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Should I tell my nursing school about my disorder?

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Hi, I am currently in nursing school with two semesters left (not counting the one I am currently in). I have been diagnosed with Narcolepsy about 4 years ago (before I even started nursing school). I have noticed that due to my disorder, I have been late to clinicals a couple of times (because it is so early and I have such a difficult time waking up). I set my alarm 2 hours before I even have to leave. Yes, I have medication to perk me back up when I am feeling really sleepy. This disorder is also covered by the ADA (American Disabilities Act). The other day, during the post-conference at clinical, I was resting my head against the headrest of the chair, still listening and rocking the chair back and forth, but closing my eyes because I was way sleepy. I noticed the clinical instructor making a point to watch me rest my eyes. I noticed it when I would open them up every couple of seconds. I wasn't falling asleep, but had a strong desire to just shut my eyes. So, after that, I am wondering if I should let my school know that I have this disorder. At first, I was worried that they may inhibit me from doing certain things, but since I have been at their school for almost 2 years, they would be able to look back at my track record and see that I've been doing extremely well, including my grades. So, should I tell my school about my disorder?

Thank you all!

HeartsOpenWide, RN

Specializes in Ante-Intra-Postpartum, Post Gyne.

You should find out if you can practice as a nurse with this disorder. It is about patient safety. How did this not get attention during your entrance physical?

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

We had to fill out paperwork extensively upon being admitted and were REQUIRED to disclose any disorders that could be covered by the ADA at that time, at which time they did a thorough evaluation as to whether the individual is capable of performing the basic functions of a nurse with their disability. The ADA protects people as long as it is physically possible to safely meet job requirements with or without accomodation. Falling asleep from narcoleptic symptoms cannot really be accomodated in most types of nursing. I am curious - did your school not do this kind of evaluation or did you cover it up?

Bottom line is yes, you need to tell them as soon as possible. If you were not honest in the beginning and were given the chance to be, I don't think it is going to go well for you. And if you weren't given the chance but this is a problem that is not adequately treated (and from your description, its not), I also don't think that it is going to go well. I hope I am wrong for your sake, but going by your post alone, it seems rather ominous. Nurses who fall asleep on the job get fired. Students who do the same probably suffer the equivalent fate I think. Talk to them and see if there is a workable solution.

Have a discussion with your physician.

You have a responsibility to manage this disorder. The school won't excuse behaviour like lateness or falling asleep in meetings ... you have to be able to do these things to be a nurse! Let alone stay awake long enough to take care of your patients.

I know what a difficult disorder it is but it's time to see your neurologist and get it under control.

You should find out if you can practice as a nurse with this disorder. It is about patient safety. How did this not get attention during your entrance physical?

Yes, I can practice as a nurse with this disorder and it's not as extreme as some may think. I have never fallen asleep except when I am in bed at night or while taking a nap. I have medication that assists me in staying alert.

We had to fill out paperwork extensively upon being admitted and were REQUIRED to disclose any disorders that could be covered by the ADA at that time, at which time they did a thorough evaluation as to whether the individual is capable of performing the basic functions of a nurse with their disability. The ADA protects people as long as it is physically possible to safely meet job requirements with or without accomodation. Falling asleep from narcoleptic symptoms cannot really be accomodated in most types of nursing. I am curious - did your school not do this kind of evaluation or did you cover it up?

Bottom line is yes, you need to tell them as soon as possible. If you were not honest in the beginning and were given the chance to be, I don't think it is going to go well for you. And if you weren't given the chance but this is a problem that is not adequately treated (and from your description, its not), I also don't think that it is going to go well. I hope I am wrong for your sake, but going by your post alone, it seems rather ominous. Nurses who fall asleep on the job get fired. Students who do the same probably suffer the equivalent fate I think. Talk to them and see if there is a workable solution.

I think most people, when hearing the word "Narcolepsy" automatically assume that all narcoleptics fall asleep unexpectedly. That is not the case for me. Mine is more classified as "Excessive Daytime Sleepiness" as I have never fallen asleep and I also have medication that I take to keep me from getting sleepy. There was no "physical entrance" exam of the like when I entered nursing school, so there was nothing to disclose.

