Mental Health and Fitness to Practice in Alberta

[Mischa83]

I was recently told by my care manager that I am not fit to practice based on my anxiety attack I had in her office following a disagreement with the head nurse on the unit.

The morning shift was very heavy and busy for me - I had 3 patients that were sick out of my 20 patient load (in orthopedic subacute): 1) one patient had an unwitnessed fall and hit his head, not recollecting how he fell, was feverish and very impacted in his bowels requiring disempaction, 2) another patient was exremely nauseated, refusing all her meals and required antiemetic injection, 3) another patient was extremely dizzy, refusing to walk and physio concerned to walk her so needed her vitals done, 4) another patient was going for a follow up apt and needed to be ready for transport and all the NAs were busy with their other patients etc etc.

Normally I do my AM rounds as I hand out the anticoagulant injections for the patients to self administer. But due to the unexpected events from my sick patients, I was not able to attend to the anticoagulants first thing.

I also came into my shift with a sore throat and made myself a cup of tea to soothe my throat after the three events happened - giving myself some time to decompress and re-prioritize my morning.

Keep in mind, that I am a casual graduate nurse that recently graduated in December 2013. I had been working on this subacute unit for nearly 3 years as a Health Care Aide, Undergrad RN and GN, therefore I am very aware of the unit 'routine' and how the facility is run - but I am also still learning new things everyday as every nurse does.

When the head nurse (quality improvement nurse) approached me on why I hadnt done my anticoagulants yet and it was already 10:00, I tried to explain how the morning went so she could understand the reason behind the delay. She refused to hear me out and stated that I had to do the injections now before my coffee break. I was agreeable and did the injections. After coffee break, I continued my rounds. I also had two complicated discharges on my side (one patient had no support system to take him home and another patient had an abusive family to go home to).

The head nurse approached me again and asked why I hadnt started a fall protocol on the patient who fell yet. I told her that I took his vitals and did the assessment but hadnt got to the protocol charting yet. I realized that yes I did make a mistake in not making the fall protocol my prirority over my other patients. But again I was trying to explain my morning to the head nurse and ask if she would please listen to how I prioritized my morning so she could give me feedback and I could improve. She instead questioned my nursing assessments as I had not charted them yet so there was no proof of what I had done. I tried to explain to her that after all my interventions were done I was going to chart. I got overwhelmed at this point and told her I have anxiety issues, please give me some time to decompress. I said I needed to go off the unit to refresh.

I then went into the care managers office in tears explaining the situation. I told her that I felt I was giving good patient care but apparently to the head nurse and the other RN on staff, I was not proritizing my patient needs and unit routines as well as not managing my time effectively. I explained that 'rountines' only work when none of the patients are sick. There will be times when unexpected events throw you off routine or plan.

I made the mistake of telling the care manager that I was recently diagnosed with Bipolar by my psychiatrist. I had a very tough year of highs and lows and I've been having panic attacks and smaller anxiety attacks the last couple weeks as I transition through this new label. I then proceeded to have a small anxiety attack in her office. She told me to go for a lunch break and when I come back she will have thought of what to do.

When I returned, she told me that her professional opinion is that I was unfit to practice as a nurse at this point and that she cancelled all of my shifts and told me to consider going on Unemployment Insurance until I was medically cleared by my psychiatrist. She then sent me home early from my shift.

I am so shocked at how fast this all transpired and now my career feels upside down as I'm not sure what to do - should I even be a Registered Nurse? I still have to pay off my student debt so I can't afford to take a bunch of time off and as a casual I don't think I am applicable for EI benefits. I also work at the UofA hospital so I'm not sure if I should continue with those shifts since my manager's opinion is that I am emotionally unstable to safely care for patients. I feel like my story is so misconstrued and misunderstood so now I am labelled as a sick person who cannot safely care for others in my profession. So now I become the mental health patient? I thought mental health was not supposed to be stigmatized in our profession - the very profession who helps these type of patients. I feel so lost now.

The Union just called me and I told them my story and they offered to help me. But it would be nice to hear some opinions/advice from fellow nurses on what I should do.

I am seeing a psychiatrist this week so I will update him on this event.

Please tell me what you think I should do.

Kind thanks,

Mischa

[THELIVINGWORST, ASN, RN]

I would recommend you see a lawyer that specializes in defending clients of the nature

[THELIVINGWORST, ASN, RN]

Also, mental illness is more common than people think it is. You CAN be a nurse but I think it is helpful to get your anxiety under control. Second, some of those patients needed to go to the hospital and I think that's a huge problem that they were still under your care.

[CodeteamB]

First, do whatever UNA tells you to, they will be your best friends and know best how to help in this situation.

Next, the cat is out if the bag in regards to your diagnosis. Did you declare this on your registration? If your boss reports you to CARNA which seems likely considering she has effectively stopped your practice on her unit this could start an investigation. Our college is there to protect the public, and they must ensure that we are practicing safely, so concerns are taken seriously, followed up and investigated.

Now, what transpired in your description doesn't sound like a huge dramatic disruption, but perhaps I am not getting a clear picture. From what you described it sounds like a typical, overwhelmed nurse who could have prioritized a little better, and should have accepted criticism a little more gracefully. Whatever happened, when the problem is explained with a disability you open the door for that to be used against you.

I'm sorry this happened to you, live and learn.

If you do feel that your bipolar disorder is causing you difficulties at work, then obviously that needs to be dealt with, I think it is wise to follow up with your psychiatrist.

Again, use your union. That is why we pay dues. Ask for their advice on whether you should continue working at your other job.

