Calling In Sick: Dealing With Mental Illness At Work, Part 1

Inspired by discussions with allnurses members and others, this is the first in a brief series of articles about how anxiety, depression and other mental health conditions affect nurses in the workplace. These illnesses are among the most common reasons we miss work, and they contribute to billions of dollars in lost productivity each year. They also carry a high cost to sufferers in terms of stigma, loss of job security, and self-esteem issues. Nurses Disabilities Article

The alarm clock jolts you awake as it does every morning at 0500, alerting you to the fact that today is yet another work day. You groan and pull the covers over your head momentarily, wishing for nothing more than to crawl into a warm cave like a hibernating bear until you feel human again......if you ever do, that is. And you're beginning to doubt that more with each passing day.

The prospect of another shift filled with unceasing demands and busy-work tasks threatens to overwhelm you as you force yourself into the shower, and once again you suspect that there really are worse things than death.....namely, going on like this. Certainly no one appreciates the fact that you have to throw yourself against a metaphorical wall every day: not your family, who counts on you to put food on the table; not management, who calls you on the carpet for every minor infraction of their million-and-one rules; and definitely not the patients who run you ragged with endless requests for warm blankets and Coke, and then complain when you're not fast enough.

You're depressed and very much aware of it, but other than taking the medication the doctor gave you at your last visit, there doesn't seem to be many options. You can't be in your therapist's office every afternoon; you don't want to burden your friends with your troubles; and you certainly can't talk to your co-workers. They're all dealing with their own stresses (both on and off the job), and besides, you don't want to end up in the unemployment office, like one fellow nurse did after suffering a 'nervous breakdown' at work.

So what can you do? You heard what people said about her.....that she was crazy. Looney-tunes. Psycho. What if they were to say the same things about YOU?

The truth is, if you need medication and/or therapy to cope with your condition, you are among the one in five Americans said to have what authorities call a diagnosable mental illness. Depression and anxiety are the most common of these, and while they are treatable, they are two of the major reasons why workers call in "sick".

It doesn't stop there, of course. Nurses are human, and as such we're subject to the same psychiatric issues as anyone else: schizophrenia, manic-depressive illness, personality disorders, even dissociative identity disorder (formerly known as multiple-personality disorder). The fact that the general public has no idea of this speaks well of the thousands of nurses who battle mental health problems and still manage to take good care of their patients.

For the most part, we struggle in silence, fearing the stigma that surrounds those who carry such a diagnosis. Everyone has seen news stories about people with whispered rumors of mental illness being accused of all sorts of horrible crimes; who wants to be associated---even remotely---with the likes of the Sandy Hook school shooter or the Aurora, CO theater killer?

But sometimes, our 'nonconformity' is discovered despite our best efforts to hide it. A nurse with depression may stop coming to work and fail to notify her supervisor; one with bipolar disorder may have a manic episode that increases her productivity at the same time it creates inappropriate levels of hostility which she cannot control. And if we are unlucky, we may find ourselves being eased out of our jobs, or even terminated outright when our employers deem it "unreasonable" to make accommodations for our disabilities.

This short series of articles on dealing with mental illness in the workplace is inspired not only by events in my own life over the past couple of years, but by conversations with others here at AN and with former co-workers who have shared their stories with me. It is my sincere hope that one day, healthcare professionals with brain disorders will be viewed with the same compassion as those who suffer from other medical conditions.

To be continued......

I've very rarely ever called out sick but I can relate to the effect that stress has on your mental health. As soon as I would look at my clock and see that it was almost time to go to work, I would get a sinking feeling of dread in my chest. And when I would get to work, my heart would start to race as soon as I walked into the building. I had a hard time enjoying my days off for fear that my job would call me, asking me to work overtime, tell me that I forgot to chart something... etc. Many of my RN friends are on some type of anxiety or depression medication. I truly love being a nurse but the stress and depression is just too much sometimes :(

It's funny that I should come upon this article tonight - I was scheduled to work at the hospital tonight but I called off. Not really physically sick but just exhausted from the past two nights straight of dealing with people with dementia, Alzheimer's, ETOH withdrawls, altered levels of consciousness, they had to put one patient in restraints last night and the hospital budget cannot afford sitters for all who really could use them. Spent a lot of last night literally running at the sound of bed alarms going off. Actually had one patient fall, which he was OK but messed up our hospital no-falls stats... So I just called in and gave myself the night off. I am entitled to do that no more than three times in six months without penalty and I very seldom resort to it, but tonight was a perfect night. Even though I'm sitting here quietly at home tapping this out on my laptop, I am still tired and exhausted. I can't imagine what it would be like if I'd gone in again tonight. And I'm off now till Thursday night. Sometimes you've just gotta do it.........

Specializes in LTC, assisted living, med-surg, psych.
RNOTODAY said:
VIVA... I dont ever have the mania, thats why I disagree with my doc with my bipolar dx. I have no highs.... only lows!!!

