I've been working as a new grad on a nursing unit for the past few months and things have been going pretty smoothly for the most part. Over the past few weeks to month, I've been experiencing some side effects from a medication that I'm on including the following: excessive sleepiness and poor concentration. During my first few months, I received nothing but positive feedback from both my nurse manager and my co-workers. As a result of the excessive sleepiness, I've had a few tardies (as a result of over-sleeping) and it was brought to my attention that it had gotten back to my nurse manager. I was recently confronted by a co-worker last night about how apparently a few of my night shift co-workers were going to bring to attention the following behaviors that they have deemed unacceptable: apparently I gave a shoddy report one day, I've been "slacking" on doing my work (which I deny. I would say I was a bit of an over-achiever when I first started and have noticed a decrease in the quality of the work that I've been doing and will acknowledge that it needs to be addressed) and that I'm not pulling my weight as I should be. Aside from the one comment where I've been slacking, I think the other complaints sound vague and while they may be true, I wish that this had been addressed when these behaviors first cropped up. On top of this drama, I've been having real trouble sleeping lately and would consider asking my nurse manager to switch me to day shift, but I don't want to rock the boat anymore than I already have.
How do I approach my nurse manager about my accountability for these behaviors? I realize that it's become a problem and I'd like to work on a solution, but I feel like part of it is not my fault and I'm really trying to improve my behaviors, but when I'm on a med that makes me excessively sleepy, it's hard to get everything done to the best of my ability. I have been battling with bi-polar disorder and have been having a particularly tough time with my symptoms lately. I work on an inpatient psychiatry unit and sometimes I wonder if I'm crazy enough to necessitate becoming a patient myself. I feel like I'm providing good care to my patients and I'm making every effort to separate my work life and my personal life, but it's been really difficult lately. How do I bring this up to my nurse manager without making her think that I'm incapable of performing my job? I'd like to improve my behavior and make it up to my co-workers that I feel I've let down, but it's frustrating that this was all mostly hear say and things said behind my back. I feel like my co-workers don't like the fact that I was hired as a new grad and can't help but think that I've fallen into becoming a victim of unit politics. I'm not saying that I shouldn't be held accountable for my own actions, but I would like support and advice on working out a plan to solve this problem.
I've contemplated taking a leave of absence until my medications get sorted out or going inpatient and just getting things sorted out on a STAT basis because this is really affecting me and my peers negatively, but I'm not sure if that's the best idea. I can't afford to make any mistakes and I want to improve my behavior. I should add that I have the next couple of days off from work and I was thinking about scheduling a meeting with my NM on Monday, before I make the decision whether to go in or think about a leave.
Not medical advise- you were mostly looking for job/HR policy advise- GO TO YOUR PRESCRIBING DOCTOR AND GET AN INTERMITTANT FMLA filled out- you can most likely get this from your HR department. It may never be an issue but if you are seeing a change in you performance, and having side effects that may make it difficult for you to work some shifts, it dosen't hurt to have this protection. As far as a LOA- not a bad idea if you can get one and still keep your job. I do know one nurse who got moved to day shift for medical issues under the Americans with Disabilities Act. I don't quite know what is involved with that but if you have a union they should be able to help you. If not- a employment law attorney may help you set this up- sorry I know that "attorney" is a forbidden profession to mention on AN but it is the only way I know to apply for ADA intervention. You don't want to see a major dicipline or dismissal on your first job resume'. Good luck.
I also have issues sometimes with sleeping through my alarm clock, and will occasionally get up, cross the room to turn it off, then fall asleep again with no memory of this happening.... so another trick I use for important occasions to drink a glass of water before bed. It can't be too big or I'll end up having to get up to pee in the middle of the night (or day), but if it's just the right amount, I'll need to pee when the alarm wakes me up and won't be tempted to just roll over and go back to sleep.
Specializes in General adult inpatient psychiatry.
Dolce:
I'd like to applaud you for owning your part of the issue that has resulted in others questioning your performance at work. Bipolar meds are major funk factors because almost all of them result in excessive drowsiness. This is an issue you might want to aggressively pursue with your psychiatrist because there might be an alternative you can try. The problem is that if you are difficulty controlling your bipolar symptoms, you are likely to have your dosages increased which will compound the problem. Maybe there is an alternate dosing schedule you could try?
I'm not so sure I would be quick to share your diagnosis with your NM. Wrong as it is, there is a stigma attached to mental health issues, and you might find yourself sliding down a slippery slope admitting to a mental illness and medication regimen being responsible for your poor performance. I would let her know that you value your job and will work diligently to improve your performance. Alternatively, you could work hard to improve your performance issues and not request a meeting unless one is requested of you. You might be able to fix this without drawing further attention to yourself.
Are you presently in therapy as an adjunct to your psychiatric treatment? You might consider this to help you with life management challenges and effective stress management.
What do you think?
Wishing you the best,
Tabitha
It sucks that sometimes psychotropics work like a charm but make you drowsy. I'm thinking of bringing this up with my doctor this week when I see him. I am seeing an outpatient therapist but it's very sporadic and I need to start seeing one on a regular basis again.
