Giving notice related to health issue

[newtress]

Hello to all. I have been nursing for a little less than a year after finally getting a position I really liked more than anything else. Until the last two weeks. I self evaluated my situation and working conditions and attributed it all to working the 11p-7a shift. It certainly wasn't a problem for me until recent. That shift really can be rough on the body. My symptoms didn't get better and became unmanageable. My attendance record swiftly went into the getting close to being fired catagory. One evening, I was still asleep after midnight and did not even call in. I slept right through the alarm clock and my cell phone ringing next to me when my supervisor called. Not due ot lack of sleep as I had been sleeping 11 hours. Seriously in some trouble, and had called off several nights prior to this. I look completely irresponsible. I went to my doctor and had bloodwork done. I specifically asked if he could order tests for autoimmune disorders. I suspected a possiblity of fibromyalgia or even lupus. So I asked please can you order an ANA. Got that done and just got the results. Severely positive ratio and refered to rheumatologist. Dr. said the titer shows about a 90% positive for systemic lupus. Bad news for me of course, but left with how am I going to clean up this mess of perfect attendance to suddenly trashed down the gutter, and feeling like I HAVE to quit the job. They can't place me on part time or PRN status, or even a different shift for better hours. That would take months. Of course I don't want to be officially fired, and sad that I will loose a good job and my medical insurance if I resign but to preserve and regain any health back and not exacerbate my condition worse than it is. Would giving a notice in writing stating this is the reason for leaving be sufficient and allow me to still get a positive reference letter still be possible? Any practicing nurses out there with lupus and how do you manage? :redbeathe

[scoochy]

Have you considered contacting the LUPUS foundation in your state?? How about attending LUPUS support group meetings? You may find that people who live with LUPUS are the best resources for support, suggestions, etc..

There is great promise for a medication for LUPUS; it is awaiting FDA approval. Google Lupus Foundation for all kinds of info.

I hope you can find your way through all that you are experiencing.

[newtress, LPN]

I found this strange that after spending time on searches today, there weren't any local or hospital affiliated lupus support groups in my city. I don't live in bum ___ Egypt or anything. I never really sought out any support groups but have always seen numerous ones for just about anything in my local paper usually connected to the large hospital system. This type of disease/disorder seems to be so behind the curtains and not presented to the public the way fibromyalgia is. Those pharmaceutical TV ads have really made the public aware of Fibromyalgia but Lupus has been put on the media back burner. Lupus is even worse than fibro. I'd venture to say if my employer and supervisors knew I had something like Fibromyalgia they would have been more understanding as opposed to treating me like I presented some ficticious health condition. They are all nurses themselves and even they don't understand this disease it seems, or how it can effect those trying to work full time.

[taiga]

I just joined the site specifically to reply to your post. I am not a nurse yet, but I do have lupus and can share my experiences going through the dx process while both working and not working....and dealing with a pretty physical job and the disease at the same time.

First off, I have to say that you need to do whatever it takes to keep health insurance at all times. This is IMPERATIVE. If you have any sort of break in insurance coverage, you may struggle to get your medical care covered for years to come. Some of the drugs used to treat lupus are quite expensive, while others are not -- I am on several, but one of them used to cost me about $14/month including syringes and all. Then I got switched to one that costs about $90/month as a co-pay for generic....and the drug itself would be at least $1000 each month at cost. This is only one medication...not all of them. If I didn't have insurance, I would be completely lost. So I am very genuine and serious when I say that you need to do whatever it takes to keep health insurance. If you absolutely cannot work, then you need to use COBRA.

I'm not sure about the FMLA stuff -- my employer let me use FMLA leave even when I had only been working for 3 months as a permanent employee. My FMLA wasn't an extended leave, but I used it to lower my hours from 40/week to 30/week in an attempt to just give my body more time to rest -- I didn't feel like I couldn't work at all, but I knew that full time was causing problems. Anyway, my employer is a huge one with a big HR department and such...I met with the disability coordinator and she helped me figure it all out and even got me donated sick leave so I could continue getting paid for the hours I was using on FMLA. It was amazing! Maybe you can see if your employer has a representative like this and you can talk to them. It is their job to keep your information confidential from your boss and everyone else in the company. The woman in charge of my FMLA paperwork actually prefers that nobody tells their boss or coworkers about health conditions because she doesn't want to see anyone discriminated against. She certainly has a point, although my boss and direct coworkers do know about my condition.

