Calling In Sick: Dealing With Mental Illness At Work, Part 4
The series concludes with a discussion about what often happens when an episode of mental illness manifests itself at work, as well as ways that nurses can fight discrimination and seek recourse when their jobs are threatened.If you are a nurse diagnosed with depression, anxiety, or any other psychiatric illness, you are probably doing all you can to maintain your mental health: you're taking your medications as ordered, keeping your therapy appointments, seeing your psychiatrist and/or PCP on a regular basis, plus taking appropriate self-care measures to keep your body as healthy as possible.
Unfortunately, almost everyone with these conditions will experience a relapse at one point or another; it's the nature of the beast. Even more unfortunate is the fact that stigma is very much alive and well in the workplace, both due to the sensitive nature of the healthcare business and to the relationships between nurses and the public, which trusts us to hold lives in our hands. So when stress and strain exacerbate an underlying mental disorder, it can become very difficult to keep it under wraps.....and sometimes, we wind up paying a terrible price, as I did earlier this year when a severe mixed-manic episode cost me a well-paying executive level position.
"But what about the Americans with Disabilities Act?" you may be asking. "Doesn't it protect us from being fired for getting sick?"
Short answer: Yes, and No. It didn't do a thing for me when I was relieved of my responsibilities because my employer deemed my request for "reasonable accommodations" to be unreasonable, and it was clear that I could not perform my job without them. But to be fair to the company, they had tried on a previous occasion to accommodate me by changing my schedule to a four-day week to help reduce stress, which unfortunately didn't provide enough relief to prevent the catastrophic mood episode that sent me out on a three-week medical leave of absence in lieu of hospitalization.
I could have fought the termination. But since the best I could have hoped for was being given my job back with retroactive pay---and because I had neither the desire to return to the job nor the intestinal fortitude for a bruising battle at that time---I decided against it. The Equal Employment Opportunity Commission allows 180 days for the filing of a formal discrimination complaint, or charge, against an employer; however, they will not always file a lawsuit on your behalf even if they find the employer in violation of anti-discrimination laws. You have the right to sue the employer after the EEOC makes that determination, and of course you can choose not to involve the EEOC at all and file suit on your own.
We have discussed elsewhere in this series the pros and cons of "coming out" with your illness at work. But what if you have a public breakdown, or worse, are admitted to the same hospital where you work? These defining moments change the game, as the illness can no longer be kept secret and you're not in control anymore. Or are you?
The answer is a guarded "Yes". No matter what happened or who was present when it happened, you always have the right not to discuss it with your supervisors or co-workers. Both HIPAA and your employer's policies protect you from unwanted intrusions into your files and provides for discipline, up to and including termination, for anyone who accesses your medical records without authorization.
But there are also situations in which experience can be an excellent teacher, and depending on the circumstances (and your own feelings about sharing it with others), you can do much to educate your fellow nurses about mental illness. You need not be ashamed of it; it's not a character defect and it does NOT define you. But it is a part of you, just like brown eyes or freckles. The fact that you are a nurse who holds down a responsible job proves that you don't have three heads and you're not an ax murderer; no one should fear you because you have something that makes you act oddly at times.
As a nurse living with a mental health diagnosis, you may also be the right person to instill compassion and empathy into those who are lacking. You can gently persuade co-workers not to use words such as "loony" or "psycho" to describe patients. You can offer insight into what makes some tick by talking about the time you had an episode because you couldn't keep your meds down for several days due to an intestinal virus. You can even place yourself in the patient's shoes and encourage others to do the same, even though they will never truly know what goes on in his brain.....or yours.
My thanks to all nurses, students, and others who have been following this series. I hope that it has proved useful in helping readers to understand not only their co-workers and patients, but also family members and friends who struggle daily with bipolar disorder, schizophrenia, ADHD and other mental health challenges.Last edit by Joe V on Oct 28, '13
About VivaLasViejas, ASN, RN
VivaLasViejas has '17' year(s) of experience and specializes in 'LTC, assisted living, geriatrics, psych'. From 'The Great Northwest'; 55 Years Old; Joined Sep '02; Posts: 25,287; Likes: 36,874.6Oct 27, '13 by VivaLasViejas, ASN, RN GuideQuote from itzvalerieGood luck to you! I'm going on a HUGE interview tomorrow myself (state surveyor!) and know my chances of actually landing the job aren't great, but the fact that they invited me to an interview makes me proud of the things I've accomplished in my career that are good enough to make them want to talk to me. Nothing ventured, nothing gained.This has been a great series & really helps! I start a new job tomorrow & I'm really nervous & hope it goes well.2Oct 27, '13 by OrganizedChaosQuote from VivaLasViejasThank you & good luck to you too! You never know what could happen!!!
