Bipolar SN is picky about shift, soon-to-be new grad can't work overnight

[KaminoAcid]

Hi guys! Sr. BSN nursing student here!

I was glad to see a number of threads from nurses with bipolar about their problems and their triumphs. Thanks for sharing!

Here's my concern;

I have bipolar (onset triggered in part by working nights) and can't work overnights. I MAY handle it OK for one night, but then things are all downhill (and uphill and downhill...) from there. I've been stable on meds for quite a few years now and don't want to jeopardize my mental health by working nights or doing rotating shifts. Sadly, there's a new grad hiring slump here in Mass right now and I'm worried about getting hired next May.

THE BIG QUESTION:

To have a shot at being hired w/out working nights:

How much do I disclose to the recruiter or hiring manager? Do I disclose to coworkers that may be resentful that I'm not working nights? Would offering to work every weekend and/or most/all holidays as an incentive to being hired and then to appease my colleagues offset the 'no nights'? What alternatives to full disclosure are there where I will be taken seriously?

How to approach? Don't want to appear to be a liability or that I'm not committed to the floor/job etc.

Please share your experiences!

Any bipolar nurse in New England or elsewhere that can speak from experience about disclosure in their hospital?

Anyone have any experiences to share when trying to request specific hours/shifts/days etc as a new grad/new hire, slump or no slump?

If you're bipolar and work nights, how have you handled it?

What have turned out to be difficulties for you professionally and personally working as a nurse and being bipolar?

Previous advice:

The only faculty that knows I'm bp is my very experienced MH clinical instructor from last semester who saw that I was somewhat uncomfortable with the clinical and asked what my issues might be. She was very supportive but suggested I never tell anyone I work for or with that I have bp.

So you see my conundrum.

This is a pretty big concern of mine because I'm very specific about my goals and I'm worried that my shift limitations will delay my progress. I'm 29, married, and would like to have kids AFTER getting ICU experience and going for my CRNA masters.

Thanks all!

This is my first time posting and I haven't determined how to allow people to email me or PM me, yet. I'll work that out soon in case someone wants to share about this more privately. Its so nice to have a forum to talk about all things nursing and all things personal for nurses.

Its a whopper of a post so if you've gotten this far I really appreciate it. You're a saint!

Looking forward to any and all input!

[palesarah]

I don't know what the job situation is in your area. In some places, staright day shift positions are available in all units- in others, they're not. If it comes down to it, you may have to take a position on a floor or in a hospital that's not your first choice, to protect your health. That's a decision you will have to make. As far as disclosing your medical situation, what you discole in your pre-employment exam SHOULD be kept confidential.

I have epilepsy, and ideally I should be working straight day shifts. I'm rotating right now and am planning on going to straight nights for the winter. There are nurses who have been on my unit for over 20 years who still have to rotate- straight days are basically impossible to get on, on my floor. If I need to go to straight days for my medical condition, I will either have to go to another unit or another hospital, and that's all there is to it.

[DaFreak71]

I am a bit confused. I have had bipolar disorder since 1966, although I was never diagnosed until 1977. I had no triggers, just cycles. Cycles where I would slowly sink into the deepest darkest depressions and rise to highs that were indescribable. I worked days, evenings, and nights before and after I was finally properly diagnosed and put on Lithium.

By the way, you do not have to reveal to your potential employer any medical issues you have. But once you are hired and asked if you have any pre-existing medical problems, failure to disclose can result in denial of your insurance claim and possible termination. Best check with an attorney in your state.

Woody:balloons:

Hi Woody!

I'm glad that having an irregular sleep schedule isn't a trigger for you. I guess BP manifests itself in various ways for different people. I have BP I, where I mostly have issues with mania (occasionally deep depression, but not so much or to the extreme that BP II causes).

Regarding your statement about insurance and possible termination, my hunch is that that is not correct, although I could be wrong. My understanding is that AFTER you are hired, then the insurance process begins, or even if it runs concurrent with being hired, it's not something your direct supervisor is going to know about. Usually HR or a benefits department deals with these issues. So I don't believe that you can be terminated for having BP and not disclosing it in your job interview (if that's what you meant). Of course if you are required to take a drug test, you'll need to list the medications you are on. To my knowledge, that is not something your employer will know about unless you test positive for street drugs (as long as you have a valid prescription for your BP and anti-anxiety meds).

You do bring up a very valid point about insurance coverage. Some policies will not cover pre-existing conditions for a period of time, sometimes up to one year. I've never experienced that myself with employer benefits, but when I tried to get individual insurance through Blue Cross/Blue Shield, they informed me that there was a one year waiting period for pre-existing conditions, they didn't even know I was bipolar--it's their policy for any type of medical condition.

My point is this: Once you are hired and have passed the drug screen, if at a later time your employer fires you for not disclosing your BP status--that spells lawsuit for discrimination. You cannot be fired from your job because of a medical condition. There are nurses who are HIV+/AIDS and I'll bet they don't disclose that in the initial job interview. Once you get your foot in the door, it doesn't matter if you're eligible for their insurance or not. A lot of people decline health insurance from their hospitals because their spouses might have a better insurance policy and they use their spouses plan.