What did your doctor mean that you tested 90% positive for lupus? I'm not sure I understand that wording and wondered if you could clarify. Lupus is usually diagnosed based on a combination of blood tests, biopsies (if appropriate), and specific signs and symptoms. The ANA is a common screening blood test because 95% of lupus patients have a positive ANA...but it doesn't actually determine that you HAVE lupus if it is positive since other disorders can cause a high ANA as well as simple viruses. There are some more specific antibodies they can test for and things like CBCs also matter since they can go haywire.

I dealt with symptoms since I was a teenager and had to start seeing a rheumatologist at 18. I went through college and had ups and downs, then eventually graduated and started working full time. After about six months at a new job, I determined that I needed to quit because I felt like it was slowly killing me. I had tried to get a diagnosis for about 4 years and figured that there was no time better than the present to pressure the docs to figure it out. About six months later, I finally had a diagnosis. One possible difference in my case though is that I had the cushion of my mom's health insurance to cover me when I quit my job. If I didn't have that cushion, I absolutely would not have quit. I honestly would have rather landed myself in the hospital than lose health insurance.

I have been working a pretty physical job for the past couple of years and did well with it until I got into a flare about six months ago. I am back to using FMLA quite a bit to either stay home or to shorten my work days because my work tolerance has gone down quite a bit since I developed cardiopulmonary involvement. Sometimes I think it would be good to take a break and give my body a chance to rest, but other times I know that I would go insane if I had to sit at home all day long. So...I try to find a balance and give in when I know my body can't take it anymore, but also work to keep my life as normal as I can. And I won't lie -- keeping my health insurance is a huge, huge incentive. I can't live without it. Seriously. I never thought that health insurance would be so important to me at 26, but I really can't afford to live if I don't have it.

I know this was a really long post, but I just wanted to say that you aren't alone. If there are absolutely no options for changing your work schedule in any way (shorter hours, different hours, etc.), then maybe you should look for a new position while hanging onto your old one for the insurance. I have found that working part-time really helps me to maintain a better balance of health and normalcy. If you are lucky enough to get a diagnosis so quickly, then just make sure to get started on medication right away -- most of the long term meds for lupus take months to kick in and you really want to avoid prednisone if you can manage to. What are the main symptoms that are bothering you?

I hope they figure it out soon and you find something that works for your employment situation and your health situation. I definitely feel for you! Feel free to message me if you have any questions. Best of luck!

[brenda sue]

FMLA is only good if you have been ther at least 1 yr.

[Jules A, MSN]

There is a nurses with disabilities section here that I would bet has a Lupus thread. FWIW a friend of mine has worked full time for years with only two incidents of needing time off for a flare, knock wood. Depending on how tings go it can be done and yes like Taiga said do not let your health insurance lapse! That protects you from the pre-existing condition clause.

[newtress, LPN]

Thank you taiga for your reply and sharing. I must be having a bad day. The predominant message I am getting here is mostly about not letting insurance lapse or loosing it, or doing what ever means possible to keep it. Yes that is very very important I know. Fellow nurses and friends, there are some circumstances that no matter how you work it or dice it an employee with less than a year's time in can loose their medical insurance and that is that. I don't qualify for FMLA, they wouldn't place me on reduced hours or leave, part time or PRN. They want a full time nurse in my position for that unit and are replace me as we are speaking. This scenario is only one example of the health care/insurance reform mess we are dealing with. Where did one of the most important fundamentals of nursing go? SAFETY. Y'all are advocating for sacraficing my health and the safety of others just to keep my insurance. It's a no can do for me at this time. I had close to 40 patients and 70 to 80% of them all were all heavy narcotic orders. So.. risk my health, risk loosing my license, endanger the patients lives by overdosing them with narcs on top of psychotropic drugs and continue to call in. I'll find a way to work part time or PRN and purchase my own health insurance. And then go to the nurses with disabilities forum where I bet I'd hear less talk about insurance.

[taiga]

I'm sorry if the only thing you heard from my message is to sacrifice your health or your patients' health to keep your insurance. That is certainly not what I'm saying. I did suggest looking for another job in the mean time...something that would be more suitable to what you can manage right now. If finding private insurance is an option for you, then certainly going that route could give you the time off that you need. I don't see anything wrong with that if it is an option for you. For me, it wasn't an option because I had seizures before I was diagnosed and so the insurance companies haven't wanted me for years!

