1st nursing job, Do I disclose condition?

Editorial Team / Admin · Apr 3, 2015

First, I would not take the word of a friend as absolute truth. While the friend may be getting 8 hours of PTO every two weeks, what is the accrual rate for a new hire? Many facilities will have a step approach to granting amounts of PTO based on years with the organization- I took me about 7 years before I accrued a full 8 hours per two week pay period.

Second, what is the policy of using PTO during the orientation program? Some facilities may restrict the use of PTO during probationary periods. Also, at what point would you actually have PTO to use? It does take time to build it up, especially if new hires start out at a rate that accrues less than 8 hours per two week pay period.

Third, it would depend on the environment of the unit as to whether I'd approach the manager. Is it a supportive environment that would be willing to work with you, such as allowing you to leave early or take a longer break than usual to get the treatment? I work in such an environment where my manager will allow people to come in late or leave early for appointments, especially those of a critical nature or those that don't offer non-working hour appointments.

If offered the position, is there a way to time your treatment so that you get one right before starting orientation, thus holding off for the maximum amount of time before needing time off for another treatment?

GuEsT78 · Apr 4, 2015

Rose_Queen make a joke about being "batty," but she's full of good sense.

She is right. Some job benefits don't start immediately. They may take time to kick in at all and accumulate slowly for the first few years. Increasing benefits with time employed is one way that companies keep workers around. Call the hospital's HR department to find out what will be true for you when you start. Ask precisely the questions you need answered.

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I'd add a comment from personal experience. A friend took a demanding, full-time, front-desk job at a community center. She desperately wanted the job despite having serious health issues such as asthma and constant illnesses. She was getting sick almost weekly. They were very patient, but eventually they had to let her go.

I suspected that her constant sickness was due to a vitamin D deficiency. She fit the pattern perfectly. She's dark-skinned, living in drizzly Seattle, and working indoors. It took me a year-and-a-half of nagging to get her to see a doctor about that. Her serum vitamin D wasn't merely low, it was dangerously so. Unfortunately, while her health has now improved greatly, she's having trouble finding a full-time job. Her former constant sicknesses haunt her attempts to find another full-time job. Employers are afraid to take a chance on her.

If your CRPS really is under control, then that doesn't apply to you. But if it isn't, if you're going to be calling in sick, be aware of the risk you're taking. You're implicitly promising them a healthy worker. If you can't deliver that, it could adversely affect your ability to hang on to that job or to get other jobs. I hate to be that blunt. But I do have that friend who, although she is intelligent, hard-working and responsible, has been out of full-time employment for about two years. I'd hate to see that happen to you.

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What would I do if I were you? This is your dream job and you're getting it just out of school. I'd say go for it and do whatever it takes to make it work.

Use all your experience with CRPS and all the discipline you can muster to keep your health up and make sure you succeed at that job. Do good work, and after perhaps a couple of years they'll not want to see you go even if you do go through a bad patch with that CRPS.

Be tough too. If there's a bout of pain, endure it as much as possible to stay on the job. And I do know how bad that can be. I had sciatica really bad about three years ago while juggling multiple part-time jobs. I gritted my teeth and did the work anyway to make sure I kept those jobs. I hated it, but I hated the loss of income more.

I'm sure your manager will eventually find out about your CRPS. You can't hide a medical condition from medical people. But let her and those you work with do so in a context where they have seen that you can do the work and do it well. Do that, and it will be a non-issue.

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Best of luck at this dream job. I'm one of those who believes that pediatrics is the best kind of nursing there is. I worked in pediatric oncology and, growing tired of hearing nurse friends who said, "Oh, I could never do that," I wrote My Nights with Leukemia to say "Yes you could and you might just love itâ€”sadness, tragedy and all." Some of the children I cared for are now adults living full and healthy lives.

The same is true of pediatric surgery. It can totally transform a child's life for the better. If you need inspiration, go to Youtube and search for "Operation Smile." I especially I like this one:

Watch for the point where that little girl sees her new face for the first time. That's what you will be doing. There is also a sequel:

--Michael W. Perry

Graduatenurse14 · Apr 6, 2015

I get a ketamine treatment once a month and everything is good in the world. The position I will get getting is 11a-2330p but I will be on orientation from 7a-1530p five days a week for almost a year. Which leaves me no time to get my treatment..

Can you go to a different pain management doc who has different weekday hours/open 1 weekend a month or receive infusions at home?

If none of those options will work, I would check the out the PTO policy then talk to your new boss about it.

Good luck!

NurseGirl525, ASN, RN · Apr 6, 2015

Talk to your physician and see what you can do. I would not disclose my health issues. One of mine is fibro. I have it pretty much under control. Pain once in a while but nothing I couldn't endure on the job. Management is not very receptive to people who have health issues. They usually do not want to deal with someone who may or may not call off. Some physicians may be able to see you on your lunch, or do something early for you. I would just explain the situation to them.

allnurses Guide · Apr 6, 2015

If there is any chance that the Ketamine may show up in your urine in a random test I would disclose. Most job applications ask if you have a physical disability and if you can do the job with "Reasonable Accommodation. I would think a day off once a month is perfectly reasonable. It would be better for your employer to know rather than have a dirty test and be reported to the board. You might want to have a conversation with your Unit manager and explain the nature of your condition, the treatment you are receiving and the name of your pain mamangement specialist.

Just a thought.

Hppy

Cricket183, BSN, RN · Apr 6, 2015

It's a tough call when deciding whether or not to disclose.