You have a responsibility to manage this disorder. The school won't excuse behaviour like lateness or falling asleep in meetings ... you have to be able to do these things to be a nurse! Let alone stay awake long enough to take care of your patients.

I know what a difficult disorder it is but it's time to see your neurologist and get it under control.

Narcolepsy, or Excessive Daytime Sleepiness, is harder to "get under control" then most would think. I did not "fall asleep" during the meeting, I only shut my eyes to rest them. I was still swiveling my chair back and forth as to show that I was not asleep. All of us at the end of clinicals are extremely exhausted. Like I said in my other responses, I do have medication I take to defeat my sleepiness. Currently, my clinical instructor doesn't allow us to take lunch, so our days are an hour shorter. With this disorder, I could really use a break. How would diabetics do without eating prior to getting their insulin injection or to prevent hypoglycemia? I bet they get coverage to have a break so to eat. Any ideas?

Narcolepsy, or Excessive Daytime Sleepiness, is harder to "get under control" then most would think. I did not "fall asleep" during the meeting, I only shut my eyes to rest them. I was still swiveling my chair back and forth as to show that I was not asleep. All of us at the end of clinicals are extremely exhausted. Like I said in my other responses, I do have medication I take to defeat my sleepiness. Currently, my clinical instructor doesn't allow us to take lunch, so our days are an hour shorter. With this disorder, I could really use a break. How would diabetics do without eating prior to getting their insulin injection or to prevent hypoglycemia? I bet they get coverage to have a break so to eat. Any ideas?

I know exactly how hard it is to control ... I also know how quickly the closed eyes spiral out of control. If you are at the point where you feel the need to close your eyes, well, you aren't managing. If you weren't sleepy then you were just being rude? I don't think that's the situation here though.

Here's what I do: Sleep hygiene. Go to bed at the same time every night. Don't do anything in bed besides sleep. No caffeine after about 4 pm (yes hours and hours before bed). Get up at the same time every morning, even if I don't have to. Take provigil religiously. I have to take it every single day at around the same time, no skipping doses. Don't drink alcohol cause it makes me a hot mess w/ the provigil.

Realistically, you aren't going to get a nap time break in the hospital. Yea it feels good (great) but it's not realistic to your setting right now. So don't get into the habit of taking afternoon naps when your job/school won't support it. It just messes with your brain and causes you pain. It takes awhile but you CAN train yourself off of the daytime napping (helps the nighttime sleep too).

You are training for a job in which you assume responsibility for people's lives. You cannot be falling asleep on the job. Period.

If you get in trouble for sleepiness, and tell your school that you are narcoleptic, you know what's going to happen? They'll hit the roof. Not because you are narcoleptic, but because it's uncontrolled and they therefore can't trust you with patient care. For your own sake you have to get ahead of the problem.

I know exactly how hard it is to control ... I also know how quickly the closed eyes spiral out of control. If you are at the point where you feel the need to close your eyes, well, you aren't managing. If you weren't sleepy then you were just being rude? I don't think that's the situation here though.

Here's what I do: Sleep hygiene. Go to bed at the same time every night. Don't do anything in bed besides sleep. No caffeine after about 4 pm (yes hours and hours before bed). Get up at the same time every morning, even if I don't have to. Take provigil religiously. I have to take it every single day at around the same time, no skipping doses. Don't drink alcohol cause it makes me a hot mess w/ the provigil.

Realistically, you aren't going to get a nap time break in the hospital. Yea it feels good (great) but it's not realistic to your setting right now. So don't get into the habit of taking afternoon naps when your job/school won't support it. It just messes with your brain and causes you pain. It takes awhile but you CAN train yourself off of the daytime napping (helps the nighttime sleep too).

You are training for a job in which you assume responsibility for people's lives. You cannot be falling asleep on the job. Period.

