Panic Attacks...now due to go back to work(yikes!)

[RN1Each]

I just need to vent, so here goes:

I am a former Infantryman with long-standing and well-treated bipolar disorder incurred during my military service. Thanks to Vocational Rehabilitation I graduated as an RN in 2011 and was eventually hired to work Telemetry overnight at a local Hospital (they were the first ones who actually called back.)

Anyhow, I made it a grand total of four months before I began having panic attacks before, and then ultimately during, my shifts. I had never experienced them before, even with the Bipolar diagnosis. I talked to my Unit Coordinator and VA Psychiatrist; both were extremely understanding and agreed to take me out of work for six months so that I could seek treatment.

The six months are up in two weeks.

Right now I have prescriptions for Ativan PRN, Propanolol PRN and Zolpidem PRN, and I am in the middle of a cognitive-behavioral treatment program which hasn't concluded yet due to both my previous provider moving to Boston and my new provider coming down with an illness that has him sidelined for a month...so I definitely haven't completed my course of treatment yet. I'm also starting to have dreams where I'm back on the floor dealing with just one patient, and it feels so overwhelming that I wake myself up in the middle of the night...and that's nowhere near my usual patient load of 5-7 patients.

I clearly can't return to Telemetry (my Psych has already told me that), but the Hospital still has me on the books as a full-time employee. My nightmare is that they just put me back on the floor and then I decompensate again.

Has this happened to anyone else? What should I do? I'm going to let my Psych know this when I meet with him next week, but frankly I'm nervous that the Hospital will just terminate me if I ask for an extension or a transfer to a "less stressful" (yeah right) department. I feel like I'm stuck between a rock and a hard place. I know a new job is a possibility, but I'm not sure whether I should start calling around now or wait until I see what the Hospital and my Psych has to say.

Any thoughts? I'll listen to whatever you have to offer...

[itsmejuli]

If you're experiencing anxiety now just thinking about returning to work you're right to seek advice.

Have you identified your anxiety triggers?

Maybe it would be wise for you to seek a less stressful position, perhaps in homecare.

I know I can't work in acute care, the stress is too much for me. I work in homecare and really like my job.

[VivaLasViejas, ASN, RN]

Welcome to Allnurses, RN1Each! Glad to have you here, and thank you for your service to our country. My 24-year-old son is in a similar position as you, and I wish he were half as sensible and realistic as you are.

I can't help noticing that you didn't list a mood stabilizer and/or an antipsychotic among your medications. If you're not on one or both of those types of meds, please talk to your p-doc ASAP. These drugs can help with anxiety, as can a low dose of antidepressant (have to watch that it doesn't switch you into hypo/mania though). I see you're already on an anxiolytic and a sleeper, but what are those meds doing for the underlying condition (BP)?

FWIW, I'm a bipolar nurse myself, and it took a drug "cocktail" made up of all four of those elements to get my symptoms under control. In addition, I do my level best to avoid work situations that stress me too severely, as they are triggering (which is why I don't work in a hospital anymore---having a nervous breakdown in my nurse-manager's office was NO fun).

I'll be frank with you: Acute care is probably not where you want to be. Any job where even the mere thought of it causes anxiety on the level you've described, isn't even worth trying. If you're anything at all like me, you've worked really hard to earn your RN license and manage your illness; why would you risk decompensating and losing everything you've worked so hard to maintain? No job is worth the kind of meltdown we BPers are notorious for, and you know in your heart of hearts that this one will send you headlong into disaster.

Please heed the warnings that your anxiety attacks are giving you. Do whatever you have to NOT to go back to acute care, your body and mind are telling you loud and clear that it's never going to be the right place for you, at least not until you are managed better medically. Take care, and keep us posted.

[jadelpn, LPN, EMT-B]

Thank you for your service!! I have seen cog/behavioral approach work wonders, however, not a quick fix and takes some time. I would not even attempt to try and go back to work until that is completed. You may need to think about disability until you are in a better place. I have also seen an anti-depressent with something along the lines of Neurontin for bi-polar d/o, so may be worth mentioning to your doc, as it may be the meds you are on may not be the correct ones for you. Finally, I would seek out PTSD after care. It is seemingly part of all of this, and so debilitating to many of our soldiers. I wish you nothing but the best, and please keep us posted.

[RN1Each]

Propanolol counters the adrenergic response; my B/P is thankfully pretty rock solid.

I'm going to really push my Psych for some more time to complete this course of treatment, as well as a note that states something to the effect of: "DON'T put him on a floor! Let him ride a desk for a while."

I'll update as I know more. And, thank you all for your insights. They really help.

[OCNRN63, RN]

Why don't you call your employer now and find out what they're planning, rather than worrying about what they might do. I don't know how VA jobs work; is there a desk job available for you to do?

[RN1Each]

I don't currently work for the VA. I just set up an appointment with HR to speak with them next week about my options; my hope is that they have something administrative.

[iluvivt, BSN, RN]

Also make certain you know your rights in your state. In California an employer cannot fire you while you are disability. They can however give your position to someone else but have to offer you a like position. If they do fire you after you are off disability you can collect unemployment but if you quit you cannot collect it.

The bottom line here is that is sounds like you cannot go back until you are more stable. Picture yourself hitting the ground full time 2 weeks from now with a full pt load. Can you do it? If you are having an abnormal amount of anxiety just thinking about it..I think you need to reconsider this position. Perhaps you would do better with a part time schedule in an area that is no so fast paced and demanding.

I would tell my psychiatrist that I do not feel my patients would be safe under my care at this time. I had to do that once during an incredibly stressful time during my life and it was true. I was so exhausted from battling pain and struggling through a tough pregnancy and I knew my regular MD would not put me out so I went to a psychiatrist and told him my issues and he put me out of work that day. I am so grateful for the mental care professionals. They tend to view an individual as a whole being that can suffer from emotional, spiritual and psychological imbalance that can effect you in all kinds of ways. We are not just physical beings which I think western medicine has not fully embraced. It is getting better though.