Calling In Sick: Dealing With Mental Illness At Work, Part 3

by VivaLasViejas 4,117 Views | 26 Comments Guide

The series continues with a look at some of the ways nurses with mental health challenges can help themselves to achieve and maintain wellness. We also discuss what can be done in the unfortunate event that an episode of illness manifests itself on the job.

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    Calling In Sick: Dealing With Mental Illness At Work, Part 3

    Among the challenges of being a healthcare professional with a mental disorder, perhaps none is so difficult as maintaining one's composure during an exacerbation of illness. Not only is it undignified to be so out of control that you disrupt a staff meeting or hear voices coming from the desk fan at the nurse's station, it's potentially disastrous to your career.

    Obviously, you want to avoid manifesting signs of your illness at work (and it would be nice if you can keep your cool at home, too). But medications and therapy will only take you so far; you have to help yourself along the way by practicing good self-care techniques. These don't have to be elaborate or expensive; in fact, they're the basic health habits everyone should follow---namely, eat well, find some form of exercise that you'll do regularly, take time to de-stress every day, stick with your meds, and of course, get plenty of sleep.

    A few words about sleep: This is one of the most vital components of mental health, and it's also one of the easiest to get wrong. Lack of sleep is a double-edged sword that can hurt you in multiple ways---it can be a sign that your condition is deteriorating, as well as a trigger for an episode of illness. It also feeds on itself; the less sleep you get, the stronger the grip of the illness, and as the episode itself escalates, the harder it is to sleep. Often it takes medication to break the cycle, and then you must commit yourself to going to bed AND getting up at the same times each day.....even on your days off. That can be extremely difficult to manage (my argument is always "But what the deuce is there to DO at six AM?!"), but it's necessary to maintain optimal sleep function.

    Still, there are times when you're doing the best you can to stay well, but trying circumstances or life events may knock you off course and a breakthrough episode results. You find yourself forgetting details such as charting meds you've given or calling lab results to a physician. Or instead of chatting with co-workers on breaks, you retreat to your car and gobble down a handful of cookies. Or you notice that you're more and more anxious and you start dreading work, fearing that you'll make a mistake or embarrass yourself in front of a patient or supervisor. Or you start getting funny looks from co-workers and criticized by managers for talking too much and too loud, rushing around too fast and making amateurish errors, and lacking attention to detail.

    Of course, you're going to be in contact with your healthcare provider (correct?) to try to bring the episode to a swift end, but in the meantime you are probably going to need some time off to deal with it. DO NOT be afraid to take it. An exacerbation of mental illness is just as legitimate as a bout with the flu, and it deserves every bit as much attention.

    You don't have to tell anyone why you need time off unless you need a formal medical leave of absence or FMLA. Use your vacation days or other personal time off---that's what it's for. Often it takes only a few days to get things under control, but depending on the severity of your symptoms and the degree to which they disrupt your life and work, you may have to go out on LOA and exhaust your earned-leave benefits. Do it anyway, even though at this point you will need a note from your doctor stating why you need it and providing a date when you may return to work. Trust me, going back before you're ready is a recipe for disaster, and in any case your facility will not allow you to return until your doctor releases you.

    Of course, by the time your episode resolves, the rumor mill at work will probably have been churning, and you may face some curious glances and perhaps even some questions from your co-workers as to the nature of your absence. You are under no obligation to discuss this with anyone. If you're comfortable doing so, you certainly can, but as a general rule it's best to avoid the gory details. Unfortunately, there is still a great deal of stigma associated with mental illness, and while your friends may understand, chances are that some of the higher-ups may take a dim view of nurses with MI, and they can make your life so miserable that the stress tips you into another episode or even forces you to quit.

    In the final installment of this series, we'll discuss what to do when a nurse finds her/himself in an untenable position at work because of a mental health condition, and what (if any) recourse is available when one's employment is in jeopardy as a result of that illness.
    Last edit by Joe V on Oct 22, '13
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    VivaLasViejas joined Sep '02 - from 'The Great Northwest'. Age: 55 VivaLasViejas has '17' year(s) of experience and specializes in 'LTC, assisted living, geriatrics, psych'. Posts: 25,160 Likes: 36,294; Learn more about VivaLasViejas by visiting their allnursesPage


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    26 Comments so far...

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    I love your articles & they make me feel so much better. I can't tell you how many times I have ran out of work in a panic or started a new job when I shouldn't have. Thank goodness I'm getting help now & my family & friends are so supportive.
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    Thank you Viva!!
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    You know, it's amazing what we learn about life from dealing with psych issues. I honestly don't believe I would have ever understood (let alone empathized with) people who hear voices, or stand barefoot on a street corner yelling at the pay phone, had I never been diagnosed with MI myself. While I don't have those particular problems, there but for the grace of God go I, so instead of judging them I'm far more apt to wonder how they got to this place and what, if anything, I can do to help.

