Cognative disfunction

[Dayray, RN]

I have MS, probobly have for 15-20 years but just found out last year. I had some bad issues with confusing the ceiling with the floor and not being able to get up off of the later. That got me diagnosed i have over the years had struggles with changing vision, unexplained pain and fatigue. It is actually kinda surprising I didn’t get dx along time ago.

Anyway several years before my dx I went threw several crisis. My daughter died, I was run out of work (partially unfairly but partially due to cognitive deficit) and my marriage almost ended. During this time I began to have sever cognitive issues with memory attention and well just not being too swift. Over the last 4 years I things have slowly been improving but still are far off from what they used to be. Weather it is due to MS or just emotional overload I’m not sure. I mentioned this to my nero and she sent my to a cognitive psychologist. 2 months after the testing I finally got the results back. I am mildly cognitively impaired in exactly the areas I thought I was. My IQ in high school was 128 it is now 109 (doesn’t seem terrible but believe me its hard to learn to live without those 19 points).

My problems are memory which kind of scares me but not horribly because I can write things down and I have been doing my job long enough that remembering what to do isn’t that hard. Most of the problems I have in this area are just embarrassing but manageable (I think). I also have issues with processing speed, multitasking, CRITICAL THINKING, strength and motor skills. I can still act appropriately to problems but much slower I can see this in my charting. It take a long time because I have to remember how the computer program works and then process that, then remember what I want to say and process that and then review the whole thing. It takes way to long. I can manage the slower charting although I really hate it and its frustrating.

However, The worry that I’m going to miss something is terrifying. I work OB and things happen very quickly one part of me says "I have been around a while and have seen situations over and over again" so I know how to react like most people know their way home. Experience also helps with assessment and although I cant add things up as fast as I used to, I just have that feeling about things and am usually right or at least close.

Also the strength and motor skills thing is worrisome. I can’t start IVs anymore and I used to be really good at that. I mentioned this to my charge and asked to get remedial training but the hospital doesn’t have anything along that line to offer. It’s embarrassing to be orienting a new grad, teaching her and then have to have her start an Iv, which is the simplest of nursing skills. I think I could get by with the IV thing but what scare's me is babies. I have never ever ever even come close to hurting anyone and would not be able to return to work if I did. For the last few years even before the IVs became an issue I just felt weird when I was cutting umbilical cords. Sense my dx I have been ultra careful when holding babies or putting bands on and exhaustingly careful cutting cords. I think I can manage this too but I don’t know that I can and thats making me think I shouldn’t be doing this anymore.

Even worse I absolutely love what I do. I am still passionate and still get happy when I know I get to take care of someone today. I can not imagine doing anything else sure I could work in an office or sell something but well it would just be for the money. I have thought of being a midwife and the doctor says I have the capacity for college but I worry about suturing and god forbid someone made me assist with surgery (which most midwives do).

Money would be a huge issue if I tried for disability my policy covers 60% of my base pay and differentials make up 25-30% of my income so that like a 50% pay cut.

So thoughts?

[phlox]

Have you answered your own questions? If you feel like you are putting your patients in jeopardy then find an area of nursing where you do not have direct contact. I was diagnosed Bipolar 13 years ago and quit nursing. I worked ER, L&D and other units and thought myself a danger. I was afraid an error might occur. It did not, but I stopped before one would happen. All these years later, I am stable and ready to go back. Now I need a refresher course and TPAPN (Bipolar) as I let my license go dilenquent. So don't let your license lapse. But you may have to step down to where you won't cause injury. Perhaps a less glamorous position.

Oh. and I get only $600. month in disability...down from a very good RN salary.

[goodneighbor]

Dayray, I'm sorry to hear what must be heartbreaking to you since you obviously love nursing. Tell me, if your patient had these symptoms would you advise them to drive? Would you leave your one year old with them? It might be time to find another area of nursing or even something else. You have good assessment skills in that you can enumerate the deficits you are unfortunately experiencing but now it has to be put into the BIG PICTURE. That means if you have to take a long time to do things and are worried, maybe your instincts are telling you that yes, you are right, maybe you should do something else. Have you thought about being a Nurse Educator? Many nursing schools need an experienced nurse in the classroom to teach students. You might try a community college. Or perhaps there is a support group for people with MS that could benefit from your nursing wisdom. Or you could try to become an OT Assistant or PT Assistant with some training. That would help people, even children need this help. Perhaps your school district needs an Instructional Assistant in a class for children with disabilities or mental handicaps. You sound like a caring person and could do this. There are always people who need help and you don't have to sell Kirby vacuums! Use your skills in an area where you can share your knowledge. It sounds like you are thinking a lot about this. I just wanted to say some of the things that I thought of and hope maybe you might find them helpful. Gee, I'm sorry this is happening to you. MS sounds hard to have. I wish something could make it go away!

[Jules A, MSN]

I'm so sorry this stinking disease has done this to you. Are there other areas of nursing that would be more fitting for you now? Maybe something will less variables like telephonic nursing, flu clinics etc.? It breaks my heart to think of an experienced nurse not being able to work in their chosen field but maybe it is time for a change. I wish you well and please keep us posted. Hugs, Jules

[caliotter3]

I would consider doing shift work with home health clients and insisting that you only work with very stable clients. There are easy cases out there that you could handle I am sure. You might have to be satisfied with close to LPN pay, but at least you would still be working as a nurse. I would strongly consider moving to this area before you give up on nursing altogether.

[island40]

There are lots of other areas to continue being a nurse. It is not any less a contribution to sit behind a desk than it is to work the floor.

[llg, PhD, RN]

I agree with the others. I wish I could support you in your desire to continue working in your current job ... but I think it is time to move on and find a safer area to work in.

You keep saying that you haven't hurt anyone "yet." When are you planning on leaving? ... only AFTER you have seriously hurt someone? You don't want to wait that long. You would never forgive yourself if something bad happened to one of your patients because you worked knowing your abilities are impaired.

You need to find something that is within the range of your current (and near future) abilities. This is for YOUR sake as well as for your patients.