Three Clicks of a Mouse

.....is all it takes to find out personal information on a nurse in some states. Since the tragic events in Newtown, Connecticut, both gun control and mental illness have been hot topics, both here and elsewhere. Unfortunately, the focus appears to be zeroing in on the restriction of rights for certain populations, and in the nursing world, our right to privacy is already in serious danger. Nurses Announcements Archive Article

As those who study the social habits of humans have observed, Internet forums are a reflection of society as a whole, no matter how exclusive the community. And as the spate of recent threads here on Allnurses indicates, the events at Sandy Hook Elementary School have spurred many a debate about the Second Amendment......and as an unfortunate by-product, the rights of citizens with mental illness.

Strangely, nowhere is the latter issue more divisive than in the healthcare professions. We have a reputation for being compassionate, non-judgmental, caring; yet within our ranks we are often merciless to those who suffer from diseases of the brain.

It starts early with nursing students, who are under immense pressure to begin with and who sometimes crumble under the weight of lengthy written assignments, skills labs, frequent tests, and clinical experiences. While the process of becoming a health professional is (and should be) challenging, sometimes students are winnowed out who could be excellent nurses, if only they were offered assistance with their mental health issues instead of condemnation.

If one is fortunate enough to make it through school and apply for licensure, however, her/his state Board of Nursing is ever ready to put a screeching halt to career plans. In many states, both the initial application and the renewal paperwork require the applicant to answer questions such as "Do you have a physical or mental condition which impairs, or may impair, your ability to practice nursing safely?" To answer this ambiguously-worded inquiry honestly means, at minimum, a delay in receiving clearance to practice and at worst, mandatory participation in a monitoring program that can subject one to restrictions on her/his license, frequent (and costly) urine drug screens, even daily reporting to a case manager or counselor.

And God help you if you should run into trouble during your career. An inpatient hospital admission will both cost you dearly and put your license at risk, especially if a 5150 (involuntary commitment) was necessary. But the worst scenario is the one that a fellow nurse shared with me recently: some states actually publish personal information about a nurse who has been sanctioned by the BON that anyone with two minutes and a computer can find easily.

That's right, folks. This nurse, who answered the mental-health question honestly, had restrictions placed on her license and was mandated to participate in a health professionals' monitoring program. The document supporting the nursing board's decision contains confidential information about her diagnosis and her psychiatrist's evaluation of her fitness to practice, yet her board order can be found with three mouse clicks.

Can we say HIPAA violation, anyone?

To say that this is outrageous only scrapes the tip of the iceberg; if this were an issue of a bad back or an incurable (but non-contagious) skin condition, we would not be having this conversation. Why, then, is it acceptable to share the intimate details of a nurse's psychiatric disorder on a public website that anyone who merely knows her name can access? Why is it necessary to make it harder for a nurse whose illness is well controlled, who sees her doctor regularly and complies with her treatment program, to find a job? And if the intention is to "assist" the "impaired" nurse, why is the focus on schizophrenia, bipolar, borderline personality etc. when the most prevalent mental disorder among nurses is depression?

Please share your experience of being a nurse with mental illness, especially if you've ever tangled with the BON or been discriminated against because of your disorder. There is strength in numbers, and if a significant segment of the nursing population stands up together to say ENOUGH, the powers that be will no longer be able to ignore us, or worse, strip us of our privacy in the name of "protecting the public".

Thanks in advance for your responses.

I was typing my post as they responded. This is all very interesting to me. Hopefully more people will weigh in on this.

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

I admit I'm biased here, but I don't think a nurse should have to say 'yes' to that question when a) it's worded so ambiguously, and b) their illness is under control.

A few months before my license was due for renewal, I asked my psychiatrist if I should disclose, and he said absolutely not---there was nothing TO disclose at that point in time. Yes, I have a diagnosis of bipolar disorder. Yes, I suppose it could affect my ability to carry out my duties. But I have never been hospitalized, I'm compliant with meds, I see my pdoc regularly, and I'm following my treatment plan. He assured me that if it ever came up, he'd give me a letter stating that I'm able to practice safely (assuming, of course, that my condition continues to be well-managed), but recommended that I leave well enough alone since I have never drawn attention to myself with the BON.

Now, I figure if an M.D. who knows me well says I'm OK to practice, I'm good to go. After all, I just picked up the BP label a year ago; I've been this way for most of my life, including when I was in nursing school and when I received my license. I'm still the same nurse I was before the diagnosis....the only difference is now I know about it. And I'm in a far better place now than I was a year ago, or five years ago, or fifteen years ago.

