National Nurses United

Disabilities:1 10/15/08 11:00 PM Page 12 And while nurses organized in a union have a grievance procedure independent of the hospital, nurses in nonunionized facilities are subject to the hospital's internal grievance procedure where administrators interested in the financial bottom line ultimately decide whether to accommodate a nurse's disabilities. L ike many people suffering from mental illness, Cara Hoepner's road to nursing was not an easy one. For years, doctors were unable to diagnose her, misdiagnosed her, or tried a variety of ineffective treatments. One doctor didn't believe her when she described her adverse reaction to a drug. Hoepner wasn't always a nurse. Her first career was as a freelance production designer for film and television. "It was a perfect job for a bipolar person. I was self employed. Many people who are bipolar and untreated change jobs frequently and have difficulty focusing on a single task, but are often highly intelligent," Hoepner says. After a television writers and actors strike, some production companies began outsourcing to Canada, taking work away from technicians in the United States. Worry over the ensuing loss of business sparked in Hoepner a cascading set of unhealthy behaviors, from unbridled anxiety to impulsivity. Soon she was suffering from severe depression. She stopped working, then stopped leaving her house. She describes curling into a ball in her bed. Even sound was painful to her. She became paranoid, fretting that if she drove she'd have an accident. "I still had clients and I had to finish up some art jobs. I was so cognitively impaired I couldn't understand my own work," she remembers. She sought treatment alone, then with the help of her family. She quickly found that most treatment plans took a predictable but unsuccessful course, one that dead-ended because doctors had a formulaic view of her bipolar diagnosis. They weren't really seeing Hoepner. They were only seeing her disease. "Many of these drugs don't work for everyone. People still have residual symptoms, are in pain, or depressed," she says. Hoepner decries the healthcare system's tendency to treat mental illness with the same approach for each person who has a given diagnosis. In the end, she says, "I was being treated for bipolar instead of being treated for me." Eventually, she was given lithium. Often seen as a stigmatizing drug because it has been used to treat schizophrenia and has questionable side effects, it was the first drug that really worked for Hoepner. She finally emerged from her depression. Her experience with cookie-cutter care was one of the factors that inspired her to become a nurse. "I liked the flexibility of nursing. I liked that nurses tend to take a more holistic approach to care," she says. She also knew she wanted to go into psychiatry. No longer symptomatic, Hoepner's contribution to nursing is apparent. She is energetic and observant, remembering every detail. These qualities contribute to her ability to diagnose patients. She currently works as a nurse practitioner at Dore Urgent Care 12 REGISTERED NURSE Center, evaluating psychiatric patients at one of the few centers remaining in San Francisco after years of government budget cuts forced the closure of key urgent care mental health facilities. These relentless cuts may be emblematic of how mental illness – and therefore disabilities – is ignored or stigmatized by our culture. Her own experience and wide-ranging symptoms make Hoepner an expert at assessing psychiatric patient needs – arguably even better at diagnosing and determining a treatment plan for her patients than a nurse who understands a patient's struggle only from a distance. Because only fifty percent of people with bipolar disorder maintain regular employment, Hoepner quickly recognizes people suffering from bipolar disorder in her practice. "If I talk to someone and they've had five different jobs and lived five different places, I know I'm onto something," she says. Because "If I met someone who had major seizures I would not advise them to go into nursing. But I've even worked with a wheelchairbound nurse who works with children, and she's right down there at the child's level." —trenee zweigle of her own struggle with treatment, she recommends treatment based on individual need. In addition to her work, Hoepner volunteers as a mentor for Exceptional Nurse. She fields a wide range of questions from nurses and students who wonder if they will be accepted as patient care providers. Hoepner draws from her personal experience to assuage their fears and assure them they can overcome obstacles. Yet despite being a mentor, Hoepner has been reluctant to open up to all of her coworkers. She understands the powerful stigma of mental illness, not just among nurses, but also the general population. Nurses, she says, can be particularly hard on one another, in part because of the high expectations of a profession that is obsessed with perfection and never making mistakes. It can be a difficult environment for a nurse perceived as "imperfect" to work in. Hoepner remembers working on a medical-surgical floor with nurses who had little exposure to mentally ill patients. When psychiatric patients landed on the unit, Hoepner saw some nurses dismiss these patients' desire for medication as addictive drug-seeking behavior because they weren't accustomed to the symptoms that accompany mental illness. Still other nurses on the same floor would set the uninformed nurses straight. Donna Maheady recognizes the unique potential that nurses have to understand fellow nurses with disabilities. "Nurses are more aware of community resources and are experts at adaptive and creative approaches to handling situations," she says. I ronically, the very work nurses perform places them at risk of developing severe physical disabilities. Statistics on stress injuries for nurses are not pretty. According to the U.S. Bureau of Labor Statistics, RNs ranked 12th out of 129 W W W. C A L N U R S E S . O R G OCTOBER 2008

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