nursing students with disabilities?

Daytonite, BSN, RN · Sep 29, 2005

In your case, I would go back to the instructors who advised you to talk this over with your clinical instructor. They all know each other and attend staff meetings together. I'm sure someone will set him going in the right direction, but you have to make sure they know what he has said to you. From the way you described what happened it sounds to me like he was either inappropriately thinking out loud (which he shouldn't have done in front of you), or he's a jerk. The fact is that I don't think he can refuse to take you on as a student in his clinical class.

I worked with a goofy RN who got a job as a clinical instructor (and only as a clinical instructor, not a lecturer) for a nursing school. Most of us couldn't believe this had happened, but then, we worked with her and knew the kinds of stupid decisions and mistakes she made. By the time she left to go to her new job we had pretty thoroughly decided we felt bad for the poor students who were going to be subjected to her. When I was in nursing school most of my clinical instructors were just that because they did not have the credentials (training as educators) to be associate professors and lecturers.

Heck · Sep 29, 2005

what concerns me is not that he'd refuse to take me on, because he's already said "well we'll play it by ear" but that clinical grading is subjective, if he's already got a bone to pick with me, or feels I don't belong around patients, I could be in trouble, and yeah he is kind of a hardass, out of all the instructors I would say he looks to be the hardest/most demanding.

Daytonite, BSN, RN · Sep 30, 2005

I wouldn't think that he has a choice as to whether he can refuse to take any particular student on. After all, he's an employee of the school. If he's going to make a beef with whoever is supervising him (and you'll never know if that happens) and he's got any brains at all, he's going to know that he's going to look like a trouble maker to his boss. The school has already admitted you. They're not going to second judge their decision now based on what this guy is telling them. His response is coming out of his emotions. There is nothing worse than a man who exhibits symptoms of PMS. :chuckle

I'm still suggesting that you report his behavior to the instructors at the school and what he said to you when you did what they recommended. I'd also add on that you are worried that he might give you a bad grade now. Just get the issue out on the table.

From now on I would never mention your panic disorder with the instructors again. If you have a panic attack it will be dealt with at the time it occurs. It may never happen during your nursing school career, so why call attention to it? FYI. . .I've never known anyone having a panic attack to curl up in a fetal position on the floor either. He's obviously revisiting the emotions he felt when he originally experienced that. Not something a nurse should be doing in front of a student--not everyone is perfect though. What you need to learn from this whole thing is to (1) be cautious about what you disclose to others about yourself; you do not have to be an open book, (2) don't let your emotions get the better of you, and (3) think about the impact of what you are about to say to someone is going to have on them (I'm referring to what this clinical instructor said to you) so you don't inadvertently do to someone else what this guy did to you.

Heck · Sep 30, 2005

well the problem here though again continues because I called the head of the program after this happened earlier today and she told me that had SHE known about my 'condition' that she would have had the entire faculty discuss it, particularly the person who handles the psych nursing, to see if theyd have let me in... which blows me away, this was disclosed by my doctor on my health release I had to hand in, what medical conditions I had and what medications I was on, so rather than have it come up and bite me later I talked to one of the instructors there about it and she said it was no problem but she told me that when clinicals came I should pull my instructor aside and inform that person of it, and I did, and you read his response earlier... and no I have never in my life fell on the floor that's just out of control, I never lost consciousness, I never crashed a car I was driving while freaking out, it's just not like that.

I also offered the head of the nursing program to let her speak with my doctors and have them advocate for me, now... my psychiatrist is a professor at havard university, he specializes in anxiety disorders and he works out of Mass General, her response to that idea? "well doctors think anyone can be nurses" that's verbatim. So the head of the program also has issues now with my disability and medications for it...

I'm thinking I've entered a hostile atmosphere now and feeling discriminated against, I think if I had epilepsy and was on medication like klonopin to prevent seizures we wouldn't be having this converasation (I don't know that for sure though I just talked to someone else whos mom, an eplileptic, runs an ER so...)

But the only reason I disclosed it in the first place was it was disclosed by my doctor on my health release form including what medications I was taking so before that came back and bit me later I discussed it with two members of the faculty the day before classes started and they assured me it would be no problem... so much for that idea.

