Not sure about bipolar and declaratory order for Board of Nursing

[953anon]

Hello all, this is a long post but I truly would appreciate a response because I don't know what to do!

I got accepted into my school's Fall 2012 nursing program. I am filling out necessary paperwork/orientation stuff and noticed something regarding being diagnosed with schizophrenia, bipolar disorder, etc under declaratory orders. Now I need to give you background information about myself. In high school, I had a single best friend who was the only person I trusted. To cut the story short, our friendship ended 2 years ago when college started and it was very traumatic for me. I became very depressed for the past 2 years. I saw a university counseling specialist (that was her official title at the time, as of this year she is a licensed psychologist) around March 2011 for the depression. It was never serious enough to get in the way of my life or be dangerous but it was distressing to me because I was just sad all the time (typical depression). I stopped seeing her after a a month or so because I felt I just needed time to 'heal my wounds.'

Then around March of this year, I went to visit her again because I was beginning to miss my friend again and was very sad about everyday life. To help you understand, most of my sadness was due to sheer loneliness. I talked to nobody other than my parents and occasionally some classmates. Anyways, I was experiencing ups and downs at the time because I was first of all depressed, but I was also very determined to cheer myself up. So I would try very hard to cheer myself up through movies, books, etc and I would feel happy for a while until I realized I was still just as lonely and sad. I told my therapist I was sick of trying to be happy and getting sad again. Basically, I think she interpreted this as bipolar disorder although she didn't explicitly say so. We just kind of discussed that people with mood swings might be bipolar. She didn't say that I was bipolar. In fact, during our discussions, I told her I've read up on bipolar and I don't fit the profile because when I'm "happy," it's not like a textbook manic/hypomanic episode (sleepless, irritable, racing thoughts, etc). I'm just simply interested in a book or movie that cheers me up...my positive moods weren't even visible to anybody. So we openly discussed bipolar, but the session did not result in an official diagnoses. She told me that I could look into calling the school's psychiatry department (rather than the counseling department she worked in) to talk to a nurse practitioner about my symptoms but I did not end up doing that because I felt the whole thing was going the wrong way. Since this session, I have done a lot of soul searching to see what it is that is "wrong with me" and I concluded that I'm simply just a negative thinker and I need to give people a chance. I think during that time, my periods of being happy were from being obsessed with fictional things like movies because I wanted to escape my sadness. I just need to let go of the past and try to be more positive, that's all. I've read inspirational self help books, gotten closer to my family, and have gone to church and I feel so much better without the help of a counselor. Even though I don't have close friends, I have nice acquaintances, a 4.0 GPA, a job as a barista, I don't do drugs or drink, I'm a very "goody two shoes" girl. I also want you to know that I am very interested in psychology and I have an understanding of mental illnesses and diagnoses and I can honestly say I am not bipolar. I'm not in denial, I am simply just not bipolar. I wouldn't want this one-hour discussion with my therapist to turn into something that could disrupt my career. My question is if this wishy-washy discussion about bipolar would be considered a "diagnoses of bipolar" that would require a declaratory order. If I don't fill out a declaratory order, would there be any consequences? Because I dont think I'm "diagnosed" and also the school counseling center has a confidentiality policy that keeps absolutely no academic record of my counseling and cannot disclose any of my information unless someone is in immediate danger (obviously nobody is in danger...) I'm so confused and stressed out! Please help me.

Note-I don't really want to call the therapist to ask her about this because obviously that might lead to no good. Because I don't feel I was diagnosed, I am leaning towards just not filling out a form but I'm nervous and wanted to ask you all for your opinion.

[953anon]

Just want to add that I've never been on any kind of medication or had any 'manic episodes'; never done self-harm; never had any hallmark "psychotic" symptoms...I truly think that my therapist was just way off base

[FORTHELOVEOF!!!!]

If you don't think you were diagnosed than you probably weren't. The school can not access your medical records without your consent so don't sweat it, don't fill out the form and get your education. If you feel you need help in the future, please don't let school policies keep you from getting help though. Take care of yourself and good luck in school!

[Stephalump]

I wouldn't bother declaring it. If you haven't been officially diagnosed, going through the process could delay your NS entry for no good reason.

If you find yourself still struggling, definitely continue to see a therapist, but I wouldn't make it an issue with the BON unless you have to.

[BlueDevil,DNP, DNP, RN]

I don't know her qualifications, but she may not be qualified to diagnose, in which case her proffered opinion is meaningless and not reportable for your purposes.

