Would a voluntary inpatient stay preclude me from becoming an RN?

Specialties Psychiatric

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Specializes in Interested in ER, OR & informatics.

I'm a nursing student and am considering a voluntary inpatient psych stay for major bipolar depression. Other than lack of insurance, my primary obstacle to making this decision is whether having a hospitalization "on my record" would preclude RN licensure or employment.

I'm 36, have a BA in a non-nursing field and have been working toward a BSN off and on since '04. At that time, I lived in Los Angeles, had a great job, took pre-req classes at night (and carried a 4.0 GPA) and - mostly importantly - had an excellent psychiatrist who did both med management and talk therapy. I saw her for 60-minute sessions as often as needed, and she was quick to adjust dosages or meds as my situation warranted.

In late '06, I left Los Angeles and returned to my hometown of Columbia, SC, to assist my aging parents with their mounting health issues. For a variety of reasons, I've been unable to secure consistent psych care here, and I now find myself heading into month 13 of the most crippling depression I've ever experienced (I've had DSM diagnoses since age 21). I haven't worked in about 14 months and am in no shape to attend school. I have, quite literally, been in bed since last January. I've never spent a day in a hospital as a patient for any reason, but I'm coming to believe that inpatient treatment may be my only hope to stabilize my mind and restart my life. My diagnoses are BP II, OCD and ADD (inattentive), but when I am properly medicated and working with a simpatico pdoc, I'm pretty formidable.

So, I have questions. I'm not looking for diagnostic info specific to my situation (I understand that is not the purpose of this board), but rather for insight. I don't have a clear grasp of what inpatient treatment involves; what does it look like in your professional experience? I'm scared of being treated like a criminal, of not being taken seriously, of giving up any agency I have over my life, and most especially, of making a decision that will prevent me from entering into what I firmly believe will be a rewarding career path.

Thank you for reading this, and any feedback you can provide is most appreciated.

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Just answering your question about licensure...it depends on the state. Go check out the state board licensure requirements. I know in Ohio, inpatient stay doesn't preclude you from being licensed, but impatient treatment for bipolar disorder or psychotic disorders CAN impact licensure -- have a friend with bipolar disorder who is having a hell of a time getting licensed in Ohio (she was licensed in another state). It's requiring notes and verifications from doctors, maybe even a lawyer.

But that's just an answer to your question about licensure -- I'm not making any recommendations about what you ought to do. It sounds like you're in a bad spot, and I really feel bad that you'd have to consider future licensing when trying to decide how best to care for yourself.

I think for inpatient settings, the big question is if you're a danger to yourself or others--you may or may not decide that you need inpatient care...but I think typically that's the "standard" by which someone is admitted to an inpatient psych facility. I'm not an expert, so maybe someone else will weigh in and tell you what to expect. My experience is that what to expect in an inpatient setting varies very widely from facility to facility, but that it's a personal decision.

It isn't clear from your post why outpatient therapy isn't working for you. Of course, my advice is not diagnostic or even very well-informed, but I'm wondering why that option isn't helping. Could you maybe try a different doctor or clinic?

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Specializes in Interested in ER, OR & informatics.

I had a feeling that licensure issues vary by state. I am planning to talk things over with a former professor of mine and will make inquiries about state board requirements in SC. I hope your friend gets her situation sorted.

>It isn't clear from your post why outpatient therapy isn't working for you.

Sorry - I get wordy and was aiming to keep my post to a manageable length. When I came back to SC, no pdocs on my insurance were taking new patients. I finally paid out-of-pocket to see someone, but after the 75-min intake, her appointments were limited to 15-min med management sessions. That was quite an adjustment after what I was accustomed to, and on top of that, we didn't see eye-to-eye as to my plan of care. After my father had a stroke, I fell into a serious depression (but nothing close to what I'm going through now) and rather than adjust dosages or meds, she suggested that I check myself into the psych ward, which I thought was completely unwarranted.

I ultimately sought care as a last resort through the county mental health department. I continued to see pdocs there for about a year but found it hard to adjust to only having pdoc appointments every 2 months, especially when I didn't find the therapist I was assigned to very helpful. I understand they are horribly overworked and understaffed but also felt like I wasn't necessarily the population their services best cater to.