I appreciate your help though, oh and yeah they aren't going to boot me but I still wonder what chances I have now? I can't take chances with this amount of money to spend the next 2 years in an atmosphere hostile to me where they're potentially doing their best to get rid of me.

rn/writer, RN · Sep 30, 2005

You HAD to disclose your situation. There's no question about that. If you hadn't, my guess is the faculty would have used a nondisclosure clause against you and you'd already be out the door.

So what does happen when you're having a panic attack?

I'm guessing that at least part of the bad reaction you're getting is fear of the unknown. I read back through your posts and didn't see any info on what might take place or how you plan to manage your condition.

Think about this from your instructor's point of view. I'm sure he's envisioning all kinds of crisis situations where you "go off" and now he has to deal with your needs AND still keep tabs on all the other students. Not to mention worries about dealing with the facility and keeping the door open for future students.

I suggest you address the faculty's concerns head on. Tell them how your condition affects you. Does the klonopin keep your symptoms in check, thereby lessening the chances of having a full blown attack? If not, do you get any warning signs that might help you head off a problem (like an aura that some epileptics get before a seizure)? What might they expect if you do start to have an attack in a clinical situation (and how likely is that to happen?)?

Next, come up with a workable plan. Depending on the answers to the previous questions, you might want to map out a strategy that starts with preemptive measures and progresses to dealing with an attack at your clinical site. How will you let your instructor know you are having difficulty? What can you do to minimize the effect of your condition on the facility, your patients, your classmates, etc.?

Contact support groups for people who have panic disorders and ask them for ideas about how to a) function successfully in a high pressure setting, and b) how to communicate with bosses and co-workers to inform and educate them about your needs while at the same time reassuring them that they do not have to treat you like a bomb that is primed to blow at the slightest provocation.

You know, that might be another one of your instructor's concerns. He could be thinking he has to treat you with kid gloves or you'll self-destruct right there on the clinical floor. Again, the best response to this is direct, non-emotional information. After all, YOU know what your condition does and does not entail. All he can do is imagine the worst.

Coming up with a realistic game plan will do a number of things. First, it will show that you are being pro-active in your own life, that you have made the effort to manage your condition and intend to live a full life despite any limitations it places on you. Second, it will demonstrate that, while you need their understanding and assistance to some degree, you view yourself as having the primary responsibility for your own future. Third, if you are dealing with reasonable people, it will help to allay their fears and help them learn HOW to assist you. (If they are not reasonable people, your efforts should expose that too.) Fourth, you will gain experience in explaining your needs without looking like a victim. You're going to run into this in the job world so you might as well gear up now. And fifth, you yourself should feel more confident and safer for having mapped out a strategy ahead of time.

It could be that if you stay on your meds and take good care of yourself there would be minimal risk that you'd actually have a meltdown during a clinical. Your instructor needs to assess the level of risk you pose to yourself, your patients, your classmates, him, and the program. If you can reassure him (without giving a guarantee) that you will conduct yourself responsibly and do what you can to mitigate the effects of your condition on others, you will present yourself as a person with a manageable condition, rather than as a loaded gun waiting to go off.

One last suggestion. When you contact support groups, learn about how others manage and share that information with your instructors as well. They might develop a different image of people with panic disorders if they find out that many have successful and productive lives despite their limitations.

I really believe the biggest obstacle you face is NOT having a panic disorder, but fear and ignorance. In the absence of accurate information, we all pretty much fill in the blanks with a hodgepodge of supposition, emotion, and imagination. Meet this all-too-human response with factual information, your personal history of coping, a gameplan for the future, and a reassurance that you will follow through on all the aspects of your condition over which you have any control.

Let them know that they don't have to walk on eggshells around you or be afraid of setting you off. Relieve them of their burdensome ignorance and give them every chance to be allies rather than adversaries.

If you do all that and they still poop out on you, then you will know they wouldn't have given you a fair shake anyway. But, having gotten a more realistic picture, they might be able to rise to the occasion and give you the assistance you need. Then they will become wonderful references for future employers who will have the same concerns.

I wish you the best. Please let us know what happens.