If you get in trouble for sleepiness, and tell your school that you are narcoleptic, you know what's going to happen? They'll hit the roof. Not because you are narcoleptic, but because it's uncontrolled and they therefore can't trust you with patient care. For your own sake you have to get ahead of the problem.

Thank you Coast2Coast,

I completely understand how the "closed eyes" can quickly spring out of control. I'll also take your advice on training myself not to take naps. The issue I have is that I only have two clinical days. Those days I get up at 4am. There is no way I am going to wake up at 4am all the other days, especially since I do all my studying and homework in the evenings after my children are in bed. So, that's going to be rather difficult (having a consistent sleep hygiene), and that's also why I have such difficulties with clinicals that are so early. I am a night owl and always have been. A night shift would be my ideal shift once I get my license. It's just these early morning clinicals that are rather difficult to work through.

How long have you had Narcolepsy?

In addition, I don't take Provigil every morning, I have been advised to only take it when I need it. I metabolize medications extremely fast, which means 50 mg is all I need to give me about 4-5 hours of "awake", I then have to take another 50 mg just before that one wears off. If I take a higher dose, then I feel as though I am "floating" or "dreaming". So, thae 50 mg has been working for me. At times, if I can't wait for the medicine to kick in, I will grab a soda that gives me a quick boost until the Provigil kicks in (but the soda is extremely short-lived). I also have learned that if I take the Provigil around the time I have eaten, the medicine has no effect on me. So, it's a bit tricky. It's best if I take it on an empty stomach. The 50 mg may appear to be extremely small, but between my dr and I, we have been trying different meds and dosages for about 3 years when we discovered that I am extremely sensitive to medication, hence metabolizing them rather quickly, and finding out the 50 mg is my dose (100 mg pill split in half).

So, you don't think my nursing school should know about my disorder, as long as it's managed?

Thank you again!!!

the early mornings aren't hard for me in the morning, but when I get home at 4 or 5 i'm usually staggering around like a drunk. I just try to keep myself awake, clean my apartment - anything to put off bedtime til at least 9 or 10. the best i can do is at least keep my bedtimes early so the few early mornings aren't such a shock to the system.

i've known i was narcoleptic since high school but only got official diagnosis/sleep testing/provigil about 3 years ago. going to a neurologist and going through that process was a total lifesaver for me !

I'm surprised to hear about your provigil regimen. From my understanding it's not supposed to be a short-acting drug (like ritalin or caffeine). it definitely gives me a little boost in the morning (at 100mg) . it doesn't feel like a buzz or a high but it does wake me up. after that, i'm up all day without experiencing sleep attacks.

I think the greatest benefit of the provigil has been regulating my night-time sleep - since taking it, i feel much better when i wake up in the morning and have an easier time getting up. i have to take it every single day to get this effect though - if i skip one or two days i'm back to falling asleep without warning and sleeping through alarms.

it definitely makes me metabolize other things faster. like alcohol. oh boy was that a surprise, the first time i ended up reeling drunk at a work function at 5 pm because i'd had half a bud light.

caffeine has never done anything to fend off my sleep attacks ... i once burned myself cause i fell asleep holding a cup of coffee. lesson learned :)

i would say from the symptoms in your first post, your current regimen isn't adequate and it might be time to go back to the Dr. and tweak it a bit. obviously i can't give you advice about what to do, other than to say go back to the Dr. If your PCP has been managing this, go to a legitimate sleep doc (usually a neurologist). they are WAY more knowledgeable about narcolepsy management.

Do a bit of googling about sleep hygiene. It really has made a huge difference for me and it requires no drugs and no docs.

As for the school bit - I just don't think telling your school is going to solve the problems, and would probably create more. Right now it's a matter of managing your personal health, which the school can't do for you. All they can do is react when they see a student falling asleep in clinicals.

Good luck !

decembergrad2011, BSN, RN

Specializes in Oncology. Has 12 years experience.

Personally, and this is just me, but I would tell them if it's affecting your performance and you are getting in trouble for it. Like you said, your clinical instructor saw you closing your eyes and was noting it - it's possible that it might come up in your clinical evaluation.

