chronic illness and the dreaded school physical

cayenne06, MSN, CNM · Oct 24, 2013

No worries. They won't deny you acceptance based on these issues. I doubt your bipolar med will show up on a drug screen, but if it does, a letter from a PCP is all that is needed. People with chronic health issues are just as capable of being competent nurses as anyone else.

I would be slightly nervous about disclosing a mental health issues, because it is a sensitive topic. I would explain your concerns to your PCP, and if you have a good relationship with them, they may be willing to leave that diagnosis off, and just say something like "this patient's has no conditions that would preclude him/her from full participation in patient care.

The lab doing your drug test will need a letter from your prescriber if you test positive for any controlled substances, but they will report your screen as negative to your school, as long as they receive proof from your pcp. I take benzos for sleep related panic attacks, and my employers do not know about it. As far as they are concerned, my drug screen was negative. (Obviously i don't take benzos when I am working)

mrsboots87 · Oct 24, 2013

The physical form should not ask about mental illness. If it does, that is odd, but still may not matter. Your PCP just needs to do a physcial to see if you are capable of completing the program. This part has no bearing on your BPII. Purely your physical ability to complete the program. As long as your PCP is aware that you are capable, thats what matters. If you come in all the time with symptoms that would hinder your ability to complete clinicals, then that is when you should be concerned about them not signing off. But if you dont, then there is no reason to worry. Your PCP will likely just spend a bit more time talking about the physical needs of the program to be sure you can do it. As for BPII, you do not need to disclose it because it is not the programs bussiness. If you are being treated and functioning well (and when not you seek help) then they dont need to know. It is discrimination to disqualify you if you are being treated and stable. There are many nursing with various mental disorders who work closely with their PCPs and therapist to ensure their medication and mood is fine. The BP meds may come up on your drug screen, but the med reviewer will call you to ask for a valid prescription. Once they recieve it, they will forward the results to your school as a "Pass" and will not mention the meds.

If you are truly worried about your PCP not signing off on the form, and you are positive you will be capable of enduring the physical requirements of the program, then go to an occupational health center for your physical. It will with a doctor unaware of your condition. They will ask, and you should be honest, but they will do a full physical and as long as you "pass" the physical, they will sign off on the form. GL

Long Term Care Columnist / Guide · Oct 24, 2013

I echo what the PPs here have said. Your mental health issues are none of the school's business unless you're requesting some sort of accommodations under the Americans with Disabilities Act.

Whether or not your meds show up in a urine drug screen is debatable. Mood stabilizers such as Lamictal won't make you pop positive, because they're not looking for that on the UDS. They're looking for narcotics and illicit drugs for the most part. If you're taking a benzodiazepine like Ativan or Xanax, that will show up and they will ask you about it; it's easily dealt with by taking the Rx bottle (with your name and that of the prescribing doctor) with you to the testing site.

For what it's worth, I think you'll do fine in school as long as you stick to your medication and self-care regimen. Your bipolar should never be an issue, either in school or in your career, unless you become symptomatic; make sure you eat well, get some physical activity in on most days of the week, and most importantly, get adequate sleep!!

By the way, I'm bipolar 1 and made it all the way through school and sixteen years of a fairly successful career before I had to semi-retire due to an exacerbation of symptoms back in late 2011. You can do this. :yes:

ixchel · Oct 24, 2013

Once you get to your psych rotation, you'll understand why your mental health diagnosis will be acceptable if it ever needs to be disclosed. I believe my health form required my physician simply state if I am in good health and if they feel I am capable of duty in the nursing program. In my first semester, I was diagnosed with spinal fractures, which changed my abilities, but the program kept me. Remember they are in healthcare. They understand.

With all of that said, I think with your BP diagnosis it will be vitally important that you check in with your prescriber often and really take a self awareness inventory when things get particularly stressful. It sounds to me like you are supremely self-aware, but it is easy to put essential health needs down the priority ladder when you are in nursing school. From one person with a chronic condition to another, don't let any part of your health slip through the cracks, even if it feels insignificant. You do that, and you will do just fine.

Best wishes to you, love, ❤️

wayward_pitbulls · Oct 25, 2013

Cayenne & MrsBoots -- I'm not worried about my PCP saying I'm not competent. We've talked about my plans and concerns, and she's genuinely excited for me. I AM worried about the medical history, which specifically mentions bipolar and "back trouble." She needs to sign off on that, too, and these aren't exactly dxs one "forgets" about.