Heck · Sep 30, 2005

nothing bad, per se, happens, and I was proactive, I attempted to tell the faculty the situation, I attempted to do this before school even began with them telling me it's not a problem... I attempted to tell them I would let my doctor contact them to ally any fears they had that I could not function in such an environment, I tried to explain that I don't just LOSE it somehow, it's not like that, that my first order of business was patient safety and if I personally had ANY doubts about my ability to ensure that I wouldn't be there. I have classic panic, it's more or less under control now with meds, but I made sure to tell them "just in case" and to say you know if I'm freaking out a bit can I leave the unit for 20 minutes after getting someone to cover for me, that kind of thing. this is all stuff they had problems with. they also have a specific problem with the medication I take and my ability to function properly on it and to meet patient safety while on it. I offered, as I mentioned earlier, to let my doctor call them and this guy is an expert and discuss it with them, they were having none of that. I offered to discuss potential alternatives, on and on.

My original emphasis today that started this cascade of events was to let the clinical instructor know I have a panic attack disorder, sometimes I get REALLY scared (probably like alot of newbie SNs get when they go into clinical, in fact I'm probably better equipped to handle it as I have alot of coping skills) But that if I'm feeling REALLY uncomfortable and can't shake it might do me good to be able to leave the unit WITH the patient safely under someone elses watch for 20 minutes and take a break. and I am currently in treatment for this issue, I see a psychiatrist, psychologist, socialworker, doctors, etc, not a single one of them, and they were all involved in my continuing care and future planning and thought nursing was an excellent idea for me, thought this was any issue in the slightest. And again, I offered to have them write letters explaining it or whatever they wanted but the response I got was kind of chilling and dark age.

When I have a panic attack and I'm driving I don't crash the car, if I'm stuck on a subway train and 'freaking' I'm not running up and down the car screaming for help I'm grounding myself and using CBT techniques to help downshift it and none of this changes my perception of reality, my ability to act rationally or puts myself at risk, I haven't jumped off a bridge yet because of reefer panic madness or something, I don't drink, I don't smoke, I don't do drugs, I work out 4-5 hours a week to help out with stress. I am NOT 'insane'.

I don't think I ever signed any manner of NDA with these guys either so I wish now I hadn't disclosed it and the health policies in the student handbook I completely adhered to when entering into this program. The clinical instructor I had who thought a panic attack involved falling on the floor and curling up into a fetal position has an EMT-P, RN, MSN and FNP.

I'm not going to "meltdown" I hear stories from instructors of ppl passing out dead away walking down the hall or during procedures, I really don't think that's going to happen to me but for someone reason I'm immediately at higher risk. at this point I'm about ready to go in tomorrow and demand my money back or atleast I'm going to be exploring the possibility of withdrawing from the program as long I get a full refund.

if the staff had any concerns, and I know some sure didn't, they have a psychiatric nursing expert on staff and again I offered to let them discuss the issue with my own doctors, I really don't know what more I can do.. and part of the problem again wasn't just the anxiety it was the medications I was on *for* the anxiety, the 4MGs of klonopin they felt could impair me and put patients at risk somehow, klonopin being a benzo even though the dosage on klonopin maxes out at 20mg's a day and the sedating effects go away after you've been on it for awhile and I'm maintaining a roughly... well it's over 3.65 GPA not sure what is is exactely in other areas, that included A&P I and II, microbio, chemistry with labs (A, B, B, A in those courses with an A in all of the labs) and algebra (and I'm terrible with math) so if my thinking is impaired somehow I must be a damn genius when I'm not doped up.