When I enrolled at university in fall '08, I switched my care to the student psych center, only to find that their fear of drug-seeking 18-year-olds meant their policy was not to prescribe stimulants (which I had been on for some time) without a battery of psychological tests to "prove" my ADD diagnosis (despite it having been made by my Los Angeles pdoc and taken as writ since then). Mid-semester I developed a serious case of pneumonia, stumbled through to the end of the semester, and things essentially fell apart after that. My depression is marked by lethargy and apathy, and I haven't had it in me to start another round of trying to find a pdoc in a city that has precious few of them.

>I think for inpatient settings, the big question is if you're a danger to yourself or others--you may or may not decide that you need inpatient care

This is really the crux of the matter. If I felt like I could pick up the phone and find a pdoc, I'd never even consider inpatient care. I'm certainly not (and never have been) a threat to others, but suicidal ideation (never attempted) has always been present in my depressive episodes.

>I really feel bad that you'd have to consider future licensing when trying to decide how best to care for yourself.

I appreciate that. It does add a level of complication I could do without.

Thanks for all your thoughts, manchmal. Writing about this has allowed me to empty my head a bit.

If it's considered overshare/inappropriate to the board, my apologies.

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No, I just really empathize with you with this one, especially in light of what you said about not being able to find acute outpatient care that you're happy with, and feeling "forced" to look at in-patient care. I guess I could share my experience, even if it's "too much info" because I've thought about this a lot myself, though I've never been diagnosed with bipolar disorder, I did once seek in-patient care for a psych medication-related headache problem that resulted in fairly serious depression. If I had been able to get decent and trustworthy care in a quick manner in an outpatient setting, I'd have done that, but...neurologists had 3 week waits, and my psychiatrist was MIA due to some medical issues of her own, so I just went to the ER to try to stabilize my medications. I actually was TRYING at that point to be admitted to the psych unit, just so I could see a decent neurologist and psychiatrist, and because the weirdness with my meds scared me.

My experience was with a private-pay hospital. I only stayed 2 days, and it was over a weekend, so it was very boring. I volunteer quite a bit at a state hospital which is very different -- lots of activity therapy, reflection groups, socialization, occupational therapy, exercise, etc. But at the private/insurance pay hospital, there was nothing to do and only one "group" at the end of the day related to reflection. I did feel trapped (it was a locked unit, and if you're admitted as a danger to self or others, I think it's likely to be a locked unit, even if it's a voluntary stay -- you could get "leave" passes from your doc if you were safe and there long enough, but I wasn't there long enough), and really they tried to get people only to be there a week or two, so there wasn't much time to stabilize meds, even if I'd stayed longer. I just wanted to be observed by psychiatrists while I was having problems with meds, and it made me feel safer to be there. I think if you'd feel safer, maybe an inpatient setting would be a good thing for you? I don't know -- you'd really have to talk to a doc, and it's too bad that you don't have one you can trust. It made me feel better to be around other people, and it made me realize that there were other people much more sick than I was, and I was able to talk to them and help (which is sort-of my nature). The therapy sessions I went to were run by counselors and R.N.s -- the psychiatrist came once a day.

I honestly don't think I was a danger to myself, but at that point, I was so anxious and worried about my meds and I live in a rural area, so I couldn't find a primary care psychiatrist...so it was worth it to me just to be reassured.

I've experienced the student health care response to stimulants myself, because I've taken a stimulant on and off to help with attention deficit related to depression (not ADD). Every time I have to switch doctors, I have to re-convince someone that I'm not seeking meds to sell or abuse.

Again, I'm sorry you can't find a good outpatient doctor. I'm fairly ambitious with those sort of searches, and I keep looking until I find someone with whom I see eye-to-eye, but I have the luxury of insurance that pays for that, and I know how difficult it is when you're depressed and feeling acutely ill. You barely feel like getting out of bed, much less searching all day for a doctor. Community mental health is certainly a big, big problem in terms of inadequate resources (and choices)...that's part of why I want to do psych nursing in a rural area.

Bottom line, I guess, as I see it is that if you feel unsafe, you should probably explore whatever you need to in order to feel safe. I'd make an informed decision, though, as you say -- and check and see if inpatient stays for bipolar disorder impact nursing licensure in the state you want to be in. That was my psychologist's advice to me -- "never let worrying about that keep you from seeking care if you're feeling unsafe, but DO look into it so you're making an informed decision."