Just my two cents on the issue. If I misunderstood what you meant/said, consider it my bad.

[rehab nurse]

***I am in NO WAY an expert on this, this is just my personal experience!!!*****

For all my jobs, my urine test was taken off site at a clinic. Only one was done in outpatient testing (hospital). When there, I filled out the form, listed meds I was on....you know the rest.

I was told by many, many people and lab personnel that the employer's themselves NEVER see the drug screen itself (the form you filled out) but only see a Pass/Fail.

If when tested, your prescribed meds are there (and I think they measure amount, to see if you are within prescribed guidelines for any narcs, etc, but of course, I may be wrong). Then the Medical Review officer will see the results, and may make sure the prescriptions are valid, etc. But once that is done, and you are not taking your meds (narcotics) as prescribed, that your test will be marked PASS. No employer or manager or HR gets the list of meds, it is a HIPAA violation I was told.

I personally know that my employer never knew what meds I was on at my last job. When I went for a new drug screen (new company took over, so had to do the "hiring" process all over again for new company) for my old job, I was on Morphine Instant Release PRN. Used it after work if needed. My employer got the results back as PASS.

I believe the only time you fail on the test is if you test pos for something and can't produce a valid presciption...the famous "Oh, I took one of my mom's Vicodin cause I hurt my back at work the other day."

This is how I thought it worked, and I did research it online extensively before I even went through it, cause I was scared to death my empoyer would *KNOW* it was prescribed for me. But everything was just fine.

Anyone who can point out any inaccuracies in my post, please do, cause I in NO WAY claim to be an expert in this subject, just relaying my personal experience and what *I* was told by quite a few people smarter than I.

Also, I am not sure what drug panel they are running, but I do know there are all different kinds, some with a basic opiate/THC/etc screen , some with expanded drug screens (usually opiates, THC, illicit drugs) and some of these screens have higher level cut-offs. (I know I am describing this terribly). I believe they would have to specifically screen for Lithium for it to show up. I didn't think they did that, I thought they were only interested if you're taking illicits or opiates without prescription.

I wish I could find a linik for you. I had a LOT of good sites. I will tryto find them again, and I wish you much luck in finding the right job and the right shift for you.

Also, another poster (woody??) said something about disclosing medical info for the group insurance?? I never had to list anything. I was just issued coverage, and as long as I was continually covered by a previous insurance and gave them a certificate proving it, I was fully covered for all health issues. I know that that may not be the case for everone though.

Anyway, I wish the OP the best, and I hope you find the job that's perfect for you!!

[woody62, RN]

Hi Woody!

I'm glad that having an irregular sleep schedule isn't a trigger for you. I guess BP manifests itself in various ways for different people. I have BP I, where I mostly have issues with mania (occasionally deep depression, but not so much or to the extreme that BP II causes).

Regarding your statement about insurance and possible termination, my hunch is that that is not correct, although I could be wrong. My understanding is that AFTER you are hired, then the insurance process begins, or even if it runs concurrent with being hired, it's not something your direct supervisor is going to know about. Usually HR or a benefits department deals with these issues. So I don't believe that you can be terminated for having BP and not disclosing it in your job interview (if that's what you meant). Of course if you are required to take a drug test, you'll need to list the medications you are on. To my knowledge, that is not something your employer will know about unless you test positive for street drugs (as long as you have a valid prescription for your BP and anti-anxiety meds).

You do bring up a very valid point about insurance coverage. Some policies will not cover pre-existing conditions for a period of time, sometimes up to one year. I've never experienced that myself with employer benefits, but when I tried to get individual insurance through Blue Cross/Blue Shield, they informed me that there was a one year waiting period for pre-existing conditions, they didn't even know I was bipolar--it's their policy for any type of medical condition.

My point is this: Once you are hired and have passed the drug screen, if at a later time your employer fires you for not disclosing your BP status--that spells lawsuit for discrimination. You cannot be fired from your job because of a medical condition. There are nurses who are HIV+/AIDS and I'll bet they don't disclose that in the initial job interview. Once you get your foot in the door, it doesn't matter if you're eligible for their insurance or not. A lot of people decline health insurance from their hospitals because their spouses might have a better insurance policy and they use their spouses plan.

Just my two cents on the issue. If I misunderstood what you meant/said, consider it my bad.

I had health insurance with several of my employers over time but I never furnished them with any information until I started working and had to fill out the necessary forms for health and life insurance. The medications I have taken do not show up on a routine drug screen, so I'm not to concerned.

I have tried to get additional life insurance coverage. I have Type 2, insulin dependent, hypertension, a seizure disorder and of course bipolar. I have been told that if I purchase a policy and die within twenty-four months, they will not have to pay if my death is related to any of my pre-existing conditions. My advice, buy life insurance when you are young and healthy and always pay it.

Woody:balloons:

[DaFreak71]

I had health insurance with several of my employers over time but I never furnished them with any information until I started working and had to fill out the necessary forms for health and life insurance. The medications I have taken do not show up on a routine drug screen, so I'm not to concerned.