*sigh*

TweetiePieRN · Sep 30, 2005

nothing bad, per se, happens, and I was proactive, I attempted to tell the faculty the situation, I attempted to do this before school even began with them telling me it's not a problem... I attempted to tell them I would let my doctor contact them to ally any fears they had that I could not function in such an environment, I tried to explain that I don't just LOSE it somehow, it's not like that, that my first order of business was patient safety and if I personally had ANY doubts about my ability to ensure that I wouldn't be there. I have classic panic, it's more or less under control now with meds, but I made sure to tell them "just in case" and to say you know if I'm freaking out a bit can I leave the unit for 20 minutes after getting someone to cover for me, that kind of thing. this is all stuff they had problems with. they also have a specific problem with the medication I take and my ability to function properly on it and to meet patient safety while on it. I offered, as I mentioned earlier, to let my doctor call them and this guy is an expert and discuss it with them, they were having none of that. I offered to discuss potential alternatives, on and on.
My original emphasis today that started this cascade of events was to let the clinical instructor know I have a panic attack disorder, sometimes I get REALLY scared (probably like alot of newbie SNs get when they go into clinical, in fact I'm probably better equipped to handle it as I have alot of coping skills) But that if I'm feeling REALLY uncomfortable and can't shake it might do me good to be able to leave the unit WITH the patient safely under someone elses watch for 20 minutes and take a break. and I am currently in treatment for this issue, I see a psychiatrist, psychologist, socialworker, doctors, etc, not a single one of them, and they were all involved in my continuing care and future planning and thought nursing was an excellent idea for me, thought this was any issue in the slightest. And again, I offered to have them write letters explaining it or whatever they wanted but the response I got was kind of chilling and dark age.
When I have a panic attack and I'm driving I don't crash the car, if I'm stuck on a subway train and 'freaking' I'm not running up and down the car screaming for help I'm grounding myself and using CBT techniques to help downshift it and none of this changes my perception of reality, my ability to act rationally or puts myself at risk, I haven't jumped off a bridge yet because of reefer panic madness or something, I don't drink, I don't smoke, I don't do drugs, I work out 4-5 hours a week to help out with stress. I am NOT 'insane'.
I don't think I ever signed any manner of NDA with these guys either so I wish now I hadn't disclosed it and the health policies in the student handbook I completely adhered to when entering into this program. The clinical instructor I had who thought a panic attack involved falling on the floor and curling up into a fetal position has an EMT-P, RN, MSN and FNP.
I'm not going to "meltdown" I hear stories from instructors of ppl passing out dead away walking down the hall or during procedures, I really don't think that's going to happen to me but for someone reason I'm immediately at higher risk. at this point I'm about ready to go in tomorrow and demand my money back or atleast I'm going to be exploring the possibility of withdrawing from the program as long I get a full refund.
if the staff had any concerns, and I know some sure didn't, they have a psychiatric nursing expert on staff and again I offered to let them discuss the issue with my own doctors, I really don't know what more I can do.. and part of the problem again wasn't just the anxiety it was the medications I was on *for* the anxiety, the 4MGs of klonopin they felt could impair me and put patients at risk somehow, klonopin being a benzo even though the dosage on klonopin maxes out at 20mg's a day and the sedating effects go away after you've been on it for awhile and I'm maintaining a roughly... well it's over 3.65 GPA not sure what is is exactely in other areas, that included A&P I and II, microbio, chemistry with labs (A, B, B, A in those courses with an A in all of the labs) and algebra (and I'm terrible with math) so if my thinking is impaired somehow I must be a damn genius when I'm not doped up.
*sigh*

I think your teacher may be concerned because you are working under HIS/HER license! At my nursing school (out here in california), all the students were working under their clinical instructor's license. That instructor is legally responsible for everything you do...including mistakes and all. I am not saying that you are going to have mistakes just because you have an anxiety disorder.

But, understand it from the instructor's perspective. If the threat of losing their license (or getting putting it in jeopardy) is looming over their head...he/she is probably less willing to take you on as their student and to be responsible for all of your actions. I don't know the legality in if they can do that to you or not. Just some food for thought...Hopefully someone who knows more about this topic will chime in.

Heck · Sep 30, 2005

I think that may be the case, or as he says "I just want you guys to show up on time in the morning and leave at 2PM and not kill anyone in between, my kids like living in their house". The head of the program refused to let me switch to someone else, like say.. one of the other ppl I had previously talked to who had no problem with my anxiety disorder. I understand it from his persepective I still don't think that's cause to kind of belittle me or treat me as dangerous. what if I were an insulin depedent diabetic? am I suddenly a danger to everyone because my blood sugar could get wacky and I might make mistakes or I might have to go take insulin and get a snack and sit down for a few minutes during clinicals? to me, my problem is no different than that but I'm being treated alot differently.And if they had concerns *why are they just bringing them up now* a month in, when I've spent 1000 on books and uniforms, taking out 10 thousand dollar loans when they knew this all along? this is certainly not fair to ME, this was all, again, disclosed in my medical release I had to get, immunizations, physical, etc, that my doctor signed off on that included *every* major medical conditions I had, including mental, and listed *Every* medication I was on, including the klonopin and they had it in their hands before school started and I had discussed my anxiety disorder with the staff the day before school started and was assured this was in no way a problem... now it's suddenly a problem.

rn/writer, RN · Sep 30, 2005

nothing bad, per se, happens, and i was proactive, i attempted to tell the faculty the situation, i attempted to do this before school even began with them telling me it's not a problem

i hope you kept some kind of diary with names and dates of these discussions. that could give you an edge if this gets any uglier.

