Case Study – Nursing and Stamina

Source: Quality and Performance Improvement Dissemination and Department for Education and Employment. October 1999. Modern Apprenticeships and People with Disabilities.

Key Facts

Sector: Care
Gender: Female
Age: 18
Region: West Midlands
Employer: Health Service Trust
Disability: Neurofibromatosis (tumour affecting the nervous system)
Adjustment: Help with heavy lifting, occasional periods of rest at work, support during extended periods of sickness


Education Prior to the Modern Apprenticeship

Amy enjoyed her school career. She had to be careful about taking part in strenuous activities because of a tumour on her lower body, but was able to participate in most things. She stayed on into the sixth form in order to improve her general education qualifications.

Employer Context

The Trust has around 1,600 employees, split roughly 50:50 between full and part-time staff. They started taking on Modern Apprentices (MAs) in 1997 with an initial intake of seven. The following year (1998), they decided to take on ten MAs, split between caring, catering, physiotherapy and business administration. Details were circulated through the local careers service.



It was a teacher at her school who gave Amy an application form for the Ma. Amy had been intending to go to a local training provider to do a full-time course, most probably in catering; her real ambition, however, was to work with children. Amy thought the MA sounded like a good idea, because it offered both training and a job (with money!)


Amy was pleased to be offered an interview. In fact, the Trust had received 65 enquiries and 40 completed application. The Trust took the decision to interview everyone, partly because this seemed the fair thing to do. Another reason was that several of the applicants did not have their examination results and the panel felt they did not have sufficient information on which to short-list some and reject others.

Amy felt very nervous during the interview although she had had some interviewing pratice at school which stood her in good stead. The panel adopted a structured approach, asking each candidate the same questions and scoring the answers given. The chronic illness was mentioned but the implications were not teased out. Four of the ten opportunities were in Amy’s selected framework of caring. The panel rated her the fifth best applicant and so she was unsuccessful. The Operational Manager for Education and Development telephoned her to give her the news and provide some feedback, as indeed she did with the other unsuccessful applicants. Amy was disappointed but “philosophical”.

Medical Screening

Just as the induction for the successful applicants was starting, the Trust learned that one of the four selected candidates for the MA in caring would not be taking up the offer. They immediately telephoned Amy to see if she was still interested. The point to stress here is that they neither favoured her disproportionately in the original assessments nor penalised her unfairly when a new opportunity arose: in short, they applied their criteria with consistency and fairness.

Amy was delighted. The offer was for a two-year fixed term appointment, subject to a medical assessment. Exactly the same conditions applied to the others. She completed a questionnaire and was seen by the occupational health clinic. They talked through with Any the implications of her health condition and agreed that she would be able to undertake the duties specified, subject to her not being required to do heavy lifting and being able to take periodic rests.

The MA and Adjustments

The MA

Amy joined the group of MAs immediately, as induction had already begun. She was a little nervous about joining a group which had already been working together for a few days, but she was made to feel welcome: “I arrived home exhausted but happy”.

Following the induction, MAs in caring do a series of ten-week placements in different departments in order to pick up a variety of experiences and insights. Amy’s first placement was in Out Patients where her duties included collecting patients’ notes, weighing patients and helping any who were distressed. Her biggest challenge, she says, was not the patients, but the doctors! According to Amy, it’s not only reading their notes which is difficult; even understanding their verbal instructions can sometimes border on the impossible!

Amy’s second placement was in a unit for patients whose specific medical or surgical condition has been addressed but who need time for rehabilitation before they can go home; most are elderly. Amy enjoyed this since there was more time to get to know the patients. The only drawback for Amy was that they needed help with lifting: Amy needed to seek help from colleagues quite regularly. In addition to her medical condition, Amy has a small build and lacks the strength to do heavy work.

Her third and current placement is in the coronary unit. She is enjoying this too. There are twelve patients in the unit at any one time and Amy is able to get to know them. She helps with teas, washing patients, taking chairs and commodes to them but, as before, seeks help with any lifting or pushing of patients.


Amy is currently working towards an NVQ2 in Care. She needs nine units for this and currently has three. She is also doing Key Skills at Level 2. she was enrolled as a Modern Apprentice from the outset and is committed to move straight on the Level 3, for which she will need twelve units.

The MA in Care requires that Key Skills certification is completed up to Level 2. However, as there are MAs in the group who are on the Business Administration framework which requires Level 3, the Trust has decided to put all MAs in for the higher level. There is a mandatory half-day’s off the job training in the Trust’s training unit for all MAs, but they negotiate individual study time with their supervisors at each placement.


No adjustments have been required for the training aspect of the MA. Turning to her day-to-day duties, mention has already been made of the fact that Amy is unable to do heavy lifting; help is readily available. She also gets tired quickly and sometimes has to take a short rest. This is cleared with her immediate supervisor as needed.

Amy’s general attendance record is very good. However, she did have six weeks off work over Christmas 1998 and into the New Year when, following a routine scan, she was told she needed urgent surgery on her stomach. The operation turned out to be complex resulting in Amy having to carry a “urinary bag” around with her. This is simply an inconvenience; it is not obvious to others, nor does it alter the type of duties she is able to undertake.

Amy is popular; when she was in hospital, several of her colleagues came to visit. Amy is happy with the way things are going. She says she does not like to be “wrapped up in a blanket”. “If I feel I can do something, I will; if I can’t I will say so”. She welcomes the friendly atmosphere. However, although she appreciates being asked if she’s OK once or twice, she gets a little fed-up if it’s repeated too often!

Future Plans

Amy should complete her MA in Summer 2000. Both she and the Trust are confident she will get her NVQ3 and Key Skills Level 3. As MAs are on a fixed term contract, she will need to apply for a permanent post when one becomes available. Her next placement is likely to be in the Paediatric Unit. She is looking forward to this; indeed, becoming a support worker with children is her current preferred career. The Trust have no doubts as to her ability to get and hold down a permanent job and think she has promotion potential.

Points of Interest

The key points to emerge from this case study are:

From an employer perspective:

  • Treat applicants with health conditions and/or disabilities with transparent fairness. Let them know the reasons for the decisions you take.
  • Be sensitive as to when employees with disabilities need support and when they are perfectly capable of managing themselves. Treating individuals with ‘kid gloves’ can be irritating when it’s not needed.
  • Medical screening can provide important reassurance, but be careful to limit the examination to aspects directly relevant to the post.

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