Disability cuts across all social identities. Any person can acquire a disability, and if individuals live long enough, most will. In the United States, approximately one quarter of the population lives with at least one disability (Centers for Disease Control and Prevention 2025), and globally, an estimated 15% of people have a significant disability (World Health Organization 2023). Currently, very little data are available to determine the prevalence of disability in the nursing profession. The absence of disability as a demographic variable for workforce research highlights the reality that disabled nurses are often ‘invisible’ to nurse leaders, workforce researchers and professional nursing organisations. The assumption is that disabled nurses do not exist and therefore are not counted. While limited data exists, it is likely that disabled nurses are significantly underrepresented within the nursing profession. Despite nursing's stated commitments to diversity, equity and belonging, disability has remained on the margins of professional discourse (Carroll and Shaw 2024), even among nurses who actively engage in equity work. In this invited commentary, I reflect on disability in nursing over the past 50 years, drawing on both historical developments and my lived experience, and offer recommendations for a future that moves beyond accommodation towards a reimagining of who is allowed to belong in nursing. I identify as a disabled, neurotypical, multiracial, white presenting Latina, cisgender woman. My identities shape the lens through which I view the world and how I experience life as a disabled person. I have been a nurse for more than three decades, and I have spent most of that time as a disabled nurse. I acquired non-apparent physical disabilities early in my professional career at a time when nursing students and nurses with disabilities were limited in their ability to practice in the nursing profession. Throughout my career, I have adapted, negotiated, concealed, disclosed and persisted within a profession that continues to ignore the potential and contributions of disabled nurses. In this paper, I use mostly identity-first (disabled nurse) because it is my preference; however, some people with disabilities prefer person-first language. I encourage readers to ask people who have disabilities what they prefer. Importantly, I do not speak for all disabled people, and my experiences may be different from those of other disabled people. To frame the history of nursing over the past 50 years, it is important to discuss the experiences of people who had disabilities prior to the 1970s. Evidence exists from archaeological artefacts that disabled people have existed as long as humans have existed. In ancient times, family members cared for people with disabilities, while in some regions infanticide of disabled babies was common (Murphy 2024). Over several centuries, society's view of people with disabilities has shifted positively, but the right to learn, work and thrive remains a challenge in contemporary times. Beginning in the Middle Ages, opportunities to work and be educated became available to people with disabilities, though there were no laws protecting them at that time (Murphy 2024). As medical and scientific advances evolved in the 18th and 19th centuries, the medical model of disability emerged. In this model, disabled people were pathologised and viewed as broken. The goal within the healthcare system was to fix the disabled person and return them to a normative state, and when that was not possible, disabled people were often isolated from society, placed in institutions and viewed as unfixable (Zaks 2024). Unfortunately, the medical model is still the dominant view of disability within the healthcare system in the United States. In the late 19th century, the eugenics movement was born. The term eugenics was coined by Galton in 1883, leading to a new ideology about disabled people, particularly in Europe and the United States (National Human Genome Research Institute NHGRI 2022). From the late 1800s to the 1970s, the eugenic movement was widespread worldwide. Through the eugenics movement, normative bodies, race, abilities and other human characteristics were socially constructed, and people who were outside of the norm were identified for eradication or sterilisation (NHGRI 2022). The concept of eugenics was based on flawed science that suggested disabled and other people who were deemed as less than desirable (people racialized as nonwhite) could be eliminated through planned breeding, involuntary sterilisation, and social isolation. The primary ideology in eugenics was the need to eliminate inferior people for a superior human race to emerge (NHGRI 2022). This was evident in Nazi Germany, where hundreds of thousands of disabled people were murdered. In the United States, forced sterilisation was legal in the early 20th century and continued until the 1970s. Tens of thousands of disabled people and people who were racialized as ‘nonwhite’ were sterilised without consent (NHGRI 2022). Though the eugenics movement faded as laws changed, its ideology persists in some areas. The United States is currently seeing a resurgence in eugenic ideology. By the 1970s, due to advocacy from within the disabled community, some progress had been made in reconceptualizing disability as a social issue rather than an individual limitation. In the social model, disability occurs because the world is not designed for people with different abilities (Zaks 2024). It is the lack of accessibility and societal views that limit people with disabilities, rather