Good luck to you! I'm going on a HUGE interview tomorrow myself (state surveyor!) and know my chances of actually landing the job aren't great, but the fact that they invited me to an interview makes me proud of the things I've accomplished in my career that are good enough to make them want to talk to me. Nothing ventured, nothing gained.5Oct 27, '13 by GoalsInTransitionThank you, Viva, for sharing your heart, experiences, and insight! I have hidden MDD and panic disorder from people since I was seven years old. Frankly, the times that I quit my meds (unadvisedly) and stopped therapy (unadvisedly) were often in response to pressure (real and perceived) to "just BE NORMAL" (fix myself, suck it up, etc).
Now, I am truly blessed to have people at work and in my personal life who accept me with my inherent difficulties, and encourage me to get whatever help I need- and to stick with it.
I pray that my fellow nurses with mental illness keep seeking out the people and workplaces that can accept us as we are, whilst promoting our well-being. There is no healing while we are still cowering in shame.3Oct 28, '13 by VivaLasViejas, ASN, RN GuideYou can say THAT again! I would like nothing more than to see people with broken brains treated at least as compassionately as those with broken bones. It's going to take a lot of education and a great many more healthcare professionals standing up for this much-maligned population, which includes nurses, doctors, physical therapists and the like. Thank you for being one of those who are willing to do this.2Oct 29, '13 by AkewataruViva, I'm glad that you included AD/HD in your list of mental health challenge. Unfortunately, the name in itself kind of trivializes the disorder/syndrome and it is not seen as one of the most life impairing out-patient psychiatric disorders that it is. I think if it we're renamed Executive Function Deficit Disorder (EFDD) or Self Regulation Deficit Disorder (SRDD) as Dr. Russell Barkley coined it I think it would get more respect and compassion (slightly on the latter).1Oct 29, '13 by VivaLasViejas, ASN, RN GuideQuote from AkewataruI think you make a good point here. Say the name ADD or ADHD and people automatically think "kids" (not that it shouldn't be taken just as seriously, but that doesn't happen often either). They don't realize that it's an actual disoreder that wreaks havoc on both personal and professional life. I can sort of imagine having it, because bipolar sometimes micmics it and I get so easily distracted and have a LOT of executive DYSfunction when I'm in a hypo/manic state. You have my sympathies!Viva, I'm glad that you included AD/HD in your list of mental health challenge. Unfortunately, the name in itself kind of trivializes the disorder/syndrome and it is not seen as one of the most life impairing out-patient psychiatric disorders that it is. I think if it we're renamed Executive Function Deficit Disorder (EFDD) or Self Regulation Deficit Disorder (SRDD) as Dr. Russell Barkley coined it I think it would get more respect and compassion (slightly on the latter).1Oct 29, '13 by ianguitaristI have the schizoaffective psychiatric condition and I am just about to start nursing school. I really appreciate these posts. I am so torn as to wether or not to disclose. I suppose it really depends on the situation. I have scoured the internet to see if I would be refused by the board or what not. I was very paranoid until I found a quote from a psychiatric NP that she was schizoaffective and I was greatly relieved.2Oct 29, '13 by VivaLasViejas, ASN, RN GuideQuote from ianguitaristIf you explore the Nurses with Disabilties and Health and Stress Management forums, you'll find tons of posts about mental health/illness. Allnurses has a very active community of nurses and students with mental health challenges, and you can find a great deal of information as to what works for individual members, as well as when (if ever) to disclose.I have the schizoaffective psychiatric condition and I am just about to start nursing school. I really appreciate these posts. I am so torn as to wether or not to disclose. I suppose it really depends on the situation. I have scoured the internet to see if I would be refused by the board or what not. I was very paranoid until I found a quote from a psychiatric NP that she was schizoaffective and I was greatly relieved.
As for whether you, personally, should disclose your condition to your school, my opinion---and it is just that, an opinion---is that you should NOT. As long as you are stable and in treatment, it shouldn't affect your performance, thus it's none of the school's business. The game changes if you become symptomatic, of course, but don't cross that bridge until you have to.
Nursing licensing board rules vary by state, but this is when things can get very sticky. Again, as long as your condition is treated and you're not having frequent relatpses, you may be able to get around it in your application, but that is not always the case and you should be prepared to answer some questions if you must disclose. It is HIGHLY unlikely that you would be refused a license based solely on a psychiatric diagnosis, though.