I have tried to get additional life insurance coverage. I have Type 2, insulin dependent, hypertension, a seizure disorder and of course bipolar. I have been told that if I purchase a policy and die within twenty-four months, they will not have to pay if my death is related to any of my pre-existing conditions. My advice, buy life insurance when you are young and healthy and always pay it.

Woody:balloons:

Getting life insurance is a pain in the butt. I have type 2 diabetes, seizure disorder and BP too. getting life insurance at this stage in the game is way out of my reach. Your advice is spot on--get it while you're young and healthy, which most don't do because as we know, the young don't think they're ever going to die, lol.

[KaminoAcid]

Thanks all,

Fantastic info and I really appreciate the support. I've decided I'll be keeping my condition private.

You guys came up with some really practical advice surrounding disclosure, insurance etc... BTW my husband and I are shopping for life insurance next week, coincidence?

Thanks!

I'll post again with how the job search goes, where I end up working and what shift. I'll give people an idea of what hospitals offer non-rotating days or have days and evenings available. Things are really competitive here and I may look for a new grad ICU intern out of state.

A practical factoid for shift workers: Sleep cycles run in 1.5 hour increments. When you wake up without an alarm it is likely that you've woken up after 1.5, 3, 4.5, 6 or 7.5 hours of sleep. If you wake up in the middle of a sleep cycle you usually feel less rested than if you never started it, ie; 6 hours is better than 6.75.

Because naps less than a 1/2 hour are restful - as you haven't entered heavy sleep yet - I will set my alarm for six hours and then reset it for 20-25 minutes later to get that extra nap. If I'm unable to get my preferred 7 1/2 sleep but have time for 6 hours and a nap, I find I'm much better off regulating my sleep like that. I'll have more energy that lasts longer through the day. Try this and you might find yourself popping out of bed rested rather than dragging yourself to the coffee pot. (The very young and the very old will have shorter sleep cycles.)

A little BP pseudo inservice for those that are interested..

Bipolar often, though not always, means a person's time clock doesn't self-regulate as well as someone else's would. This means a few different things. For example, its harder to get back to a regular sleep schedule after traveling or staying up late. In fact if too much sleep is lost, instead of being able to crash from exhaustion someone with bipolar can go into "overdrive" and end up manic and unable to get enough restful sleep. This is definitely the case for me. I need a regular sleep schedule. If I stay up too late I may end up not being able to go to sleep at all until morning, only sleep for a few hours and find that wants to repeat the same cycle the next night, (read: BIG TROUBLE). If I lose sleep the best I can do is pay close attention to any hint that my body wants to take a nap and seize the opportunity or I will remain deprived and be thrown off. It can take me two days of these 'interventions' for me to 'recover' from poor sleep until I feel like myself and my schedule again becomes regular. If I'm unsuccessful in my 'recovery' I'll likely end up manic. Further down the road - for me between one and three weeks - I'll crash hard and end up depressed as I swing to the other end of the spectrum. In fact when I was poorly regulated on meds sleeping too much made me depressed. My clock is very sensitive!

What's nature's body clock regulator? The sun! So for anyone doing nights I recommend an eye mask from AU, it doesn't fall off and its very comfortable, washable and durable. I'm not sure if I'm allowed to post it but... its a Hibermate from hibermate.com. A little pricey ($25 U.S. w/ S & H two years ago) but when I need it, I sigh with happiness that its there. Black being the darkest is the best at blocking light.

[KaminoAcid]

LostDruid

Thanks for the advice on a possible way of working my way into ICU. I really appreciate hearing the ins and outs of navigating these things.

I think I'm going to turn in!:zzzzz

[azor]

Oh Dear,i really feel for you when i read all the replies concernig this thread.I'll tell you not to all any illness limit your ability or to affect your future.Its alright.You dont have to let your employers know of it before hand cos i am cerytain it'll limit your chances of getting the job but during the physical if you are asked before U/A,kindly declare it if you think it'll be seen in your urine.You dont tell your NM even cos she didnt hire you and i dont think she 'll come out to ask you.Goodluck Dear.Be your best in all you do cos i know that you can be hired to work days only if you dont have bp and prefer days.There are pple that can do well on days and some on nights,it all depend on you chemistry.

Azor

[NRSKarenRN, BSN, RN]

For those looking for day shift ....plenty in home health and community health positions.

[DaFreak71]

LostDruid

Thanks for the advice on a possible way of working my way into ICU. I really appreciate hearing the ins and outs of navigating these things.

I think I'm going to turn in!:zzzzz

Glad to help!

[alkaleidi]

As many others have suggested, I would definitely not disclose your mental health history, or any other health history for that matter. It's NOT anyone else's business, and COULD definitely cause people to treat you differently.

There are other opportunities too, like outpatient/day surgery clinics that might be better guarantees of day hours with good experience especially if your interest is in CRNA at some point. Good luck!

[time4meRN]

don't tell them. Look for day shift. Keep in mind , you may be narrowing your jobs but, if thats what you need to do them so be it. Prevent going to a job and complaining about the shift, how hard it is etc,,,,because, there are many reasons night shift is difficult for nurses, ie' children, inability to seep etc...most of us just don't want to hear it.