than the individual's body. As a result of activism and advocacy, laws began to emerge in the period from 1970 to 2000 in the United States and other countries. The Rehabilitation Act of 1973 (Section 504) was one of the first laws impacting nurses and future nurses in the United States (Murphy 2024). This law prohibited discrimination against people with disabilities by entities that received federal funding, including schools. It meant that disabled people were afforded the right to an education. In 1990, the Americans with Disabilities Act (ADA), which was modelled after the Civil Rights Act of 1964, was signed into law (Murphy 2024). This law was necessary because disabled people were excluded from protections under the Civil Rights Act. The ADA guaranteed equal opportunity and access for people with disabilities. The ADA was later revised in 2008 to expand the definition of disability (Murphy 2024). Similar laws were enacted in other countries from 1970 to the present. Though laws exist to require accessibility and human rights for disabled people, oppression and lack of accessibility remain significant concerns. Historically, disabled nurses have been excluded from nursing education and practice, and while laws have changed in the United States and in other countries, the culture of nursing has made little progress in addressing access and equity for disabled people. Disabled nurses often experience significant stigma and ableism, which shows up as a ‘set of beliefs or practices that devalue and discriminate against people with physical, intellectual, or psychiatric disabilities and often rests on the assumption that disabled people need to be “fixed” in one form or the other’ (Smith 2025, 1). While legal protections have expanded in many countries over the past five decades, the deeply ingrained belief that disabled bodies are incompatible with safe nursing practice continues to shape the professional culture in nursing. From approximately 1970 to 1990, nursing students and nurses with disabilities had minimal legal rights or protections in the United States and were widely viewed as unfit for practice. These exclusionary norms were rooted in longstanding ideals of nursing that emphasised physical endurance, obedience and self-sacrifice. Florence Nightingale's early conceptualization of nursing established restrictive norms about who could be a nurse. Throughout much of the late twentieth century, the ‘ideal nurse’ was imagined as physically and mentally able to endure long shifts, heavy workloads and emotional strain without complaint. These views of the ideal nurse persist, as evidenced by the push for resilience amid ongoing moral injury in contemporary practice. Within the context of an ‘ideal nurse’, disability was framed as risk rather than difference. Since the colonisation of nursing, ableism has been firmly rooted in nursing culture. By the 1970s, due to advocacy from within the disabled community, some progress had been made in reconceptualizing disability as a social issue rather than an individual limitation. In the social model, disability occurs because the world is not designed for people with different abilities (Zaks 2024). It is the lack of accessibility and societal views that limit people with disabilities, rather than the individual's body (Zaks 2024). From 1970 to 1990, people with disabilities may not have considered nursing, or may have left the profession upon becoming disabled based on the strict physical and psychological requirements. It is difficult to know how many disabled people were impacted because they were not considered or counted. Nurses who had non-apparent disabilities or disabilities that could be hidden were forced to conceal their disabilities to gain admission, remain employed or avoid professional harm, while those with apparent disabilities were not even considered for inclusion in nursing. Disclosure often carried the risk of exclusion, discipline or forced exit from the profession. My early career unfolded in this climate, where survival in nursing meant sacrificing my well-being to remain employed in a profession I did not want to leave. Prior to laws establishing disability rights and access, many nursing schools and employers required extensive physical exams to demonstrate that they were fit for duty as a nurse. For example, when I applied to nursing school in 1989, I was required to complete a health assessment form that included a health history for all body systems, including past injuries or illnesses. Upon acceptance to nursing school, I was required to complete an occupational health examination that included lifting and carrying heavy objects, hearing and vision exams, and the ability to climb stairs. These types of medical histories and exams were also required of me when I entered the nursing workforce in 1992. If I had not been able to perform the required tasks or had been perceived as limited in my abilities, I would have been denied admission to nursing school. The passage of disability rights and access legislation in the late 20th and early 21st century marked a significant shift in formal protections, including access to education and employment for disabled individuals. Laws mandating reasonable accommodations created pathways for some disabled nurses to enter and remain in practice. However, legal requirements did not translate into cultural change because many nurses and administrators in leadership roles have not been educated about disability rights or their obligations under the existing laws (Neal-Boylan and Miller 2020). Ableist assumptions continued