Not sure about bipolar and declaratory order for Board of Nursing

Nurses Disabilities

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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.

Specializes in psych, addictions, hospice, education.

I think your ways of improving your mood are soooo healthy! Kudos on that.

As long as you aren't dangerous to self or others and are able to take care of yourself, you records are totally confidential, at least if you're in the US.

Something to consider, but it doesn't take away from the confidentiality factor: Sometimes a diagnosis is discussed in a session with a therapist and client, and the therapist doesn't necessarily state that the diagnosis is being attached to the client. But, it shows up on paperwork. When there's a session, the therapist has to state a diagnosis in order for billing to be possible. I'm saying you may not know you've been given a diagnosis, because your therapist might not have told you directly. Again, this doesn't take away any part of the required confidentiality...

Specializes in LTC, assisted living, med-surg, psych.
Just to clarify, vivalasviejas, I wouldn't need to disclose anything/fill out a declaratory order since I haven't really been diagnosed, correct?

Other posters have covered this very well, so I hope you're reassured that you really have nothing to disclose. :) Believe me, there's a world of difference between a therapist raising the question of bipolar disorder and a psychiatrist pronouncing that diagnosis and entering it in your medical record.

And, FWIW, while I'm certainly not a doctor, nothing you've posted here sounds like BP to me. Not all mood swings are bipolar, and not all bipolar is about the mood swings......in fact, they're only a part of a very complex syndrome that can include (but isn't limited to) sleep disturbances, paranoia, delusional thinking, substance abuse, anxiety, even psychosis and suicidal ideation.

Whatever you do, don't borrow trouble by trying to diagnose yourself and ruminating endlessly on all the possibilities. That's not healthy. If you just can't let it go, please get another opinion from a psych nurse practitioner or psychiatrist---preferably someone who can prescribe for you if the depression persists. Good luck!

Thank you all so much. I realized that I'm just extremely conscientious when it comes to this matter---I just don't want anybody, especially the BON, to think I'm hiding anything. You have all reassured me that I have nothing to hide and that bipolar was merely a possibility when symptoms of depression and mood swings came up. I suppose my knowledge of psychology made me try to self-diagnose, which as Viva pointed out, is not healthy. I've been doing so well the past few months (since the session I posted about), free of any emotional problems, and when I saw the word bipolar on the declaratory paperwork I guess I just felt like my past problems were coming back to haunt me. I know better now and I will not be disclosing anything. Thank you again. :)

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.

Stop doing that and start soul searching to highlight what is RIGHT about you :)

You sound like you're in the throws of the "pre-school panic mode". I went through this majorly (um and I kinda still am lol). Analyzed and dissected every word of my application materials and criteria and found a way for everything to become a stumbling block. My friends are doing this also, we're all a total mess about every little detail of our past life as it relates to nursing school until we have a moment of clarity and realize we're freaking over nothing.

You are not alone in this panic-mode...would just like you to know that :)

I am filling out necessary paperwork/orientation stuff and noticed something regarding being diagnosed with schizophrenia, bipolar disorder, etc under declaratory orders.

She didn't say that I was bipolar.

So we openly discussed bipolar, but the session did not result in an official diagnoses.

My question is if this wishy-washy discussion about bipolar would be considered a "diagnoses of bipolar" that would require a declaratory order.

If you were not actually diagnosed as having bipolar disorder then you do not have to fill out the declaration stating you were. If the person you spoke with truly believed you needed follow up with the psych dept NP they would have referred you and possibly followed up, telling you to call the psych dept if you want to talk to them is not a referral.

kids, to clarify, she did give me a phone number to call for the psychiatric department and told me to request an appointment with a psych NP. I asked her why, and she said I could speak to the nurse practitioner about my symptoms, giving her an entire overview of my feelings and things that have been going on with me (basically tell the NP what I told her), and the NP would be able to determine if medication was necessary. I openly discussed my doubts and fears about medication and I also openly told my therapist that it was possible that all of this "bipolar" stuff was just in my head since I did so much reading on it. I also told her I did not believe I was bipolar, I was just depressed and going through hard times (with loneliness, losing my friend, etc). She said that scheduling an appointment with the NP was entirely up to me and emphasized that the NP would be able to identify all of my symptoms when I spoke to her (which I found strange, since my therapist is a licensed psychologist). She told me that the NP might decide that medication would be unnecessary and that I just needed to do some more cognitive therapy, and that I could discuss that at the appointment if I decided to go. We ended that one session with her writing down the phone number for that department, leaving the decision up to me if I wanted to go. My interpretation of this was that she suspected bipolar as a mere possibility, and that the recommendation to see the NP was to let the NP decide about diagnoses. Does anybody interpret this the same way? She called me about a week later and left me a voicemail to see what I wanted to do for treatment and if I wanted to do any follow up with her and I did not respond (again, because I was very apprehensive about the whole bipolar thing).