I too have CRPS. I was working as a RN when I was diagnosed in Nov. 2006. It started in my neck, right arm & shoulder. Initially, I chose not to disclose. There were a lot of reasons I chose not to disclose but the biggest one was denial on my part. I was really at a sweet spot in my career. I was working as the charge nurse on a busy, inpatient oncology unit and had just recieved my OCN. I was 38 and just didn't want to accept that I had CRPS/RSD.

However, when it became necessary for me to file FMLA paperwork and then go on short-term disability to have a spinal cord stimulator implanted, I had to disclose to HR & Employee Health. By that time my Manager & co-workers already knew anyway. They had started asking questions when I suddenly started doing everything left-handed (except writing) and I couldn't hide the amount of pain I was in even though I tried. I continued to work until March 2008 when my SCS stopped being effective and my RSD spread to my entire upper body and started affecting my heart (SVT & tachycardia) and stomach (gastroparesis). At that point, unfortunately, I had to go on disability.

I started ketamine infusions about 15 months ago and have had great results. I am off the high dose daily narcotics that for years were the only treatment available. In June I am taking a nurse refresher course (my license is currently on inactive status) and hope to return to nursing by the fall.

I have decided that I am going to probably have to disclose when I return to work. My ketamine infusion schedule is for four days in a row every 4-6 weeks. Even though I will probably only work part time or per diem, I don't know of many hiring managers who will work with that schedule without me disclosing. (Not sure if any will even with me disclosing!)

As far as whether you decide to disclose or not that is a personal choice. What was your impression of the hiring manager? Does she seem fair? Understanding? If so, then I personally would disclose. Your CRPS is under good control. The last thing you want is to be a new employee with a reputation of taking frequent PTO/sick days with no explanation. It might give your manager (and co workers) a very wrong impression of you. On the otherhand, if you didn't get the impression your manager would be understanding than I would not disclose at this point. Although it has not been my personal experience, nursing can be a very cut-throat world. The last thing you want to do is give anyone a reason to get rid of you. And while technically you can't be fired because of a disability, you might be surprised how closely you can be watched and if every t isn't crossed or every i isn't dotted.....especially if you are in an "at will" state.

I'm not sure I helped you at all. í ½í¸”

Loxam10 · Apr 7, 2015

Thank you all for your replies.

Rose Queen - I am not positive of all the specifics for PTO. I do know what my friend is only in her 8th month of orientation and has been getting and has used some of her PTO. I will find out more of the specifics when I talk to HR this week. Depending on when orientation would start I should be able to get my ketamine infusion right before, at least that's my hope. As far as the environment.. I'm not sure. They seemed like an understanding group of people but the manager was a little hard to read.

InklingBooks- thank you for the encouragement. The YouTube videos touched my heart. I know what a lot of these kids are going thru and I want to be there for them like I had people for me.

Graduatenurse14- unfortunately my doc is the only one that does them in my area. He is one of only three places in Ohio that offers this treatment.

Heathermaizey- that's what I am afraid of. My last two semesters in nursing school I had a clinical instructor who found out and made my life miserable. She basically told me I was wasting my time and I would never make it as a nurse. I think I am gun shy about talking to management because of it. You would think people in the medical field would understand people having medical conditions but unfortunately not .

Hppygr8ful -as far as I know ketamine would not show up on the drug test. I plan on asking my doc when I see him next week. (Hopefully before I do the pre-employment testing). If it will show up I will have no other option but to explain.

Cricket183 - it is nice to know that I am not alone in this. I too had a spinal cord stimulator but had it removed within a year after the leads malfunctioned. I am so glad the ketamine treatments have been helping you. They have been a miracle for me. I get one large bolus dose one day a month. I wish you luck this fall and hope the ketamine continues to work for you.

I really appreciate everyone's response and advice. I plan on talking to my pain doc next Tuesday about it but it seems like I would be better off disclosing (and letting them know its under control) then not disclosing and them finding out later and think I tried to cover it up. Now I just need to figure out when to disclose, during pre-employment testing or after I am hired?

Ddestiny, BSN, RN · Apr 7, 2015

Would this position be eligible for FMLA? The physician I work for has several patients that use FMLA longterm in situations where they may need a few days off here and there due to flare-ups in chronic issues (major back pain, migraines, debilitating anxiety, etc). This paperwork always asks about potentially needing time off due to treatments or medical follow up. It may require an appt with your physician every 6 months or so but it might be worthwhile if it saves your position.

Editorial Team / Admin · Apr 7, 2015

FMLA is not an option until the one year employment milestone is reached.

Mavrick, BSN, RN · Apr 7, 2015

WOW! What kind of job did you get that comes with a year of orientation. I am familiar with an orientation that implies you are working very closely with an experienced nurse and not actually a part of the staffing matrix. During this time you are on probation and subject to dismissal for any/every reason. PTO may accrue but cannot be used until you are at least off probation or 6 months (check your facility's policy).

It's a shame though that you couldn't leave early on some day, say 2:00 or so and get to your Dr's. office before they close. Bummer.

BeachsideRN, ASN · Apr 7, 2015

Even if ketamine does show up on a drug screen you do not need to disclose to your employer. Drug screens are monitored off site and if something pops positive the medical review officer will notify you and you have a period of time (usually 48-72 hours) to send them proof of a valid Rx from the pharmacy or physician at which point the MRO will mark the screen as negative since you have a valid RX.