to shape nursing education and employment practices (Carroll and Shaw 2024). In fact, many nursing schools have not updated their health requirements to address the difference between essential functions (employers) and technical standards (nursing schools). Some schools still have intrusive health forms and publish requirements on their websites that give readers the message, explicitly and implicitly, that disabled people need not apply. Had I become disabled during nursing school, I am certain I would not have been able to graduate, despite the newly signed Americans with Disabilities Act (ADA), which granted disabled people rights to access and accommodations. Essential functions and technical standard descriptions have remained grounded in normative assumptions about physical and mental ability (Jackson et al. 2025). Despite legal protection granted by the ADA and other laws globally, nurses who were empowered to make admission and employment decisions have remained cognitively anchored to the idea that nursing cannot be safely practiced by people with disabilities, especially physical disabilities. Accommodation, when provided, was frequently framed as exceptional or burdensome rather than as routine aspects of inclusive practice. Disabled nurses were and continue to be expected to justify their presence and repeatedly demonstrate competence in ways their nondisabled peers are not. Despite policy changes, many disabled nurses continue to experience exclusion, isolation, fear, hindered career progression and pressure to leave nursing practice, especially in bedside or clinical roles, regardless of expertise, skills or capability (Lindsay et al. 2022). In recent years, nursing has increasingly embraced the critical need for diversity, equity, inclusion and belonging. However, disability is often absent from these conversations or treated as an afterthought (Carroll and Shaw 2024). When disability is acknowledged, the focus frequently is on patients rather than on nurses themselves. When included in nursing curricula, disability is often framed using the medical model of disability, which views disabled people as unfixable and applies a deficit-based ideology (Zaks 2024). Data on disabled nurses remain scarce, as disability is rarely included in workforce surveys or research demographics. This absence reinforces the perception that disabled nurses are rare or anomalous, further marginalising their experiences and contributions. As a result of the lack of inclusion of disabled nurses in nursing research, it is difficult to ascertain how many nurses and students leave the profession due to ableism and how many persist despite it. Though legal protections exist, disabled nurses and students continue to navigate professional environments that were not designed with them or other disabled people in mind. While the ADA and other laws around the world now require employers and nursing schools to ensure accessibility for people with disabilities, the underlying ableist culture continues (Lindsay et al. 2022). As a nurse educator, I have heard countless colleagues make biased and harmful statements about students. For example, when discussing students with psychological or learning disabilities, I commonly hear, ‘They will not get extra time in real life, so they should not get it now’. I have also heard many comments about nurses with physical disabilities, including ‘They will not be able to hear the alarms’, ‘How will they do CPR in a wheelchair’ or ‘They cannot safely perform sterile technique with this limitation’. There is an overarching lack of curiosity about the resources and strategies available to support disabled nurses in practice. Further, there is this anchoring bias that all nurses must be able to work 12-h shifts in an acute care setting, yet many roles exist for nurses with and without disabilities, and opportunities for shorter shifts and more accessible work environments are possible. While organisations may provide accommodations, the belief that disabled nurses do not belong in the workplace creates environments where disabled nurses are always on edge, trying to prove their value, and navigating spaces where colleagues feel they do not belong (Baker et al. 2023). For many disabled nurses, practicing under toxic stress from ableism has become the norm. Further, nurses who have other marginalised and intersectional identities face additional discrimination and stress that takes a physical and psychological toll on their bodies. Nurses and students who have apparent (visible) and non-apparent (not visible) disabilities experience profound ableism in nursing both as patients and clinicians. Nurses and students who have non-apparent disabilities often struggle with whether it is safe for them to disclose their disabilities, especially during school admission or early in their employment process, while people with apparent disabilities are often rejected from admissions and employment with no reason offered. My experience as a disabled nurse spans 25 years and multiple roles within nursing. Throughout this time, I have developed adaptive strategies, problem-solving skills and a deep knowledge of what it is like to live with chronic and disabling diseases. In addition to my personal experiences, I have learned tremendous lessons from disabled people, including nurses. Rather than diminishing my capacity to practice, disability has deepened my understanding of vulnerability, access and the challenges within the healthcare system from both professional and personal As a result of my experience as a disabled person and I the of with