What can they do?

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I'm a nurse with 20+ years of experience. I have worked at the same home health job for more than 10 years. In that 10 years I once was out of work for 2 months because of my Bipolar disease. I had been hospitalized with a lot of med changes, and my PsycMD felt I was too "manic" to perform patient care, not sleeping enough to be effective on the job, and she took me out of work. FMLA, nobody ever said a word about it. Fast forward 5 years and I got sick again, went through a lot of med changes, and had to be out of work for a few weeks on FMLA again. I seldom have to be out of work and never do I just call out unless I'm extremely sick. I am on a SLEW of medications, but I'm a darn good nurse. If I am not "medicated" I can't work. I can't function. I take meds for ADD each morning before I walk out the door to go to work, I take antipsychotics, sleep aids and PRN anxiety meds every night before I go to bed. I have to keep myself healthy and take my medications in order to perform my job. They have have NEVER questioned my nursing skills, judgement etc. I used to be known at work for having a bad attitude and after some med changes I can see that they were probably correct. I never really discuss my illness with my co-workers or my managers. But a few months ago, I got called in by my young, power hungry supervisor. This is what happened. I got called to go out at midnight to go do a vac dressing change. We have an evening nurse that works 3-11 for these types of things but for some reason that night he did not answer his phone, so after trying to get him on the phone for 2 hours the triage nurse finally called me stating she was sorry but someone had to go. Our policy is that the patietn put a wet to dry dressing (with verbal prompting of the triage nurse) on the wound and wait for a nurse to come the next day to reapply the dressing. However, the primary nurse did not leave the patient with any wet to dry dressing supplies, so I had to go out. I had not taken my slew of "bed/head meds" yet, so I went out. It was a 45 minute drive to the patient house, an hour visit after documentation and 45 minutes to drive back home. Now it's 3AM and I have to take meds. At that time I realized I would not be able to function the next day safely, starting my day at 7am, after just taking meds 3-4 hours prior. So I left a very detailed email about the patients that would have to be restaffed the next day, and called my manager and left a message on her voice mail that I could not work that following day. She called me into her office to have a meeting with me stating she felt I called out the following day to "punish them for me having to go out late at night." I was furious. I just said to her, "Honey, you are sitting across the desk from a bipolar/ADD person that has to take medications to function, and after taking said medications late, due to work, it was not safe for me to get out and drive let alone see patients. And I'm a old nurse that does not have time to play tit for tat games" Now I take call about one night every two weeks, and because we have evening nurses it is seldom that we do get called out at night, if I do get called out late, after I've taken my "bed/head meds" I always ask my room-mate to drive me and I try to do the best that I can. I've never even thought about asking if I could be taken off the call rotation because of my disease. I just suck it up and do the best that I can. Our health insurance company requires employees to do a slew of blood work yearly and fill out health and physical forms. I waive that requirement and pay an extra $25 per pay period for "unhealthy premiums". I don't think they have any business having my health info. I have never divulged to my company exactly what medications I am on, or much about my disease, until that day.

That has been a few months and I've had no reprocussions from this. But I really did not want to tell this power hungry young manager that I have an illness. Being a "full time nurse and taking part in the on call rotation" in mandatory if you want to keep health insurance benefits. If I don't have health insurance I'd probably have to be institutionalized. I, after all these years of being a nurse never realized that they can consider you as being under the influence if you are required to take these meds to manage your disease. It is just what I have to do to funtion and be healthy.

What can they do to me? What should I be doing? Should I ask to be taken off the on call rotation because I have an illness and have to take meds? I really have never had a problem until this incident. I read some about the employees wtih disabilities act last night. I honestly never considered myself as having a "disability"... I function quite well ON my medications, it's only when I don't take them that I get sick. Is taking these meds (adderall, xanax, seroquel, ambien) really working under the influence? I really don't want to be treated any differently than other employees.