... i attempted to tell them i would let my doctor contact them to ally any fears they had that i could not function in such an environment, i tried to explain that i don't just lose it somehow, it's not like that, that my first er of business was patient safety and if i personally had any doubts about my ability to ensure that i wouldn't be there.

i suggest getting letters from your various practitioners now. have them address the letters, "to whom it may concern." keep the originals for future use, then make copies and send them registered mail to anyone who is involved in deciding your future. create a paper trail that documents your efforts to work this out. make sure the letters focus on your ability to manage your condition, your committment to ongoing treatment, and the progress you've made during your time with each provider.

they also have a specific problem with the medication i take and my ability to function properly on it and to meet patient safety while on it. i offered, as i mentioned earlier, to let my doctor call them and this guy is an expert and discuss it with them, they were having none of that. i offered to discuss potential alternatives, on and on.

i doubt you're going to get very far with offering to have your doctor call them. and maybe that's just as well. it would be far better to have him write an explanation. that way, there will be no dispute about what was said. and you will have a copy of it for your own records. offering to have him call might sound pro-active and it is to a small extent. getting the letters on your own is more so.

my original emphasis today that started this cascade of events was to let the clinical instructor know i have a panic attack disorder, sometimes i get really scared (probably like alot of newbie sns get when they go into clinical, in fact i'm probably better equipped to handle it as i have alot of coping skills) but that if i'm feeling really uncomfortable and can't shake it might do me good to be able to leave the unit with the patient safely under someone elses watch for 20 minutes and take a break.

i can see why your instructor might object to this. now, in addition to keeping a watchful eye on his students (how many in your group?), he also has to worry about you. even though you are confident that you can recover and return, he may not see it that way. what if you have a bad spell and you can't pull yourself together in a timely manner? he is responsible for you as well as his other obligations.

when i have a panic attack and i'm driving i don't crash the car, if i'm stuck on a subway train and 'freaking' i'm not running up and down the car screaming for help i'm grounding myself and using cbt techniques to help downshift it and none of this changes my perception of reality, my ability to act rationally or puts myself at risk, i haven't jumped off a bridge yet because of reefer panic madness or something, i don't drink, i don't smoke, i don't do drugs, i work out 4-5 hours a week to help out with stress. i am not 'insane'.

well, of course not, but you have listed many of the images that are going to flash through people's minds. don't reinforce these stereotypes by repeating them. rather, describe what they would see. "i sit quietly and concentrate on my breathing patterns. i might look like i am meditating for a few minutes. when i feel restored, i return to whatever i was doing without any fuss."" something to replace the bad images and focus on the positive.

i don't think i ever signed any manner of nda with these guys either so i wish now i hadn't disclosed it and the health policies in the student handbook i completely adhered to when entering into this program.

you didn't have to sign a specific agreement. in just about every nursing program, it's just sort of implied that any lack of disclosure will be look on as a problem and possibly grounds for dismissal.

the clinical instructor i had who thought a panic attack involved falling on the floor and curling up into a fetal position has an emt-p, rn, msn and fnp.

that's sad but not too surprising. even in our enlightened age, we still carry around many misconceptions about things we don't understand. when people are ignorant, don't take that as an insult or an attack. look at it as an opportunity to (kindly) set the record straight. meet them where they are and then take them someplace better. no, you shouldn't have to, but your life wil be better if you do.

i'm not going to "meltdown" i hear stories from instructors of ppl passing out dead away walking down the hall or during procedures, i really don't think that's going to happen to me but for someone reason i'm immediately at higher risk.

does this surprise you? of course you're at a higher risk. that's what this is all about. anyone with any kind of condition that is out of the ordinary is going to be viewed as a higher risk. what you need to do is convince them that the risk can be managed and that it's worth the benefit.