Specializes in ICU, OR, LTC, Utilization Management.

I would be super-careful about disclosing Bipolar Disorder to the BON, depending on your state of course. In a prior state, I disclosed and got thrown into their "diversion" program, simply because I was Bipolar. I spent 6 years going to Caduceus meetings, getting randomly urine tested, and it was a general nightmare. I made sure when I took this job, in a new state, that I wouldn't have to disclose my mental illness (gawd, I hate that term!). My state application stated "any mental illness that interferes with your practice" or something like that. It doesn't interfere, therefore, I didn't disclose.

Food for thought.

Specializes in LTC, assisted living, med-surg, psych.

Wow.......so how did that state's BON justify putting you in a diversion program for being bipolar??! Sure, many BPers have substance-abuse issues along with the illness, but nobody should 'assume' that and force a nurse into a program that's for addicts and alcoholics. So sorry you had that experience.

:down:

I'm coming up on renewing both my nursing license and drivers license this winter, and having picked up this diagnosis since my last renewal, I'm a bit concerned about the hassle. Both applications have questions about mental illness, and I want to answer "No" because I don't feel mine makes me unsafe, either to be a nurse or to drive a car. Guess I'll cross that bridge when I come to it.

:down:

I'm coming up on renewing both my nursing license and drivers license this winter, and having picked up this diagnosis since my last renewal, I'm a bit concerned about the hassle. Both applications have questions about mental illness, and I want to answer "No" because I don't feel mine makes me unsafe, either to be a nurse or to drive a car. Guess I'll cross that bridge when I come to it.

This is so stupid to me that you have to even have to prepare for a hassle. As if being diagnosed with bipolar disorder somehow now affects your ability to practice, especially since its likely you had bipolar disorder already ....An undiagnosed individual gets to skate by but someone who is taking care of themselves has to potentially deal with a bunch o bullcrap. Jerks.

Specializes in LTC, assisted living, med-surg, psych.

Yeah......that's kind of what I think, too. :rolleyes:

This is why I am scared I will never get my license. I disclosed to the BoN because the way I read the question was if you have a mental illness, you have to disclose because of the possibility of becoming unstable. So, I did. It took three weeks just for the BoN to acknowledge receiving the letter from my provider and that was after calling multiple times. Now, I am still waiting on a decision. I don't have a criminal record, had a stellar school record (good GPA, attendance, etc.) and I volunteer a lot where I live, etc. Nonetheless, I am terrified that I will be treated like a criminal. No offense to anyone who this applies to; but I don't understand how people who have had a drug possession, criminal record, etc. can get their license without a hitch and a person with a dx in the mental health realm gets hassled.

I have no problem disclosing; but I am afraid the BoN will make a decision based on the what-ifs or diagnosis alone instead of what I have actually accomplished and the fact I was up front and honest about it. Plus, my provider wrote a generic letter even after my request for him to change it to fit me as they need to know the dx, tx, prognosis, and if I am fit to practice. It made me sound like a horrible person because it was a description of the condition, possible txs, and possible prognosis. Some of the drugs mentioned that could possibly be used to treat the condition, I was never even prescribed (neuroleptics). My provider told me he didn't think I wanted to be a nurse because I want to work in public health instead of a hospital and work my way up to working for a federal gov. agency. These doctors don't understand what is within the world of nursing and therefore, in my opinion, are poor judges to be able to influence such an important decision. I just want to be a public health nurse more than anything. It hurts so much to see my classmates getting their licenses and I am still waiting on a decision.

Has anyone else disclosed and how long did it take for the board to reach a decision?

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