I was treated too. I answered "yes" because I have a mental illness. I didn't think it would be a big deal because I was treated and I wanted to answer honestly as mental illness is not a crime (and I don't feel comfortable lying to the Board.) I got put in the monitoring program. I had asked point blank what that question meant (afterwards, but I did ask.) I was told if you have a mental illness, you must put it down.

Yes, those other threads were probably started by one of us. Viva and I are your AN advocates on mental health issues (along with our lovely fellow peers with mental health issues and peers that work in psych.)

I know I am preaching to the choir on AN, but mental health is important. I am also trying to work things out and advocate in "real life", as well.

wish_me_luck said:
(and I don't feel comfortable lying to the Board.)

That's what my doctor told me to put, and the question is very ambiguous. It does not point blank ask you if you have a mental illness. It is not lying.

Specializes in LTC, assisted living, med-surg, psych.
That's what my doctor told me to put, and the question is very ambiguous. It does not point blank ask you if you have a mental illness. It is not lying.

Exactly. If the question had asked straight out "Have you been diagnosed with, or treated for x mental health disorder within the past five years?" I would've answered in the affirmative, because that much is true. But since there was some major wiggle room, and my doctor advised against disclosure, I didn't lose too much sleep over it.

I have an overactive conscience. Big time...I don't know why....

It still blows my mind that all this info is just out there for folks to see.

Can you imagine if they were to do this with any other profession? The backlash would be incredible.

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

And people wonder why nurses with depression and other MI's don't seek help until it's almost too late......:no:

Specializes in Critical Care, Telemetry, CCU, PCU.

Great article Viva! And yes, these outrageous displays of a nurses' very personal information often results in delays in getting help. In SC, not only can this info easily be found on the BON's website, the sanction/discipline/surrender is automatically published in the state's nursing magazine (which is mailed out by the NA to every licensed nurse). I understand the need to protect the public and the concept of their "right" to know certain things. But anyone (INCLUDING a nurse) who is under a doctor's care IS a patient. And shouldn't every patient have an expectation of confidentiality regarding their diagnosis or other health information. I believe that the public should be able to know any professional's licensure status, but they do not need to know medical specifics. By releasing these details, what 'public good' is being accomplished, and how does this 'aide' the nurse in any way? Seems like double standards to me. Just sayin'...

Thank you for sharing this article. It makes one reflect about things that are happening around us and what can we do as nurses.

In my experience in several different nursing programs over the years, as a student and then as a faculty member, I have seen schools bend over backwards to assist students with emotional/psychiatric difficulties to identify resources available to them to get help and to continue to progress in school.

In my diploma nursing program decades ago, faculty had to come to in the middle of the night to talk a student out of jumping off the dorm roof three times before they finally told her she couldn't come back after the leave of absence she took each time. I have personally been involved in assisting students with getting mental health help and staying in school a few times. I've never (personally) encountered a situation in which a nursing program was quick or arbitrary about "weeding out" a student because of mental health issues.

What I have seen is that schools tend to be very good at respecting students' privacy about these issues, to the extent that most students in a program have no idea of how many students are having problems and being helped by their programs -- they are only aware of the few students who are unable to continue in school, and think that those individuals are the entire population of students having difficulties, and the school has a "no tolerance" sort of policy, when, again, in my personal experience, exactly the opposite has been true.

The BONs, on the other hand, have a primary responsibility to regulate nursing licensure and practice to protect the public, not to help nurses. I don't feel they are out of line in the degree to which they do that. I do have problems with private information being unnecessarily released to the public. However, in the larger sense, we all agreed, by entering a licensed profession/occupation, to be held to a different, higher standard than the general public, and to accept a greater responsibility to the public than "regular people." That is a price of being licensed, and people should think long and hard about that before entering a licensed profession/occupation.

elkpark said:

In my diploma nursing program decades ago, faculty had to come to in the middle of the night to talk a student out of jumping off the dorm roof three times before they finally told her she couldn't come back after the leave of absence she took each time. I have personally been involved in assisting students with getting mental health help and staying in school a few times. I've never (personally) encountered a situation in which a nursing program was quick or arbitrary about "weeding out" a student because of mental health issues.

However, in the larger sense, we all agreed, by entering a licensed profession/occupation, to be held to a different, higher standard than the general public, and to accept a greater responsibility to the public than "regular people." That is a price of being licensed, and people should think long and hard about that before entering a licensed profession/occupation.

The story you told is an awfully extreme example, elkpark. It doesn't do justice to the large # of well-managed professionals with mental illness. I do agree that we should be held to a higher standard. For me, that means I am both personally and professionally obligated to be compliant with my treatment regimen and take care of my personal health. It does not mean I should not be a nurse.