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The only med I see that is label to treat bi-polar is Seroquel if I am not mistaken, I am not a nurse but a EMT, so please educate me if I am wrong. Tney are probably talking about xanax and ambien and Adderall, because it is almost like your taken downers at bedtime, the uppers in the AM when those arent really used to treat bi-polar. I know if I took xanax and ambien at the same time, I would be OUT of commission for a week. Maybe you can talk to your doctor about not taking xanax just the ambien and adderall because you don't mention you having anxiety issues. I can see where they can say you are impaired to be honest. This is coming from someone who has ADD/Anxiety/Chronic Pain. I know the stigma, and I feel for your situation and hope it works out for you to what is best for you!!

God Bless,

Jenn

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I have been treated for BiPolar for many years, and have been on and off so many meds that it makes me sound like a pharmacy if I'd list them all. Some meds with terrible side effects then I'd have to take other meds to combat the side effects. Xanax is for severe anxiety/panic disorder. I take it PRN for that reason, and the Adderall is for ADD that I have had for more than 8 years...(YES I guess I'm a psych nightmare). But I do function pretty well most of the time. the Ambien is used to put me to sleep after the Adderall has done it's job for the day. Otherwise I'd be awake 24/7. I have to be careful to not go too many nights without sleep, or I become manic. But if I don't take the Adderall for ADD then I can't function either, I'm constantly losing stuff, racing thoughs, can't complete a sentence and can't teach my patients.

I have never discussed this med regime/or my issues with my employer. However, I do know when I can't work. I could not work the day after being out until 3am doing wound care for sn on call patient, then take meds and be expected to be up and out the door by 7 am the next day. My boss was being pushy so I just told her the truth. She's a younger nurse with lots of letters behind her name and she is power hungry. I'm just afraid that she will try to use this somehow against me. Maybe I'm being paranoid. But I've been on some sort of med regime for bipolar and ADD for many years and nothing has ever been said, no complaints about my work etc. As a matter of fact I've been told I'm an "exceptional employee" and always have gotten above average evaluations in the 13 years I've been employeed there.

I just do not understand the laws, I've read on some of these disability threads that the BON considers you to be "under the influence" if you take these kinds of meds and work. I can tell you from years of experience that if I did not take my medications that is when I would be too "impaired to work". I can't take care of a patient if I feel my heart is pounding out of my chest, I'm sweating profusely, and feel like I may pass out from anxiety, I can't take care of my patient if my thoughts are racing, I can't complete a thought, keep up with my pen, find my car keys, lose my jacket from ADD, and I can't take care of my patient if I am so depressed I can't get out of bed and life is so dark and dreary that I can't even bathe myself or eat from depression, And lastly I can't take care of my patent if I've been awake for days and not sleeping because the adderall has kept me awake OR mania has set in from the other spectrum of bipolar. I have found a balance in my life with these medications and I am really grateful that I have my life back and that I can function.

What to people do that have to take these kinds of meds to function? Is it considered being under the influence by the BON, what are my rights as far and the EEOC is concerned? I've tried looking that stuff up, and reading about it as much as possible, but it is so "general" that I can't interpret what they are saying...maybe it's meant to be like that so you would have to be evaluated on a case by case basis if something did happen. I don't know...

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Specializes in med/surg, home health.

Yes... We live in a different age. 10 years ago, your business was your business. Not anymore. I am going through something similar although it's a different condition. I am being denied employment because I take meds. I have worked for many years without issue. Employers do have to make accomadation for "disabilities" but that does not include letting you work "under the influence" of what they consider mind altering medications, legally prescribed or not - in direct patient care. They might make you see an occupational health specialist. I'm sorry you told your boss about the medications. You should have said, and should say, (in my opinion) if it happens again - "I just didn't get enough rest to feel I can give patient care safely today." Or ask if you can go in a bit later when rested. In the nurses with disabilities section there is a thread written by someone with ADHD who is being investigated after a patient complaint now because of her ADHD.. You might want to get a release from your doctor saying that you ok to work as a nurse. I think each case is different, but employers are more concerned with liability. If you were to lose your position, It may be very difficult to find a new one, what with drug testing and all. I had a drug screen, they put down "negative" after verifying my scripts but still recommended a "fit for duty" test. The FFD test was done at the same facility that did the drug screen, so no way to hide anything. It seems very unfair to me, when a nurse has a history of good nursing - that it is this way now. It's best to say as little as possible, in my opinion. "Anything you say CAN and WILL be held against you" I Don't mean to be negative, but...