I hope you understand that the talk about insurance is trying to be realistic. Everyone needs to take care of themselves, but the reality is that if you have a serious disease like lupus, you are going to count on that insurance in order to be ABLE to take care of yourself. If you don't have that insurance, you'll be fighting to get anything covered and the insurance companies will blame almost anything on lupus if they can (and in turn, not cover it).

I know it sucks to hear, but it is the reality. My point in telling you this was to be honest.

If you think you are seriously endangering the lives of your patients, then of course you need to do what's right for you and for them. I was trying to give you honest advice from someone who has been there, has struggled with work, has had to quit, gone back to working, struggled, etc. Rinse and repeat. I mean...to be realistic, my baseline of medications run about $3500/month right now -- and I'm not even on any infusions or crazy stuff! If you can get private insurance right now and know that your stuff will be covered, then please do that and allow your body the rest. But I'm pretty sure that most people in this country would not be able to afford $3500/month for medications only, not to mention visits to specialists and all the regular bloodwork and testing required to monitor disease activity. Not everyone's medications cost this much, but you can bet that bloodwork is not cheap either.

I hope you find a solution that works for you, but I didn't want to sugarcoat the reality and that's why I talked about the importance of keeping your health insurance.

[TDCHIM]

Thank you taiga for your reply and sharing. I must be having a bad day. The predominant message I am getting here is mostly about not letting insurance lapse or loosing it, or doing what ever means possible to keep it. Yes that is very very important I know. Fellow nurses and friends, there are some circumstances that no matter how you work it or dice it an employee with less than a year's time in can loose their medical insurance and that is that. I don't qualify for FMLA, they wouldn't place me on reduced hours or leave, part time or PRN. They want a full time nurse in my position for that unit and are replace me as we are speaking. This scenario is only one example of the health care/insurance reform mess we are dealing with. Where did one of the most important fundamentals of nursing go? SAFETY. Y'all are advocating for sacraficing my health and the safety of others just to keep my insurance. It's a no can do for me at this time. I had close to 40 patients and 70 to 80% of them all were all heavy narcotic orders. So.. risk my health, risk loosing my license, endanger the patients lives by overdosing them with narcs on top of psychotropic drugs and continue to call in. I'll find a way to work part time or PRN and purchase my own health insurance. And then go to the nurses with disabilities forum where I bet I'd hear less talk about insurance.

I understand that you are having a rough time of it, but the concern about insurance is entirely valid. You can suffer for many years because of a lapse in insurance. You can face periods where you simply cannot afford treatment - a scenario that could be an utter health disaster given your diagnosis. You are quite right when you say you don't qualify for FMLA leave and if you believe you can't provide appropriate care for your patients, then that's that. As a nurse you have to make the decision you believe is ethical for your patients.

I hope once you have stabilized you are able to find good work on a more manageable time frame. However, please take it from someone who has been there - you have virtually no chance of finding any form of health insurance on your own, even catastrophic care insurance. When the new regs go into place, the premiums will be stratospheric. While you don't qualify for FMLA, you do qualify for COBRA on your former insurance coverage and I once again urge you to take advantage of the opportunity. You apparently think it's a minor or mercenary concern; I can assure you it's neither. Each person must walk her own path, but I hope you choose to pursue COBRA. It can mean the difference between decent care, subsequent stabilization, and the ability to work, and lack of care, inconsistent therapy, major fluctuations or deterioration in your condition, and the inability to maintain a job. I would hate to see anyone condemned to an unnecessary struggle due to lack of foresight.

Oh, and you'll probably hear more about insurance and insurance-related issues on any disability forum, including the allnurses.com Nurses with Disabilities forum, than you have on this thread.

[newtress, LPN]

In response to taiga I don't mean to offend you specifically for the advice and importance of trying to keep or maintain insurance. "My bad." You all mean well and care about an unfortunate circumstance of a sister nurse, so I apologize if I came off harsh or defensive. I am determined to discuss my options with my HR dept to see if I can initiate COBRA which after investigating the eligibility and criteria I should be able to obtain this if I can afford the expensive monthly payments, but without any coverage as tough as reality is would be a grand hardship as y'all were just trying to say. I suppose my body and my mind are sensitive at this time. I am looking at applying for a PRN position and hope that might at least contribute to insurance coverage payments and allow for working non night shifts and rest until the doctor comes up with a tx plan.