mental illness affected by night shift

sallyrnrrt, ADN, RN · Apr 1, 2018

You are working nights, which not congruent with our human circadian rhythms, this could contribute to you increase symptoms..... Think of physician office practice, or home health....to reduce your stressors.... You need to be in active treatment with your physician...

Best wishes

Long Term Care Columnist / Guide · Apr 2, 2018

This is a tough one. Bipolar disorder makes working nights all but impossible for most of us, unless we keep to a nighttime schedule all the time in order to maintain a stable routine and medication regimen. Unfortunately, that puts us out of sync with the rest of the world, which operates on an 8-5 schedule five days a week. So, the best I can tell you is to make your health your Number One priority; I'm assuming you work 3 12-hour shifts in a given week, so you'll need to make your appointments and do your exercise program on your days off. (Some people are able to fit exercise around their 12-hour shifts, but I never figured out how...then again, it was never one of my "must-dos".) If you have trouble sleeping during the day, put up blackout curtains in your bedroom and/or use a sleep mask to keep things as dark as possible; turn off your phone and use a fan or other soothing "white noise" to filter out sounds. I used to take a long bath when I got home from work in the morning, then put a blanket into the dryer to throw over me when I went to bed.

Your mental health must also be at the top of your list...without it, nothing else is possible. Be sure to take your meds as prescribed and see your mental healthcare providers regularly. You don't have to tell your bosses about your illness; in fact, I recommend you don't. Unless you absolutely need accommodations made, the fewer people who know about your bipolar and other conditions, the better. In my own experience, nothing good has ever come from disclosing my illness. It's amazing how little the Americans with Disabilities Act does to protect workers from being fired for having a disability. I lost two jobs that way. So if you can avoid it at all, don't share the fact that you have mental health diagnoses with your supervisor or co-workers.

I really wish you the best of luck. If you can, try to stick it out the full year; that way you'll have some leverage when a day shift position does open up. But I think you do need to consider other employment options than the hospital where you can work days. Just my $0.02 worth.

zoeywr · Apr 8, 2018

I was in almost the exact same position as you very recently. I'm going to share my story and what happened to me/how I handled it in hopes that maybe it helps you and anyone else reading this who happens to be in a similar situation.

I was a new nurse and I worked night shift for only 3 months. I have generalized anxiety disorder, major depressive disorder and insomnia. I have had those issues my entire adult life. My mental health/sleep problems actually became very manageable for me throughout the years, and I was able to cope with things and live my life properly until I started to work night shift- then I slowly deteriorated after the second week. I was no longer able to do my regular self-care routines (even the little things like eating right, going to yoga, having the energy to walk my dog, clean my house etc) that made me feel balanced and "normal" because my schedule was flipped. I also felt completely isolated on top of that because most of my friends and family weren't awake when I was. I wasn't able to restfully sleep during the day (I think because I already had insomnia, going so strongly against my circadian rhythm just really was bad and not manageable for me). I tried everything to try and adjust- and I mean everything. I read countless articles, bought a few books, read tons of threads on allnurses, and I asked coworkers and nurse friends for advice to deal with night shift work. I wore ear plugs, I hung nice blackout curtains in my room and turned my phone off, I tried meditation and even tried several supplements and medication to help me sleep better and manage my mental health. Some things slightly helped me, but nothing truly worked enough to make it bearable.

I kept pushing myself because I told myself I needed to make it to the one year mark and I needed to pay my dues. I figured if everyone else can do it, I could too. but I was having many of the same issues as you and it just got to the point where I was not functioning properly anymore outside of work, and I was using the very little energy I had left to try to safely practice as a nurse. But I was barely scraping by.

The two big issues for me was that I no longer felt mentally stable due to shift work and my own sanity was slipping, and the fact that I had become terrified to go into work because I felt like I was no longer safely practicing as a nurse when it came to taking care of my patients. I started making a few silly errors simply due to the fact that I was exhausted and not thinking clearly. I started to realize that I needed to be able to take care of myself before I was able to safely take care of other people, especially ones who were seriously ill with a lot at stake.

With having a significant history of mental illness and being very in tune to myself, I couldn't imagine being able to cope with a situation where I caused serious harm to my patient simply because my health declined so much from shift work. There was a local nurse I heard about that worked 13 shifts in a row (extreme I know), and he accidentally gave a patient too much insulin out of exhaustion and almost killed the patient. I wouldn't be able to live with myself if I did something like that. Not to mention the fact that I worked way too hard/made too many sacrifices to get my license to just potentially lose it all over something like that.