I wish nothing but the best for you. Sorry for rambling, and this is the first post I've ever responded to, so hopefully I've not broken any rules. :)

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Specializes in Interested in ER, OR & informatics.

>Sorry for rambling, and this is the first post I've ever responded to, so hopefully I've not broken any rules.

We are firsties together! And you're not rambling; I very much appreciate your willingness to share. One of the worst side effects of isolation is forgetting that other people have endured pain and come out on the other side.

>feeling "forced" to look at in-patient care

Very succinct - forced is exactly how I feel. I didn't know how good I had it Los Angeles; I honestly never expected this kind of difficulty find a doc. It's admirable that you feel drawn to psych nursing - especially in a rural area - based on your experience with "the system." I feel strongly that my experience with illness enhances my ability to empathize with my (future) patients, although I don't think I'm cut out for psych nursing. But I'm still early my education, so maybe that will change.

>I actually was TRYING at that point to be admitted to the psych unit

That's gone through my mind as well. It would seriously suck to sort of throw myself on their mercy, only to be told that I'm not "sick enough" to warrant immediate care.

>Just found this via extensive Google searching

This is excellent - I was buried in legalese on the SC Code of Laws page, linked from the SC Board of Nursing page. Your synopsis is much clearer. It reads to me like the Board expects self-disclosure of hospitalization. I'll check with them for details.

Thanks also for mentioning "attention deficit related to depression" - I need to investigate this. I wasn't diagnosed with ADD until '06 (at age 32), and I never went through any extensive testing, just a few diagnostics my doc administered. Concentration is one of the first things to go for me when things get bad. Adderall was like a miracle drug for me, because in addition to making me able to read, work, study and string a sentence together, it also alleviated the fatigue and lethargy that are doing me in right now.

It sounds as though your situation is improved and hopefully well-managed. And good on you for volunteering on a psych unit. I'm feeling a bit more optimistic about at least exploring my options, and for that, I thank you.

Best of luck to you - you strike me as someone who'll be credit to the profession.

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I strongly suggest that you get in touch with your former doc in LA and ask if their office could help you with a referral. Docs make all kinds of connections while they're in training, and it could be that your doc knows someone in your area. Even if he just knows someone who knows someone, that's better than picking names out of a phone book.

If you call your old doc and explain your current circumstances--that you are basically falling down the rabbit hole and have no one else to reach out to--he (or she) might understand the intensity of your need.

As a nursing student, you have probably run across Maslow's hierarchy of needs. Maslow says that survival takes precedence over everything else, and he's right. Yes, you might run into some difficulty down the road because of an inpatient stay, but that is by no means a given. I know many medical folks who have a history of mental illness who are functioning well without any restrictions. The one sure thing is that you have to survive to even get to the point where the rest is up for discussion.

I know you don't have a lot of energy at this point, but, please, ask around. Call hospitals and universities. See if you can find the names of several good practitioners. And then see if there's any way at all that you could see them. Use your LA doc as a reference.

I wish you the best.

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Specializes in Interested in ER, OR & informatics.

That Maslow - he's always right.

Thanks for your suggestions, Miranda. When I first encountered trouble finding a doc, I did contact my former doc in LA, but she did not have any contacts in SC. I'm hoping that some of my professors here can help with names and/or pulling strings to get me an appointment. They are a pretty well-connected bunch, and I formed good relationships with several of them.

> I know many medical folks who have a history of mental illness who are functioning well without any restrictions.

You're so right - Kay Redfield Jamison is a hero of mine, and though I am not nearly as brilliant as she, her experience gives me hope.

Just posting here tonight was a big step for me - I've been mulling it over for weeks. The responses have rekindled some hope, and I haven't felt that in a long time.

By the way, I love your username. You are two things I aspire to be - a nurse and a writer.

All best to you.

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The most important thing is for you to obtain the help you need. Then go from there. In this case, you can not help others until you first help yourself. I understand your concerns about any possibility of not being able to be licensed as an RN, however, at this point your first concern must be obtaining the proper care for yourself.

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Specializes in General adult inpatient psychiatry.

I would recommend looking into a Partial Hospitalization Program, if I were you, as an alternative to going inpatient if you don't find yourself to be a threat to yourself or others. I just got out of one and it was very helpful. I needed adjustments with my medications and it was just what I needed to get out of the house and get things situated to go back to work. Ask me anything!

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