    I'm glad these articles are helpful to people here. Someday, I hope that MI will be treated just like any other illness, both in the workplace and out in the larger world; but in the meantime, helping and supporting each other here at AN is a good thing.
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    Viva, this hits home for me, because I just had this very issue to deal with. I've recently begun an exacerbation, and had to call in sick for work. I wasn't safe. I have a lot some stressful things going on at home, and I knew I just couldn't handle work. I called in and they asked me what was going on. I blanked on standing up for myself ("I don't have to tell you, mind your own business" lol) and just said, "A cold." I have to go in later this week to schedule myself, and I clearly do not have a cough or runny nose. What do I do? I'm afraid of all the repercussions if I were to tell the truth. I don't work enough to know who I can and cannot trust at work. I have several scary scenarios going through my (racing) head:
    "I have bipolar disorder, I didn't feel I was safe to work." Does she come to work when she's not safe? Maybe she's not safe enough to work at all. Maybe we should test her for benzos and fire her for being "impaired." Maybe we should contact the BON. She lied when she called in, she probably lies about everything.
    I'm freaking out over here.
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    Have you called your doctor about this? If not, please do it today---I don't have to tell you how dangerous mania can be. Best to catch it before it gets out of control.

    In the meantime, I would simply tell your work that you had some serious issues at home that had to be taken care of, and you didn't want to share that information so you told them you had a cold. You don't have to tell them about the bipolar part, in fact, you shouldn't tell them if you can avoid doing so. You don't want to open up a can of worms, like you mentioned above.

    I know it's really, really hard, but try NOT to panic. Call your doctor instead. Hopefully he'll give you a PRN benzo or antipsychotic if you don't have one; they can help get you down off the moon pretty quickly. (((((HUGS)))))
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    Viva, I really appreciate your posts about MI (I'm a cardiac nurse so it's odd to abbreviate that way because I first think myocardial infarction...lol), I fortunately don't have a mental illness but we have nurse on our unit who is bipolar. This is only known by management (I'm the ANCM). Your posts have made me more empathetic to her situation. Recently I have seen her become very animated at work any suggestions on how I can help her without making her feel uncomfortable because I'm not sure if she knows that I am aware of her situation? She has been a nurse for a very a long time and is very good at what she does.
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    Thank you for caring about your staff! Trust me, too many managers wouldn't.

    You already realize that you have to be very careful when dealing with someone who has MI, but even more so when you suspect incipient hypo/mania. Most people in this state have little to no insight into their condition, and they are apt to be both incredulous and offended when somebody mentions it ("What are you talking about? I'm FINE!!").

    If you do approach this nurse---and you probably will have to, because once mania gets started it usually progresses---try to arrange it where you don't have to call her into the office. That will immediately put her on the defensive, because people in a manic state are hyperalert and hypersensitive, and you don't want your message to be lost before you ever get it out of your mouth. Then you can say something like "How are things going, X? You seem to be really happy lately". (Of course, you run the risk that the word "happy" is a code word for "manic", like it is in my house .) But in general, asking open-ended questions encourages the other person to talk instead of grunting "Yes" or "No".

    If she seems receptive, you can gently suggest that you've noticed some increased animation (I like that term, BTW) and are concerned since it's a change from her usual behavior. At this point, she may get upset, OR she may realize that she is indeed ramping up, and do whatever she needs to do to get it back under control. Some BPers actually do appreciate being told when they're getting hypo; hopefully she's one of them.

    I wish you luck with this situation, because dealing with a bipolar on a 'high' is a minefield!
    Sailnskinurse and poppycat like this.
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    Quote from VivaLasViejas
    Thank you for caring about your staff! Trust me, too many managers wouldn't.

    You already realize that you have to be very careful when dealing with someone who has MI, but even more so when you suspect incipient hypo/mania. Most people in this state have little to no insight into their condition, and they are apt to be both incredulous and offended when somebody mentions it ("What are you talking about? I'm FINE!!").

    If you do approach this nurse---and you probably will have to, because once mania gets started it usually progresses---try to arrange it where you don't have to call her into the office. That will immediately put her on the defensive, because people in a manic state are hyperalert and hypersensitive, and you don't want your message to be lost before you ever get it out of your mouth. Then you can say something like "How are things going, X? You seem to be really happy lately". (Of course, you run the risk that the word "happy" is a code word for "manic", like it is in my house .) But in general, asking open-ended questions encourages the other person to talk instead of grunting "Yes" or "No".

    If she seems receptive, you can gently suggest that you've noticed some increased animation (I like that term, BTW) and are concerned since it's a change from her usual behavior. At this point, she may get upset, OR she may realize that she is indeed ramping up, and do whatever she needs to do to get it back under control. Some BPers actually do appreciate being told when they're getting hypo; hopefully she's one of them.

    I wish you luck with this situation, because dealing with a bipolar on a 'high' is a minefield!
    Thank you for the advice--hopefully I don't get blown to kingdom come if the situation comes to that. In the end I just want what is best for her because she is a great asset to the unit.
    catebsn25, Sailnskinurse, poppycat, and 1 other like this.
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    Well, everyone with BP experiences it differently, and each episode can be different as well. It's truly a chameleon; and if WE don't know which way the cookie's going to crumble, how can anyone else?

    FWIW, your co-worker could be waiting for someone to broach the subject with her, in which case she'll welcome your input. Sometimes we know on some level that we're out of control, and are actually relieved when someone calls us on it. I remember one particularly bad manic episode a while back that went on for a couple of weeks before a couple of my staff went to our administrator with their concerns; at that point he called me in, told me that both he and the staff were worried about me, advised me to call my psychiatrist, and then sent me home.

    I was so grateful to him that I almost hugged him, because I was exhausted and needed to downshift, and I couldn't do it at work. Hopefully your nurse will take your concern the same way.


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