[VivaLasViejas, ASN, RN]

Here's some good news from a nurse who IS bipolar: You have absolutely nothing to worry about.

You do not have a diagnosis of bipolar disorder. All you have is one therapist's opinion that BP is a possibility, nothing more, and that's nobody's business but your own. Believe me, if every nurse/student was forced to declare that s/he had suffered from depression at some point in life, there would be no nurses. :)

I think your coping mechanisms are much healthier than some of the things people do to deal with their depression (e.g., drugs, alcohol, thrill-seeking etc.) Meds are also very helpful to many sufferers, but that's beyond our scope of practice here so you'd have to discuss that with your physician, if you choose to.

Wishing you the best in your nursing career,

Viva

[953anon]

Thank you so much for all of your responses and support. I feel so much better.. I guess I'm just panicking because I unreasonably think this little thing is something that might haunt me when I try to get my license. It's not like the BON will snoop around and research me later or anything (because 1, they wouldn't have/know of any reason to, and 2, they wouldn't have information anyway because of the confidentiality)...right? Just curious though, what would an "official" diagnoses be that would require a declaratory order? Would someone have to go through like a procedural bipolar diagnoses, and would that be on some kind of medical/mental illness record? I guess that's the question I had that started this whole thing.

[VivaLasViejas, ASN, RN]

Unfortunately, a diagnosis of bipolar disorder is one of those that could theoretically make a nurse unsafe to practice, which is why the BON requires disclosure, although I think it depends on the individual state.

Now, I didn't have this dx when I last renewed my RN license, so I'm not happy about having to disclose it when renewal time comes around again next January. (I've probably always been bipolar, but didn't know for sure until this past winter.) But I certainly don't think it's wise to lie; the way things are today, if even the most trivial complaint is raised against a nurse, their work history and personal, financial, and other records may be examined. Conceivably, that could include their health history, so if they 'forgot' to disclose a serious mental illness, it could jeopardize their entire career.

From what I understand, the nurse has to obtain a letter from their psychiatrist or other mental health provider that states they are stable enough to practice safely. Of course, healthcare providers keep a history (or "problem list") on every patient, so any psychiatric dx will be there along with the medical issues.

[953anon]

Just to clarify, vivalasviejas, I wouldn't need to disclose anything/fill out a declaratory order since I haven't really been diagnosed, correct?

[953anon]

(though I've spoken to the school counselor, I have not spoken to anybody else...she is the only person who knows about my depression, etc so I don't think it's on any medical records)

[jadelpn, LPN, EMT-B]

Unless you have signed a consent form for your school counselor to share your medical record, then the BON nor anyone else has the right to know what it contains. A lot of what you describe in your post is pretty typical young adult feelings--away from home, college, difficulty making friends (compounded by the fact you had one main friend for so long). And your ways of coping sound pretty typical as well (books, movies, a job....). Do not let your counseling sessions back in college define you. Don't let your education and knowledge of mental illness make you suggestive to the fact that you perhaps are bipolar. IF your parents said to you "we are concerned" or you couldn't hold a job because of your behavior, then I would have a different take on it. But since none of that seems to be true, don't diagnose yourself, and there would be no need to disclose any of this to the BON as there is nothing to disclose. IF, however, you are finding that you are too sad to function at an appropriate level, or having difficulties of any emotional sort, then I would most definetely enlist the help of your family, and go and see a doctor to rule out any medical cause, and a referral to a mental health specialist. But again, by your post this doesn't seem like it is an issue at all in the present.

[Gold_SJ]

Like Viva said you don't have anything to worry about.

Despite the fact bipolar takes years of mood study to diagnose, a psychological opinion doesn't diagnose the disorder and in my country only a Psychiatrist can make such a diagnosis. You don't need to divulge anything on a declaratory order if it's an opinion/concept/consideration unless it's an official diagnosis. So you can relax a little :)

If you were ever diagnosed with a condition, check your state laws on whether it has to be divulged to the BON. Often bipolar, schizophrenia and other medicated or potentially unpredictable conditions do have to be disclosed.

Personally I think it's things like this that make so many people fearful/stigmatised on mental illness. Especially when it's perceived as a potential career killer (My career is going fantastic). ^.~ But you have to take the good with the bad and when people realise it's more common then they know, I hope mental health disorders eventually will be seen like any other chronic illness. Lol my hope anyway.

All the best to you and hope you feel uplifted and peaceful in the future.