this subject makes for a nice segue to another of your posts.

what if i were an insulin depedent diabetic? am i suddenly a danger to everyone because my blood sugar could get wacky and i might make mistakes or i might have to go take insulin and get a snack and sit down for a few minutes during clinicals? to me, my problem is no different than that but i'm being treated alot differently.

i am an insulin dependent diabetic and, yes, i am a potential risk for the reasons you mentioned. i have had to manage my illness in various ways and to explain and demonstrate that i have taken measures to reduce that risk as much as possible. it is not at all unreasonable for instructors or employers to be concerned about this. if i "get wacky" and i make a mistake that harms someone, i am still liable and so is the institution i'm involved with. this is reality. as far as ducking out for twenty minutes during a clinical, who will cover your patient? have you discussed this with your classmates?

and if they had concerns *why are they just bringing them up now* a month in, when i've spent 1000 on books and uniforms, taking out 10 thousand dollar loans when they knew this all along? this is certainly not fair to me, this was all, again, disclosed in my medical release i had to get, immunizations, physical, etc, that my doctor signed off on that included *every* major medical conditions i had, including mental, and listed *every* medication i was on, including the klonopin and they had it in their hands before school started and i had discussed my anxiety disorder with the staff the day before school started and was assured this was in no way a problem... now it's suddenly a problem.

this is all in your favor if, indeed, you do decide to go after a refund. an attorney would be able to advise you about the school's failure to address all of this before the fact.

no doubt, you're in a tough situation. but regardless of the outcome this time, you will most certainly be faced with similar circumstances in the future. i would encourage you to go beyond simply "dealing" with reactions and making offers for your doctor to call. anticipate reactions and have letters of explanation ready. gather references from past jobs. keep a diary of your condition and be ready to say, "in the past year, i had only two episodes where i had to leave my post for a brief time. in both cases, i was able to return in ten minutes." to borrow from a billy joel song, "give them every reason to accept that you're for real."

is it fair that you should have to deal with all of this? maybe not, but then don't many of us have some kind of ongoing struggle?

i hesitate to tell you this, but it's important. if, in this conflict, the main thing the authority figures see is your anger and frustration, they may allow themselves to judge you as a trouble maker and boot you for that alone. for your own sake, take your anger and frustration somewhere else and vent until you can't anymore. then go back with an attitude of confident humility and do your best to work things out. get the letters. get the references. do anything you can think of to demonstrate maturity and a workable nature.

does this mean you cave in on yourself. not at all. it only means that you are going to make it darn difficult for them to categorize you as a problem child.

if you should decide to chart another course, maintain your dignity, get legal advice, and withdraw with a clear conscience.

i'm sorry you have to work so hard in this area. it says much about you that you are seeking after health with such determination. if nursing is where you belong, you will find a way to make it happen and give better care for all you've been through. if nursing isn't your niche, you will find something better. either way, you sound like someone who is determined and strong.

Daytonite, BSN, RN · Sep 30, 2005

oh, my eyes hurt from reading all this stuff in this thread! look, i've been a supervisor and manager for a long time. when things tend to go on and on and get complicated i like to take a step back and try to ferret out what the main problem is again and re-state it in a concise and simplistic way. so, sitting here having just gotten up from a good night's sleep, here is my last advice to you about this.

you followed the rules by disclosing your condition on your medical history. if the director of your nursing program is now saying she would have handled your admission into the nursing program differently, that is her problem and not yours anymore.

now, knowing what bringing up this subject with your clinical instructor and head of the nursing program has set off, just keep your mouth shut and go on about your business of being a student. they've just realized that they made a mistake; you didn't. don't be the one to bring up this panic disorder business ever again; you'll be throwing their mistake in their face and aggravating things. i'll repeat, you do not have to be an open book. this total honesty and disclosure business is sometimes so unnecessary. things will die down. the only thing for you to do now is to study your nursing and prepare for your state boards--just like all the other students in your class. go and meditate, take a hot bath, take a jog around the block, or whatever you do to calm down. go to your next clinical and next class as if nothing ever happened. save all these thoughts and emotions for your therapy sessions which is where they really belong.

i wish you well.