Calling In Sick: Dealing With Mental Illness At Work, Part 3
The series continues with a look at some of the ways nurses with mental health challenges can help themselves to achieve and maintain wellness. We also discuss what can be done in the unfortunate event that an episode of illness manifests itself on the job.
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Among the challenges of being a healthcare professional with a mental disorder, perhaps none is so difficult as maintaining one's composure during an exacerbation of illness. Not only is it undignified to be so out of control that you disrupt a staff meeting or hear voices coming from the desk fan at the nurse's station, it's potentially disastrous to your career.
Obviously, you want to avoid manifesting signs of your illness at work (and it would be nice if you can keep your cool at home, too). But medications and therapy will only take you so far; you have to help yourself along the way by practicing good self-care techniques. These don't have to be elaborate or expensive; in fact, they're the basic health habits everyone should follow---namely, eat well, find some form of exercise that you'll do regularly, take time to de-stress every day, stick with your meds, and of course, get plenty of sleep.
A few words about sleep: This is one of the most vital components of mental health, and it's also one of the easiest to get wrong. Lack of sleep is a double-edged sword that can hurt you in multiple ways---it can be a sign that your condition is deteriorating, as well as a trigger for an episode of illness. It also feeds on itself; the less sleep you get, the stronger the grip of the illness, and as the episode itself escalates, the harder it is to sleep. Often it takes medication to break the cycle, and then you must commit yourself to going to bed AND getting up at the same times each day.....even on your days off. That can be extremely difficult to manage (my argument is always "But what the deuce is there to DO at six AM?!"), but it's necessary to maintain optimal sleep function.
Still, there are times when you're doing the best you can to stay well, but trying circumstances or life events may knock you off course and a breakthrough episode results. You find yourself forgetting details such as charting meds you've given or calling lab results to a physician. Or instead of chatting with co-workers on breaks, you retreat to your car and gobble down a handful of cookies. Or you notice that you're more and more anxious and you start dreading work, fearing that you'll make a mistake or embarrass yourself in front of a patient or supervisor. Or you start getting funny looks from co-workers and criticized by managers for talking too much and too loud, rushing around too fast and making amateurish errors, and lacking attention to detail.
Of course, you're going to be in contact with your healthcare provider (correct?) to try to bring the episode to a swift end, but in the meantime you are probably going to need some time off to deal with it. DO NOT be afraid to take it. An exacerbation of mental illness is just as legitimate as a bout with the flu, and it deserves every bit as much attention.
You don't have to tell anyone why you need time off unless you need a formal medical leave of absence or FMLA. Use your vacation days or other personal time off---that's what it's for. Often it takes only a few days to get things under control, but depending on the severity of your symptoms and the degree to which they disrupt your life and work, you may have to go out on LOA and exhaust your earned-leave benefits. Do it anyway, even though at this point you will need a note from your doctor stating why you need it and providing a date when you may return to work. Trust me, going back before you're ready is a recipe for disaster, and in any case your facility will not allow you to return until your doctor releases you.
Of course, by the time your episode resolves, the rumor mill at work will probably have been churning, and you may face some curious glances and perhaps even some questions from your co-workers as to the nature of your absence. You are under no obligation to discuss this with anyone. If you're comfortable doing so, you certainly can, but as a general rule it's best to avoid the gory details. Unfortunately, there is still a great deal of stigma associated with mental illness, and while your friends may understand, chances are that some of the higher-ups may take a dim view of nurses with MI, and they can make your life so miserable that the stress tips you into another episode or even forces you to quit.
In the final installment of this series, we'll discuss what to do when a nurse finds her/himself in an untenable position at work because of a mental health condition, and what (if any) recourse is available when one's employment is in jeopardy as a result of that illness.