Please feel free to send me a PM

CAT:nurse:

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just because a nurse takes certain meds, doesn't automatically mean they are under the influence.

rather, it would seem that a nurse could be more of a hazard if s/he didn't take them.

i'm not seeing how or why you are worried about working impaired.

it really wouldn't hurt for you to consult with someone from the ada.

you need to know your rights, should you ever be implicated.

it has nothing to do with getting treated preferentially...

but the bottom line is, people with disabilities need protection and advocacy.

what was your supervisor's response to your disclosure of bipolar/meds?

and why are you worried about the bon?

leslie

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My supervisor seemed a little "stunned" like she was almost put in her place when I told her about my conditions. I did not mention specific medications that I take, I just told her it was not safe for me to be out driving and seeing patients without adequate rest after taking medications. Her initial approach to me was that I had "called out of work to punnish her for me having to go out late at night". I also cleared that up with her by telling her that I am an OLD nurse and I do not have time in my life to play tit for tat games. She kinda just slumped down and didn't have much else to say. I am just worried that she will somehow use this information against me as she is young, inconsiderate, and power hungry. I hope that she appreciates all that I do for her and the company and just leaves it alone. It has been several months since this happened, and nothing has ever been said since.

However, I just stumbled across this allnurse website and started reading threads that put me a little uneasy after reading other people's experiences. I do not take meds that "put me under the influence" but I do take meds to keep me stable and functioning. I do plan on talking to my psychiatrist about this issue at our next appointment. I never even realized I was a nurse with a "disability" until I started reading some of these threads. I do not expect any special compensation from my employer, but I do expect that they allow me to use my Paid Annual Leave time when I am not fit to work. I do not use my PAL time frivolously. I have been an employee of this company for more than 13 years and have over 6 weeks of saved PAL time. If there is a day or a time when I am sick due to my bipolar/anxiety/ADD problems then I do not work. Again, this has only happened a few times and I sought out FMLA on 2-3 different occasions for said issues, and only when I am VERY sick, usually involving hospitalizations/and major med changes. I have read from some nurses on this forum that they have gotten in trouble with the BON for taking these kinds of medications and have been considered "working under the influence". I do NOT want that kind of problem.

I just want to know what is the right thing to do?

I will contact the ADA and ask what are my rights. Like I said, I just realized that this COULD somehow be a problem, and it has me a bit concerned. I feel that knowledge is power, and so I feel I should be informed.

I, as a nurse tell patients all the time, "you can not be out driving if you are taking pain medication." I know they need pain medication for their pain, but while they are taking it I know it is not safe for them to be out driving, and I tell them that they could be considered "being under the influence" if they were to have an accident. In all these years of nursing, I never thought that my disease/medications fell under that same category. I have to have meds to function, just as they have to have meds to be out of pain. I never correlated the two as being one in the same. I don't know if it is considered as being the same or not. I guess that is what I need to find out.

Thanks for your help!!

