Requesting TPAPN / TBON Walkthrough

Nurses Disabilities

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Hello all! This one is geared more towards nurses who work in Texas, my home state.

I am an LVN-to-RN bridger, due to graduate in May! As excited as that is, it's been a rough go. I've been working 24-36 hours on the weekend (no choice, as I need the money), classes all day Thursday, clinicals the rest of the week. It has been... a trial, as most of you already know. It's not nursing school if it ain't a damn gauntlet.

The thing is, it (school stress, family stress, work stress, the major loss of regular exercise, the damn weather, an increase in the frequency of migraines, AND the chronic sleep dep) has all exacerbated my mental illness. Annnnd, has caused my doctor and psychologist to propose a new diagnosis...

Until this point and since adolescence, I have been treated off and on for depression, anxiety, and ADHD...

Now they are suggesting that a better label would be bipolar II.

My medication regimen has been adjusted with such a diagnosis in mind, and I've been asked to track my moods as a part of my therapy now. However, the diagnosis is not yet official. Tentative, I suppose? My doctor was saying that the TBON's stance on bipolar spectrum disorders is unnecessarily strict, and that she's just going to list my previous diagnoses plus insomnia on her official paperwork for me for that reason...

However, I know if I recruit a psychiatrist to help me with this, to really confirm this is what I have and to help with fine-tuning my meds, instead of just going through my GP and psychologist, I know that will all change in a frikin' flash.

Meanwhile, another student I know of in my program was hospitalized last fall for suicidal ideation. She has bipolar I. The TBON is now saying she will not get her ATT for the NCLEX upon graduation unless she fulfills a slew of new requirements. This put me in a panic. Do I disclose? Not disclose? Since it's not even "official?" What exactly do they say about bipolar spectrum disorders anyway?

So I researched TBON's Licensure Eligibility page, and the way I understand it is this: unless my MI impairs my work, has a history of impairing my work, OR I've been hospitalized since last seeking a license of renewal (which, seems like they treat it the same as having a drug relapse), I don't need to disclose to them jack ****.

HOWEVER, that it may be in my best interest to disclose and jump through their hoops in case there is an issue later on...

The TPAPN site they mention is the exact same program used to nurses who are caught stealing meds on the job. Whether or not you actually have a substance use disorder. This is what you go through just for disclosing you have one of the MI's they mention? Which is... I'm not sure how I should feel about that, beyond a touch resentful honestly, but hey.

My point for sharing this: I would like guidance, advice, anecdotes from Texan nurses who have already dealt with this. What the hell am I in for? What do y'all think I should do?

Thanks.

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Specializes in LTC, assisted living, med-surg, psych.

I wouldn't say anything. After all, you do not have an official diagnosis of bipolar yet. No need to open that can of worms!

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I mean, the aggravating thing about all this is: I'm a really good test taker, in spite of my emotional struggles.

I'm already an LVN, had the second highest entrance exam score for that LVN program (the highest score belonging to someone with the exact same diagnosis they are now proposing for me), and passed the NCLEX-PN after answering the minimum number of questions, in spite of everything I was going through in my life personally at that time (I mean, it was more an issue with my wife at the time than an issue *I* had, but hey).

Coming into this program, I had exemplary/99th percentile on the TEAS, the highest score in our group, and in spite of technical hiccups and nerves and new meds and all that nonsense, I just got a 1022 on the HESI. In my current and previous jobs, the patients and families tend to like me, at least, and the only real consistent issue I seem to have is the tendency to bite off more than I can chew, to take on all burdens too deeply and personally. (If anything, I feel my emotional struggles make me a touch more compassionate than the average bear.)

I'm NOT a bad student, and I don't think I'm a bad nurse (I mean, there's always hella plenty room for improvement, but...). On the contrary. I was a literature and drawing major long before pursuing this career path. I love to question, create, and problem-solve. I readily apply these same drives and aptitudes in my new career. I feel like I still have so much to offer here.

I just... have some issues on the emotional side of things, sometimes. Issues with coping. With over-extending. With worrying. With overthinking. Caring too much, until I reach a threshold and I have to "check-out" and not care so much at all just to protect myself.

But, there's the politics. The bureaucracy. The stigma. TBON is not always... aware, understanding, up-to-date, much less kind about all this. (Some nurses out in the field could use a little more awareness and compassion and a little less ignorance, too. Hell, some of the people on this site, even.)

I don't want to be tripped up by this.

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I'm not in Texas, but where I live I know some nurses who got a lifetime membership to monitoring. I wouldn't share unless I ended up straightjacketed in the booby hatch. Have you ever lost touch with reality? Do you self-medicate with alcohol or any other mind/mood altering substances? If you can answer no to both those questions, I would not disclose.

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I'm already essentially jumping through all the hoops I should be jumping through en regards to meds/tx, and I've never been hospitalized for anything psychological (or anything at all since the age of six, really). I am compliant with all that business.

I used to self-medicate my anxiety/depression with alcohol in my early 20's, but then I got my meds/tx recalibrated at that time and I haven't since. That was years and years prior to becoming a nurse (former liberal arts major and late bloomer). I have inherited my mother's strong dislike of opiates; we both get the itchiness/nausea pretty hardcore and the pain has to be really bad for me to be willing to put up with the side effects, so I doubt I'll ever go down the path of opiate addiction that some like to associate with nurses and mental illness (pheh!). I once in a blue moon sort of... take a step out of myself as a knee-jerk reaction to extreme stress, but the way different terms are described, that is more akin to disassociation than anything else. I actually get paradoxically calm and focused in high stress situations focused on other people, putting my own emotions on the back burner for the moment, hence the aptitude with emergency care?

I can tell you that this has never negatively affected my work; on the contrary, this line of work has actually occasionally helped me become more grounded and centered than I would be otherwise. I go into a different frame of mind when I'm caught up worrying about / fussing over other people. I become a sort of interactive non-entity, I become more my actions and drives than who I am and how I feel as a person. It's almost... meditative?

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Specializes in ICU, Agency, Travel, Pediatric Home Care, LTAC, Su.

Agreed with dont claim bipolar, etc. Not an official dx, i wouldnt open up that can of worms. Maybe post a general question on mental health dx in ur state forum and have people message u instead of reply to their post?

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Specializes in ICU, Agency, Travel, Pediatric Home Care, LTAC, Su.
I'm not in Texas, but where I live I know some nurses who got a lifetime membership to monitoring. I wouldn't share unless I ended up straightjacketed in the booby hatch. Have you ever lost touch with reality? Do you self-medicate with alcohol or any other mind/mood altering substances? If you can answer no to both those questions, I would not disclose.

What state if u dont mind my asking? I have bipolar, used to travel. Had licenses in AZ, PA, OH, NV, & CA. Ohio had questions about psych issues: bipolar, schizophrenia and one other. I answered yes to bipolar. No, i hadnt been involuntarily committed. And my psych doc had to send them a letter. Year and a half later i got an Ohio license good for like 14 months. It was very odd. I live in PA, but have family in Ohio (2 hrs away) and have thought about staying with them when/if im physically able to do travel nursing again. My Ohio license is inactive. I reviewed application to make it active and it only ask for hospital stays that were nonvoluntary and letter from psych dr that im safe, sane, and fit to work. The whole thing is so infuriating & discriminatory! Is this what u mean by lifetime monitoring?

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