It's a grey area between student health services and ADA. Back when I was first checking out schools, I asked vaguely about admissions and chronic illness, and was told, equally vaguely, that our medical histories stay with the people in charge of flu shots and accidental needle sticks -- unless they see "something of concern," in which case they "take it to admissions." I couldn't find out more without disclosing more, and no way was that happening in a packed auditorium.

KelRN215, BSN, RN · Oct 25, 2013

It is illegal for them to discriminate on the basis of disability. The admissions people shouldn't see your medical forms at all, those belong in the student health center.

I had to take a medical leave of absence during nursing school due to, among other things, a severe eating disorder. The dean of the nursing school had to sign the form that I filled out saying I was withdrawing and then the director of counseling services had to approve my readmission when I was ready to come back. That was it. There was very little drama.

wayward_pitbulls · Oct 25, 2013

Thanks for your recent posts on mental health issues in the workplace, and for your support here. It's a hard topic, and I am appreciating your writing.

Does gabapentin turn up on the screen? I'm not currently using it, but it helped get me unstuck the winter before I decided to go back to school, and it's a good tool to have on reserve.

It's funny, a big part of why I want to do this is BECAUSE nursing is a physically demanding career that also pays well enough for me to take care of myself. I go nuts if I have to sit still too long. On the flip side, the harder I work, the more I'm in tune with what I need, in terms of food and sleep and relaxation, to keep performing well. There's a breaking point, but my body typically gives me plenty of warning before I cross the line from "a little irritable" to "emotional and cognitive land mine."

KelRN215, BSN, RN · Oct 25, 2013

I echo what the PPs here have said. Your mental health issues are none of the school's business unless you're requesting some sort of accommodations under the Americans with Disabilities Act.
Whether or not your meds show up in a urine drug screen is debatable. Mood stabilizers such as Lamictal won't make you pop positive, because they're not looking for that on the UDS. They're looking for narcotics and illicit drugs for the most part. If you're taking a benzodiazepine like Ativan or Xanax, that will show up and they will ask you about it; it's easily dealt with by taking the Rx bottle (with your name and that of the prescribing doctor) with you to the testing site.
For what it's worth, I think you'll do fine in school as long as you stick to your medication and self-care regimen. Your bipolar should never be an issue, either in school or in your career, unless you become symptomatic; make sure you eat well, get some physical activity in on most days of the week, and most importantly, get adequate sleep!!
By the way, I'm bipolar 1 and made it all the way through school and sixteen years of a fairly successful career before I had to semi-retire due to an exacerbation of symptoms back in late 2011. You can do this.

Lamictal can actually cause a false positive for PCP:

Phencyclidine false positive induced by lamotrigine (Lamictal®) on a rapid urine toxicology screen

I learned this when I was working in pedi neuro and had a 2 year old whose UDS came back positive for PCP. Fortunately the MDs had seen it before and knew what it was.

Stephalump · Oct 25, 2013

I don't know if it's how it works everywhere, but my program states that our medications and health history are protected information that we are under no obligation to share (thanks HIPAA.) There are certain requirements that must be met, but it's a "yes/no" kind of thing done by your physician, not an in-depth profile.

Even writ drug screens, they're done from an outside company. If something shows up, a physician from the company calls and asks you to verify that you have a prescription. If you do, no problem. If you don't, you fail. The school has no idea if you're taking anything or what you're taking.

Anything more than that seems wrong to me. Your health history is your business. If you can perform at clinical, you should be good to go.

Long Term Care Columnist / Guide · Oct 26, 2013

Lamictal can actually cause a false positive for PCP:
Phencyclidine false positive induced by lamotrigine (Lamictal®) on a rapid urine toxicology screen
I learned this when I was working in pedi neuro and had a 2 year old whose UDS came back positive for PCP. Fortunately the MDs had seen it before and knew what it was.

That's interesting! I wonder if that happens very often? I've been on Lamictal for quite a while and nothing showed up on UDS for my current job. Thanks for the info.....I'm interviewing for a state surveyor position and I would HATE to have that show up on a test (if I get the job, of course).