chronic and disabilities in a that is not designed for people who have disabilities. I both the lived experience of a and a nurse in ableist This knowledge significantly to my work as an nurse and me to experiences that people may not the first years that I was disabled, I my I was as an and I was very that if I for accommodation or disclosed my non-apparent disabilities, I would be of the For this meant that I my body beyond its capacity and often significant and from the time, shorter shifts or to where I could for would have been perceived as to the other nurses. Disabled nurses and people are often as to be rather than as to knowledge and The emotional of accommodations and a toll that remains within the profession. lived experience as a form of challenges deficit-based of disability and for more inclusive of competence and in nursing. The 50 years of nursing require a shift in how disability is within (Carroll and Shaw 2024). beyond individual accommodation towards inclusion and access is the of the it is difficult to what the future will like in 50 years, but there are some reasonable assumptions that can be It is likely that there will continue to be disabling from as and with an population will likely the of people who live with disabilities. This will require to and a more accessible Further, as advances continue in the 50 years, the opportunities for and the of could significantly the lived experience of disabled people. However, it is critical that disabled people are included as and in reimagining a future where disabled people have the access and opportunity to as people without disabilities. in and healthcare could significantly expand opportunities and for disabled nurses to practice to the of their and Rather than whether disabled people can be nurses, the profession must ask how nursing practice environments and leadership must change to support a workforce that people who have disabilities. This shift in how disability is viewed must also from contemporary of disability, as the medical and social (Zaks 2024), towards disability and While the social model of disability progress by that disability is socially and from an world and societal about what is it has not in significant movement towards a more and inclusive nursing profession or (Zaks 2024). When disabled people are no by an will inclusion and equity are essential for all people. must how environments are designed to make all spaces and nurses must disability laws and nurses do not know the laws accessibility and disability and these rights are often (Neal-Boylan and Miller 2020). must their beliefs about who can be a nurse and the of disabled nurses in addressing longstanding health nursing schools must their and to ensure that people with disabilities are not or denied schools must using essential functions to determine who admission nursing schools should work with their disability or access to technical standards that focus on rather than the to (Jackson et al. 2025). can support learning environments that all not those with disabilities. disability and support within nursing education can stigma and and a of belonging. must use curiosity when with disabled disability and colleagues to ways to in a safe and organisations should to into and In my experience, nurses who require accommodation are often from clinical work and some up their after a must the of disability rights laws and in to provide accommodations. curiosity and are There is a of roles and accommodations available for nurses with or disabilities. advances in there are opportunities for nurses to use to care and to engage in nursing and advances can significantly how disabled nurses are into health For example, nursing roles are developed that could be by disabled nurses. Disabled nurses must not be from clinical roles without for their and Disabled nurses an essential in understanding the experiences of people who have disabilities within health care and As new are disabled nurses must be included in the and to ensure Currently, disabled nurses and students are not included in most professional organisations and workforce This I cannot how many disabled students have been excluded or nursing schools. I also cannot how many disabled nurses have left practice or remain in the research with disabled students and nurses is a critical towards addressing the and they experience (Baker et al. 2023). Research is also essential in understanding the contributions and of disabled nurses. Disability should be included as a demographic variable in nursing research to data about workforce and nursing must the of disabled nurses and knowledge as and Disabled nurses should be for their both as and When research on disabled nurses should be included on the research and in the and of As nursing workforce disability like and an the inclusion of disabled nurses in healthcare is My continued presence in nursing for more than three not personal but also the potential of disabled nurses who are often excluded or from in the a system that was not designed for people with disabilities and ableism across my career in a of roles made in the workforce very Disabled nurses should not be expected to and The future of nursing on reimagining the profession as one that bodies, abilities and ways of disabled nurses in this reimagining an opportunity to a more and profession. to my and colleagues who have to shape my understanding and ability to navigate nursing as a disabled including the nurses on the in Research by and I am especially to and for research and The has to The no of The has to
Anna M. Valdez (Thu,) studied this question.