Have you gotten a second opinion? Sometimes doctors will diagnose bipolar when a patient reports periods of unusual energy and activity (hypomania) that don't necessarily come with an elevated mood. Sometimes people have "agitated depression" or "dysphoric hypo/mania" which don't follow the DSM criteria for a true manic or hypomanic episode. And bipolar is such an odd little duck anyway; you put any two psychiatrists together and they'll probably disagree on the diagnosis.

I would definitely get a second, or even a third opinion if you have doubts. Best of luck to you.

RNOTODAY said:
VIVA... I dont ever have the mania, thats why I disagree with my doc with my bipolar dx. I have no highs.... only lows!!!

Sounds more like a dx for depression than bipolar. I used to take anti-depression meds myself (this was like fifteen years ago or so) but now I don't take anything - I try to use other non-pharma means of coping. In my own experience non-drug methods are better if you can work that out.

I used to be on Lexapro, Wellbutrin, and Remeron. I'm off all those now, and I read and exercise a lot instead. But I still have a glass of wine or two or Jack Daniels just to help me sleep almost every day and that doesn't even always work. I'm only 30 and I cannot imagine feeling like this for 30+ years until retirement.

Specializes in LTC, assisted living, med-surg, psych.
AZ_LPN_8_26_13 said:
Sounds more like a dx for depression than bipolar. I used to take anti-depression meds myself (this was like fifteen years ago or so) but now I don't take anything - I try to use other non-pharma means of coping. In my own experience non-drug methods are better if you can work that out.

They are, in many cases. A healthy diet, exercise, sleep, and a sense of purpose are all some people need to combat mild depression. The kind of psychiatric conditions we're talking about here are the serious, soul-sucking, energy-sapping, life-wrecking ones. You wouldn't treat bacterial pneumonia with honey-lemon drops; serious mental illnesses demand serious medical treatment and therapy along with a healthful lifestyle. Just saying. :yes:

Specializes in Psychiatric nursing.

I know that I lost a job a few years ago due to calling out too much during the initial 90 day probationary period. I was hospitalized several times for exacerbation of my schizophrenia symptoms. Even though they were legitimate absences, they didn't need a reason to let me go. Thankfully I'm on a med regimen that works well for me. I've been at my current RN position for a year and a half and have minimal symptoms. Haven't had to call out since I started this job!

Specializes in Neuro.

I recently had to deal with this situation with a family member and no one understood. I was able to explain what was going on with him, fortunately I work in this field and know what to look out for. Its so unfortunate that us nurses are educated on mental illness but cant find the compassion to deal with it when its one of our own.

VivaLasViejas said:
They are, in many cases. A healthy diet, exercise, sleep, and a sense of purpose are all some people need to combat mild depression. The kind of psychiatric conditions we're talking about here are the serious, soul-sucking, energy-sapping, life-wrecking ones. You wouldn't treat bacterial pneumonia with honey-lemon drops; serious mental illnesses demand serious medical treatment and therapy along with a healthful lifestyle. Just saying. :yes:

And I agree with you 100 percent. Sometimes a person doesn't have a choice. Actually that's where I was at say fifteen to twenty years back - was seriously considering just checking out. So I cannot tell anyone that psych meds are of no value whatsoever. They were there back when I needed them. But I got to a point to where I made the conscious decision that I didn't want to be on them for the rest of my life either. I'm living proof that there's life after major depression - and no, it doesn't always entirely go away - you always have to be on guard and self-aware, just like with any other medical issue

sweetbunny said:
I used to be on Lexapro, Wellbutrin, and Remeron. I'm off all those now, and I read and exercise a lot instead. But I still have a glass of wine or two or Jack Daniels just to help me sleep almost every day and that doesn't even always work. I'm only 30 and I cannot imagine feeling like this for 30+ years until retirement.

One trick I've used is to keep myself busy - I am an LPN and I work full time in a busy hospital, but I am also in school to get my BSN. Plus I have some other outside of work/school activities that keep me occupied. Very little idle time and in my case that's probably a good thing. I just turned 60 in April and I have no intention of slowing down or "retiring". I think that if I went the traditional retirement/person of leisure route, I'd end up slipping back into that cold gray funk of "this is life and it sucks" type of thing. Best to keep yourself occupied....

Thanks for sharing your thoughts. How did you end up landing your next job? Are you still in acute care?

Sailnskinurse said:
Thanks for sharing your thoughts. How did you end up landing your next job? Are you still in acute care?

That old saying "it's who you know" really IS true, I've found out. Network, network, network. I know that sounds like a modern day "buzzword" but in my own case the last three positions I've held were due to knowing someone within the organization. Yes, I'm still in acute care - I actually started out working at the hospital in security believe it or not. This was about seven years ago. Even that job I would not have gotten if I had not already known someone working there. Same for the nursing assistant job. My advice to students who are student nurses but don't have too many hospital contacts is to make the most of your clinicals and get to know as many people as possible while you are working there. Places will hire someone they know or that someone there knows over someone they don't know, all other things being equal.