Specializes in General adult inpatient psychiatry.
Not medical advise- you were mostly looking for job/HR policy advise- GO TO YOUR PRESCRIBING DOCTOR AND GET AN INTERMITTANT FMLA filled out- you can most likely get this from your HR department. It may never be an issue but if you are seeing a change in you performance, and having side effects that may make it difficult for you to work some shifts, it dosen't hurt to have this protection. As far as a LOA- not a bad idea if you can get one and still keep your job. I do know one nurse who got moved to day shift for medical issues under the Americans with Disabilities Act. I don't quite know what is involved with that but if you have a union they should be able to help you. If not- a employment law attorney may help you set this up- sorry I know that "attorney" is a forbidden profession to mention on AN but it is the only way I know to apply for ADA intervention. You don't want to see a major dicipline or dismissal on your first job resume'. Good luck.
Thanks! I will get in touch with HR on Monday to see what my options are as far as ADA or taking an LOA. I know I had to get a letter of clearance to work without restrictions from my psychiatrist when I first started so maybe that might be a way to get some more flexibility now.
Your employer is under no obligation to offer you reasonable accommodations. You must request them. What "reasonable accommodations" consist of is not set forth in black and white. There is some room for employers to make a case that accommodating you could place an undue burden on the employer or affect the safety of patients in your care.
I'm glad to see that you're willing to hold yourself accountable for your performance issues. Is it possible that the side effects of your medications will lessen in intensity as your body adapts over time?
MY husband is also bipolar and he works nites. He will sometimes not take his med that makes him sleep so dang hard just so he can get up at a decent time. Do you work 12 or 8 hour shifts? I also have difficulty waking him up but the alternative without medicine is not good for anyone (he went to jail on fathers day and we are still paying stuff off). your nurse manager should be fully aware of the issues with bipolar and that should play a part in what and how she deals with whatever issues you have. Keeping her in the dark may not be the thing. If you can see how she acts with your bipolar pts and if you see understanding or an attitude (as some people do). It sounds like you want to help fix the issue. And you may need to change your environment (shift hours to 8 if not already) your career needs to work for you also so that may be something you also need to look at.
Your employer is under no obligation to offer you reasonable accommodations. You must request them. What "reasonable accommodations" consist of is not set forth in black and white. There is some room for employers to make a case that accommodating you could place an undue burden on the employer or affect the safety of patients in your care.
I'm glad to see that you're willing to hold yourself accountable for your performance issues. Is it possible that the side effects of your medications will lessen in intensity as your body adapts over time?
I agree with Virgo and would tread lightly especially as a new grad/new hire because they may or may not be willing to work with you. FWIW I'd be hesitant to disclose to my NM or anyone on my team. Putting personal stuff out there always seems to result in a bite in the butt sooner or later. If you decide to discuss your performance with your NM I'd be very humble and not make excuses. Perhaps just saying that you are on a new medication and it has affecting your sleep but you have come up with a plan to fix it would be sufficient? Wishing you all the best. You know I'm a fan.
Specializes in General adult inpatient psychiatry.
Your employer is under no obligation to offer you reasonable accommodations. You must request them. What "reasonable accommodations" consist of is not set forth in black and white. There is some room for employers to make a case that accommodating you could place an undue burden on the employer or affect the safety of patients in your care.
I'm glad to see that you're willing to hold yourself accountable for your performance issues. Is it possible that the side effects of your medications will lessen in intensity as your body adapts over time?
It's possible and it's something that I'm considering a hopeful thing. But I'm not sure if I'll be on the same meds for an infinite amount of time. I've been playing the medication merry go round/roller coaster for just over a year now.
Specializes in General adult inpatient psychiatry.
MY husband is also bipolar and he works nites. He will sometimes not take his med that makes him sleep so dang hard just so he can get up at a decent time. Do you work 12 or 8 hour shifts? I also have difficulty waking him up but the alternative without medicine is not good for anyone (he went to jail on fathers day and we are still paying stuff off). your nurse manager should be fully aware of the issues with bipolar and that should play a part in what and how she deals with whatever issues you have. Keeping her in the dark may not be the thing. If you can see how she acts with your bipolar pts and if you see understanding or an attitude (as some people do). It sounds like you want to help fix the issue. And you may need to change your environment (shift hours to 8 if not already) your career needs to work for you also so that may be something you also need to look at.
I work 12 hour shifts; my unit just switched to all 12 hour shifts (7p-7a or 7a-7p). I had already brought up switching to her and might see it fit to bring it up again because I really need to be able to take my medication on a reliable schedule. I've been taking my meds based on when I go to sleep, which of course varies based on whether I sleep during the day or at night. I sleep less during the day, which means the side effects are more prevalent if I have to go back to work that following night.
Re: new grad struggling with unit politics and poor performance
If you decide to discuss your performance with your NM I'd be very humble and not make excuses. Perhaps just saying that you are on a new medication and it has affecting your sleep but you have come up with a plan to fix it would be sufficient? Wishing you all the best. You know I'm a fan. 
bjess46
2 Posts
New nurse too here and looking to chat with some others. Would love to chat on aim or yahoo with an experienced nurse. Thanks!