Anyway, my official breaking point was when I didn't sleep for close to 70 hours... and at that time, I had a complete mental breakdown. I had to call in sick to work and I made an emergency appointment with my doctor. My dad had to take me to my appointment because I was in such bad shape I couldn't even safely drive my car. I was at rock bottom at that point... I was having panic attacks, I was deeply depressed and having non-stop suicidal thoughts. I remember I couldn't stop sobbing that day and I was so embarrassed. After meeting with my doctor and telling him everything, he told me it was necessary for my health have a meeting with my nurse manager or HR (whichever I was more comfortable with) to explain what was happening, and my doctor said he would write me a note if I needed.

Now how I handled this from here is what worked for me and my situation... I'm not saying this would work for everyone, but this is what I did and the end result worked for me. I personally had a good relationship with my manager and felt very comfortable with him, so I wrote him an email saying I needed to meet with him privately and it was urgent. I didn't disclose any details of the reason for the meeting in writing. He responded immediately to my email. He was really accommodating and made himself available to meet with me the next day. When I met with him, i was honest with him about everything without going into a lot of detail; I told him I have had some health issues for many years (mental illness and a sleep disorder), but it had gotten to the point where night shift work was not manageable for me at the advice of my doctor. I explained to him that I was very normally high functioning before my night shift schedule disrupted it all and exacerbated my symptoms, and how I didn't feel like I was able to safely care for my patients anymore in the state I was in. I brought a note from my doctor, but it turned out I didn't even need to show my manager because he was 100% understanding and very concerned for me, and he felt horribly. He went over all of my options (turns out I had more options than I expected) and he let me decide what I wanted to do. He wanted to switch me to a day shift position on my unit, but there weren't any positions open on my unit at that time. He tried to get approval from his supervisor to create another day shift position, but it was denied. I was disappointed with that because I liked my unit, but the fact that he even tried meant a lot to me.

It turned out my hospital had a program called "job placement leave" specifically for newer nurses who are unable to continue their current job for a multitude of reasons (health issues, personal issues, etc)- and they determined I qualified for the program. My manager contacted HR on my behalf, and they put me on leave for a maximum of 3 months, and in that time I was still considered an employee. I was able to keep my insurance benefits and PTO, and HR attempted to place me in a new position that met my requirements. It wasn't ideal because you obviously don't get paid during that time, but it turned out to be a huge blessing for me. It took 3 weeks, and I was able to find a dayshift position in a different unit that I ended up loving more than my previous unit. And the best part is, I'm back on a normal sleep schedule and I finally feel balanced and back to my old self again. I think if you don't have a close relationship with your manager, I would go through HR. But either way, without knowing the details about the company you work for, I can assure you that you do have options and there are probably more than you realize.

I was scared to do all of this initially, but looking back now I am so happy I did what was best for me. I was originally so embarrassed and terrified of being judged because of the stigma surrounding mental illness. I also think there is a lot of stigma among nurses (especially new grad RNs) when it comes to speaking up about what's best for them. A lot of nurses seem to think you need to "suck it up" and stick it out. And I do agree with that mentality to a certain extent, but in my situation I knew it just wasn't doable for me- I had truly exhausted all my options and I didn't know what else to do. I knew deep down I needed to either speak up, otherwise something really bad could potentially happen. And I had the responsibility to make sure I was okay, and that my patients were safe.

My hospital was incredibly accommodating and understanding throughout this entire thing- I never felt judged or embarrassed. I felt supported and like they really cared about my well being be valued me as a nurse. I truly hope you have a similar outcome to me if/when you decide to do something, because everyone deserves that. If you don't, then I am confident you will be able to find something that works for you somewhere else. Remember that if you are unable to care for yourself, it's unrealistic to be able to safely care for others and it is NOTHING to ever be embarrassed about. It's actually one of the bravest/smartest things you can do, and shows that you know your limitations and deeply care about your performance as a nurse.

Sorry this was so long, but I hope my experience is able to help in some way. I know how hopeless it can feel to be in this situation and I really feel for you. But I promise you aren't alone and this has happened to many of us. A lot of people just don't talk about it due to the stigma surrounding all these issues. But I promise you that you have options!!!