Good luck.

[tareija]

I second using your union.

As for applying for EI, did you work while you were in school? If so you might be eligible for EI medical benefits, which are different than regular benefits if you lose your job. You can get paid up to four months. I had to use these last year when I had time off for a medical reason. You could ask your union about this as well. It's important to apply for EI promptly, ideally as soon as you stop working, if you delay too long you aren't eligible any longer. Definitely involve your union. I am sorry you are dealing with this on top of being a new grad, how stressful.

I work in psych. Unfortunately unfounded stigma against people with mental illness is a real thing. We would hope all health care professionals would be educated and not stigmatize, but unfortunately it is not always the case. On the other hand, some nurses are very accepting and supportive. I have had patients ask me, so, how and when should I tell people I have a mental illness? It can be a unclear decision when to disclose. In general I tell patients, once you tell someone, you can't untell them. If you're unsure of telling someone, you can always wait and see and tell them later. I tell patients, you have nothing to be ashamed of, and stigma is not your fault. If people are judgmental, it is a reflection on them, not you. That said, I say to them, your health information is your private business and you don't owe people to share your private business.

As for nursing license, I don't know how that works in Alberta. In my province the nurses college has an early intervention program. The idea is for nurses who have mental illness or addiction to seek assistance from the college so they can help you address it proactively, before it impacts your practice. I would ask your union about this as well, maybe Alberta has a similar program? In my province, fitness to practice questions are between you and your doctor. You are not obliged to share your private health information with your employer (diagnosis, etc), only to share if you are able to work or not, and if you need any modifications to your job for health reasons.

Some people get judgmental when they hear the term "bipolar", which can be unfair. A psychiatrist I've worked with has said, you know there are actually many successful, professional people who have bipolar, and are successfully managed as outpatients. Even people who are nurses and doctors, professors and lawyers. It can be done. It takes strength to admit when you have a mental illness and need support, and to get help. That is very tough when you are also a new grad, and I applaud you for being honest with yourself and getting medical help.

As for your job, wow that sounds like a stressful day, even for an experienced nurse. Try not to beat yourself up. Again, go to your union. All the best to you and I hope this is resolved quickly for you.

[VulpesVulpes]

Mischa83

Unless one have been unformed of the death of a family member, it is never wise to cry on the job. Any job. Especially to a superior.

This may have been what ultimately made her decide you were unfit to work and not the disclosure of the label. You cannot be denied employment for being competent and bipolar but you can be for being incompetent and bipolar. Unfair or not, crying will be used against you as evidence that your condition isn't "controlled".

In regards to mental illness...

I have been hospitalized three times in my short life for major depression, an anxiety disorder that eventually manifested into compulsion (OCD), and dissociation manifesting as profound depersonalization/derealization. I was on a litany of psychiatric drugs from age 14 - 20, all of which harmed more than helped. I was denied any treatment that wasn't biological and therefore was unable to find well-being until my mid-twenties when I encountered nonjudgmental, psychodynamic therapy. I was able to talk freely without fear of being locked up or labelled for the very first time.

The only stigma I have ever encountered has been from the mental health and medical establishment. The same establishment that chants "It's just like diabetes! It's just like diabetes!"

The truth is, healthcare and mental healthcare providers say they believe in recovery but most don't actually believe it. Ideal mental health care is psychological/behavioural-social-biological. Not capital b Biological with psychological/behaviorlal and social factors as a nice after thoughts. And certainly not Biological-Biological-Biological - the current mode of care. Mental health is emphatically different from diabetes.

A common rhetoric in anti-stigma campaigns is "People once believed that mental illness was a moral issue! But now we know it's BIOLOGICAL! It's a fact! Any one who says differently is ignorant!"....But please consider:

1. Since the early 1900s the Western medical establishment has firmly believed that mental health problems are inherited and biological. Freud and his ilk were psychotherapists, not standard psychiatrists of the day. The true norm was a biological paradigm.

People who were labelled mentally ill were segregated from the general population, put in asylums, stripped of any autonomy or freedom of choice, sterilized (as to not pass on the ever elusive "gene"). This happened right in Canada. Germany took this one step further when psychiatrists sought to systematically destroy their patients and were successful, paving the way for efficient methods used during the Holocaust.

2. Espousing a purely biological view of mental illness is associated with having no impact on reducing stigma, and often an increase in stigma. Don't believe me? Well, believe psychiatric journals.

http://isp.sagepub.com/content/45/3/216.abstract

http://ajp.psychiatryonline.org/article.aspx?articleid=102500

This is because when people perceive someone as having a mental illness caused only by biological disturbance they are more likely to perceive the person as "out of control" and "a lost cause". It also dehumanizes people as it invalidates their life experiences, culture, traumas, and life challenges as being contributing factors in their current condition/state.

I suggest you two excellent books on modern mental healthcare: Blaming the Brain by Elliot Valenstein (a professor emeritus of psychology and neuroscience at the University of Michigan), and Mad in America by Robert Whitaker.

Please do not victimize yourself by passively receiving a psychiatric label. If you are not spending your life savings, racking up huge debt due to mania, or actively entertaining a suicide plan while staring at a wall and unable to go to work - question whether you want to accept that you "have" bipolar (in other words, meet the criteria in the DSM). It is an waaaay overdiagnosed and complex disorder.

Perhaps not relying so much on the DSM and simply assessing your life might be in order...

I wish you the very best of luck and hope you are back working as an RN as soon as possible. As a psychiatric survivor I am unfortunately not surprised you were treated so harshly.