I said I done my Access course, was Student of the Year in XX College. So I was asked then to reconsider my position on nursing because they don’t

encourage...urn...well, admitting nurses with disabilities. I was told I could end up killing somebody, actually being in nursing with dyslexia because through problems that dyslexics have got, reading and writing I suppose, d and b back to front...” (Matthew)

This was another example of viewing dyslexia through a medical model of

disability and consequently as a problem and threat. Emotive language was used to try to persuade the student not to enter the nursing profession probably

because legislation to prevent discrimination is stopping the institution from being able to bar them. It appeared that although the School and University had an open and supportive policy towards students with disabilities and specific learning needs, the message received might not be so clear as it was subject to individual interpretation. In the interview with the University Dyslexia Tutor she commented she had not been able to make sense of the mixed messages from the students

and staff about whether individuals who were dyslexic should be entering nurse training.

“And it seemed very blurred because there seemed to be people saying that there’s no reason why a dyslexic person is any more dangerous than someone without it. And whereas there were other members of staff saying Well it’s a bit worrying isn’t it?’...So I definitely feel it is a puzzle.”

(University Dyslexia Tutor)

She wondered how the students made sense of it. From the student’s point of view withholding information about their diagnosis at this stage removed any danger of this information affecting the selection decision.

During the interview with the University Dyslexia Tutor she reported that a pilot study using a screening test for specific learning needs would begin in two schools within the University at the beginning of the academic year 2003/04. The Nursing School was not one of the pilot sites. It was compulsory for all students in the two chosen schools to complete the screening test and be followed up by the Student Support Services Unit. The test was a modified (to make it relevant to Glynrith) version of one used at another University. If the pilot proved successful and sufficient resources could be found to sustain the resulting demand on resources the University planned to roll the test out to all schools. In future the student or applicant might have less choice in whether to disclose if they had a specific learning need, which raised certain questions about the rights to confidentiality of personal information. It was not clear whether the University was planning to impose a penalty if the student had withheld information about a specific learning need or disability. This was a human rights issue as it affected the equality of treatment of the students. It was also likely to increase the number of people diagnosed.

The data reviewed in this section showed that the University and School had considered the needs of students with specific learning needs and had in place clear processes for support, as required by legislation and the Quality Assurance Agency‘s Code of Practice (1999). However, interpretation of policy and

determination of who was offered a place on the nursing course was at the discretion of the admission lecturers and the clinical representatives involved in

the selection process. It was clear from the comments made that these individuals experienced a tension between the rights of the student with a learning difficulty to be offered an opportunity to study nursing against the possible risk they might pose to the patient/client set in the context of the requirements of the UK regulator. Another way of expressing this tension was that viewing dyslexia through the lens of the medical model of disability or the social model of disability profoundly affected how dyslexia was seen - either as a problem or something to be accommodated by the profession.