Wishing you the very best :)

DextersDisciple, BSN, RN · Apr 8, 2018

This is a tough one. Bipolar disorder makes working nights all but impossible for most of us, unless we keep to a nighttime schedule all the time in order to maintain a stable routine and medication regimen. Unfortunately, that puts us out of sync with the rest of the world, which operates on an 8-5 schedule five days a week. So, the best I can tell you is to make your health your Number One priority; I'm assuming you work 3 12-hour shifts in a given week, so you'll need to make your appointments and do your exercise program on your days off. (Some people are able to fit exercise around their 12-hour shifts, but I never figured out how...then again, it was never one of my "must-dos".) If you have trouble sleeping during the day, put up blackout curtains in your bedroom and/or use a sleep mask to keep things as dark as possible; turn off your phone and use a fan or other soothing "white noise" to filter out sounds. I used to take a long bath when I got home from work in the morning, then put a blanket into the dryer to throw over me when I went to bed.
Your mental health must also be at the top of your list...without it, nothing else is possible. Be sure to take your meds as prescribed and see your mental healthcare providers regularly. You don't have to tell your bosses about your illness; in fact, I recommend you don't. Unless you absolutely need accommodations made, the fewer people who know about your bipolar and other conditions, the better. In my own experience, nothing good has ever come from disclosing my illness. It's amazing how little the Americans with Disabilities Act does to protect workers from being fired for having a disability. I lost two jobs that way. So if you can avoid it at all, don't share the fact that you have mental health diagnoses with your supervisor or co-workers.
I really wish you the best of luck. If you can, try to stick it out the full year; that way you'll have some leverage when a day shift position does open up. But I think you do need to consider other employment options than the hospital where you can work days. Just my $0.02 worth.

Second to last paragraph is spot on.

DextersDisciple, BSN, RN · Apr 8, 2018

Definitely get your mental health back in order because life can not go on without it. I agree with Viva do not tell people about your illness. Just tell your manager (I personally don't think HR is very helpful) you are physically unable

To do nights because it's affecting your health. And you need your health to provide quality care for your patients. Then ask if there is any way you could go to days.

A girl on my unit once did this (there were supposedly NO day shift spots) and the second a very coveted day shift position was posted she took it before Nurses with Much seniority could. Pissed some people off but management helped her do it. They understood she could not work nights.

Worse comes to worse you could always transfer to a sister unit/floor. But definitely get off nights.

04jabez · Apr 9, 2018

I also have a history of metal illness. I walked out of work and did not go back for nine weeks because I was in a metal health facility. I am very open about my mental illness, mainly because I feel our mental health patients are still seen as "faking it", "looking for attention" or malingering. I have heard nurses say "they need to exercise and eat probiotics ", "my husband won't treat borderline patient's because most of them are manipulative and just want attention" or my favorite " they just need to get over it" These comments are beyond ignorant coming from a health professional , especially since these same health professionals work with veterans. Most chronic illnesses come with visible symptoms, many mental health problems are internalized by the patient. Therefore if you can't see it, it doesn't exist. You may like your job but it's not worth your mental health. You need to find a position that allows you to care for yourself because if you don't you won't be able to care for others. Which is what nurses do.

SturblrBurblr · Apr 17, 2018

I also struggle with mental illness, and while I function better than some, I have to say: for me, sleep deprivation is a HUGE trigger. I will downwards spiral from there in some manner and, like you say and fear, I am soon no longer fit to care properly for my patients.

This job can be so demanding, and it's easy to overextend ourselves, bite off more than we can chew. I'd almost say, some forms of mental illness actually intensify such a trend: I care too much, give too much of myself, go long periods obsessed on my work and not eating/sleeping or otherwise taking care of myself (even outside of this job). I overthink everything, always wondering how this or that treatment, approach could be improved, or if I could do something differently and achieve a better result. Can't turn my mind off and just unwind, relax. Gotta go go go, do do do. I go the extra mile for my patients...

Until I start to burn out. Get exhausted. Start to doubt myself. Start to hesitate.

I've had to learn to recognize when I reach that threshold, and force myself to take a step back, take a break, engage in self-care, even request a change in my work (if possible). It takes self awareness and the resolve to be proactive about your own mental health to do this, but it's possible.

After all, "the heart must pump blood to itself first."

(This is especially hard right now because I am back in school while still working. Switched from working overnights to days for this program because I KNEW it was going to be an issue in a hurry. Still is, but the difference is I've likely saved myself from crashing and burning by the end of all this.)