I have generalized anxiety, and have discussed the issue with clinical instructors in the past when it's been a problem. In med-surg, with 12 hour clinicals, I would get so overwhelmed and freaked out that sometimes I literally needed to leave the floor for a few minutes and splash some water on my face and calm down so I could provide safe patient care. My clinical instructor was a lot more understanding of my need to do this since she knew what was going on. However, I've had clinical sites where the anxiety hasn't been an issue, and there was no need to bring it up to my instructors because it wasn't affecting my performance.

I disagree with not allowing a lunch during a long clinical, so if your clinicals are over 6 hours and you're not getting even a break, that seems very unfair to me. Even with my 5 hour clinicals my first semester, we were given a short break in order to get a snack and rest our feet. And even if people say "Oh in the real world blah blah blah"...I really feel like it's just not a good comparison. We're still students. We're still learning. And when it comes down to it, there should still be a nurse responsible for your patient while you're in school, and they shouldn't be dropping the ball completely just because you are there. If you are letting him/her know when you leave the floor, there shouldn't be a problem at all with you taking a short break for yourself. Naps are probably out of the question, but 15 minutes to pee, eat a banana, and check your phone is allowed on every floor I've ever seen even in the real world.

I would say it would be in your best interest to disclose this information. Since they are unaware, all they will see is some lazy student falling asleep in meetings, instead of someone with a real disorder. They need to know so they can do what they need to help you, and if that means you take a break(which you should be allowed to do whether or not you have a disorder ), then so be it.

I remember I told my instructor I have hypothyroidism and have to take medication for it. I don't know if it made any difference, but it just came up. Explained why I'm so tired all the time, as well.

I wonder if I could have narcolepsy. I have always had trouble staying awake, especially during classes. I have tried everything, but I am always falling asleep during lectures, especially long ones. I even did this as a high schooler. One of my instructors even joked about me nodding off in class, so now I am worried because I don't want them to think I am being rude.

Hancock330

Specializes in Medical-Surgical - Care of adults.

By all means tell your program. And continue to work with your physician (hopefully a sleep specialist -- mine is also a neurologist) to assure you're trying all of the combinations of medication and sleep hygiene to maintain daytime wakefulness. I don't know what the difference is between the formula for Provigil and the new drug from the same company (I think) that is called something like Nuvigil but that may be worth exploring. I suffered with excessive daytime sleepiness for decades before I was diagnosed -- but Provigil works well for me. I do recommend that you try taking it every day for a few weeks -- and I mean, 7 days a week -- unless your physician and you have determined that this is not advantageous for you. I think that taking it every day on a schedule that keeps you awake and alert for an appropriate number of hours may improve your sleep quality and therefore make it easier for you to stay awake when you really need to, like during conferences and classes. I'm going to assume that you've had a formal sleep study done. If you haven't, by all means have one done. If you have undiagnosed sleep apnea you need treatment for that too. Good luck with it all.

In my opinion based on long experience, NO. You have so little left, do what you have to to finish. That ls all you have to do. At this point you are not looking for stellar, excellence, etc You want to finsh. You have already proven yourself as far as quality of your work. Finish this and then fine tune what you have to do be able to practice like you want. Don't let other's discourage you at all. Nursing is very broad in what you can do with it. Nursing school is very different from the typical schools and can be very political and very unforgiving. I would not at all divulge this unless you can go to disability services, go through their entire process and get their protection. Even then you are not fully protected. The commitee that will meet to put their thumb print on those graduating may not feel comfortable graduating you as you will represent them. Too much in nursing is subjective and requires no proof. We have to change that but not in your two semesters. They definitely will not understand it as fully as they should for your sake. Think long and hard before you divulge this with so little left. Barinbass

TNCC RN Guy

Specializes in Peds and adult ED, trauma. Has 2 years experience.

Ditto for Provigil. I wouldn't mention it unless there was a compelling reason to, i.e. program policy or a potential affect on your performance issue. While the is an issue of "reasonable accommodation" for those with disabilities, you have an obligation to minimize the potential problems with lifestyle modification, meds, etc.