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so far, there hasn't been a problem, but i do sense you're feeling somewhat vulnerable now?

if you can take yourself off-call, then i suppose that would help in maintaining a medication regimen you can rely on.

just keep in mind, it's all about balance.

it's true that many nurses wouldn't be able to work, if they didn't take their meds (whatever those meds might be).

it's also true that taking these meds, raises us to a sense of 'normalcy' where we can and do function.

it's important though, that one isn't overmedicated...which would then deem you 'under the influence'.

if a chronic pain nurse needs to take his/her pain meds to function, then driving would also be ok...agreed?

just as you'd be ok to drive on your meds.

so yeah, it is categorically the same in that you both have an ailment that requires meds to function.

and allow me to repeat, by contacting the ada, you are not seeking special compensation.

but you do need to voraciously protect and advocate for yourself.

and that is where the ada is a great ally to have.

what do you mean when you say, "I just want to know what is the right thing to do?"

i would just go on and do as you're doing.

perhaps contacting the ada, would give you some much-needed reassurance?

leslie

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I have Bipolar disorder and also have worked in Home care for 4 1/2 yrs. It's tough, tougher then people think. Especially, if you have BP disorder. The change in schedule, the late hours charting, numerous calls, visit changes in mid/late day, on-call, late vists/admissions etc, etc. I took FMLA in Sept. for 7 weeks do to a manic episode and now have taken 3 days off before the weekend for a few "mental health" days. I really am quite tired of being a field nurse and have applied for a home health coordinator position that I interview for on Fri.

I want to try the office environment, no late nights, no weekends and no on-call....most important to me a routine of some sort where I'm not a crazy woman in the morning because of schedule changes and trying to find supplies and work regular hours with....A LUNCH BREAK!!!! Don't know about you but those are tough to come by as a home health nurse.

Sorry to get off topic but I saw the post and well started rambling....

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I wish you all the best. I have 6-7 years of managment/CM/DON experience in home health and hospice. I NEVER want to be in the office again, I am not a paper pusher (although that seems to be what HH is becoming). I didn't like managing staff, I do enjoy patient care and teaching. I like my job but it's becoming too much. I know how you feel. I hope that you find what works for you and that you like it.

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If your disability is epilepsy but is under control with medications and a VNS do you have to disclose that to employers?

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

In most areas of life, I'm pretty much an open book; but after seeing what others have gone through in the mental-health and substance-abuse arenas, I believe it's best for nurses to disclose as little of this information as possible to their employers and the BON. There's simply too many ways it can be used against us, even when we are stable and functioning at our optimal levels (which is all they should be concerned about).

My boss does know that I'm a recovering alcoholic with 20 years' sobriety under my belt, but I only disclosed that after I'd been at my current job for a year and I knew I could trust him with this information. He does not know that I'm seeing a psychiatrist because I'm newly-diagnosed with bipolar d/o and at the beginning of experimentation with meds, mainly because I've been using sheer force of will to channel whatever energies I have on a given day into my performance on the job.

Some days I'm too fragmented to concentrate on paperwork, so I'll use that restlessness to get out of the office and just go visit residents or run messages to other staff; on other days when I'm down and prone to isolate, I'll lock myself in the office with the computer and the charts, and do the in-depth documentation I never seem to have time for otherwise. Bottom line, my stuff gets done and I look good to my superiors. They have NO need to know what goes on inside my head, or what medications I'm taking to try to even out my moods.

And I do think having a job that provides regular hours (8-5 Monday through Friday) is a stabilizing influence for me. I'd probably be twice as messed up if my schedule included nighttime hours, or a mix of shifts, so I'm grateful for what I have.

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I want to wish you well and encourage you to get the advice of an ada attorney and then maybe a nurse attorney. Just so you know your rights. You want to be safe for yourself and for your patients. I also want to applaud you for knowing your limits and taking care of your disease. My dear friend is a physician and suffers from Bipolar I. I have seen the horrors that have happened when she has chosen to play PharmD even for one dose of meds. I also would like to caution other that are reading posts on this website about psyc disorders. Every disorder is different. Each person is different. PLEASE do not simply see the name of a medication (ie. Xanax) and assume that YOU personally know what this person is on it for. These are complex neurological DISEASES. Most have been on numerous regimes of meds to try to find the right fit to make us function daily. Followed by one or more MEDICAL DOCTORS. Please don't jump to conclusions.

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