Sometimes, we as nurses need to be off of work more than just “I’m calling in sick today because my tummy hurts.” Some of us may need to be off for an extended period of time, which is usually covered under the Family Medical Leave Act. But sometimes you don’t need that prolonged period of time off. Instead you might have a condition that flares up, it ebbs and flows and you might need to be off here and there, intermittently. So today we welcome Lisa onto the podcast, an experienced progressive care nurse, and she’s going to share her journey with experiencing a medical leave from work.
Alice (2:54): Let’s start off by having you tell us a little bit about yourself and your background.
Lisa (2:59): I have worked in healthcare since high school. I did an internship that kind of sparked my interest in working in healthcare, and I’ve done everything since from clerical jobs to eventually becoming a CNA, then LVN, and eventually moving on to get my RN. I’ve mostly stayed in the same companies, moving around to different positions, just finding my footing until I found the job that I really wanted and loved.
Alice (3:47): It sounds like your passion has been progressive care stroke patients in particular. I know you’re very knowledgeable about those things, and you’ve been loyal to a particular organization for a very long time.
Now, just as we are nurses and we take care of other people, sometimes we have to take care of ourselves, and there came a point where you needed to step back and take care of yourself. What happened?
>>Listen to this episode on the Ask Nurse Alice podcast
Lisa (4:20): I’ve always suffered from migraines and I know a lot of people have them. They don’t look at it like it could be a disability, or something that could affect their career, but it really can. It’s sort of one of those unknown medical conditions where they don’t really understand fully why they happen to certain people. We just treat the symptoms and try to figure out what the triggers are and how to avoid them. There have been some enhancements with medications which have helped a lot, but overall throughout my life, I’ve suffered and it’s affected my job. Before I knew what opportunities I had to actually protect my employment, I would call in sick whenever I was really sick from migraines.
That happened to me a lot. When migraines hit you, you can get hit with all types of symptoms from nausea, vomiting, dizziness, sleepiness, pounding and throbbing headaches to confusion and sometimes weakness. There’s a lot of reasons that you would need to stay home, because you’re literally just too sick to go to work and take care of other people. So you have to take care of yourself first, otherwise you are no good to your employment.
Alice (5:31): And this would hit you out of the blue, right? You can’t plan for a migraine and call in 6 hours before shift to give them plenty of time for staffing. Sometimes this could happen right before work, right?
Lisa (5:46): Right. I work the night shift a lot and just getting your life organized down to the minute to get dressed, getting in the shower and all of a sudden you start feeling so dizzy and nauseous, your head starts pounding and you’re realizing it’s coming on right now and there’s nothing that stops it. Even medication takes some time to kick in, and even then, the medications can make you feel sleepy or weak so you have to lay down. So it comes out of nowhere, and sometimes it could be within those two hours that you’re getting ready to report to work, and then what do you do? You’re at risk of having a late sick call when you call in sick. For years I dealt with that.
Working While Sick
Alice (6:37): As nurses we often put ourselves last and there’s so much pressure for us to show up, even when we don’t feel our best. How often would you say you went to work still with your migraine, trying to take care of others?
Lisa (7:01): I would say 75% of the time. Then there were times where I would go to work, report and then halfway through my shifts I would leave because I was just too sick. And again, we’re talking about a time period also where there wasn’t much advancement in the medication either. So you’re just stuck with meds that essentially knock you out and almost make you feel worse before you feel better.
So I’ve gone to work feeling ill because my migraines were called intractable migraines, where they’ll last for 2-4 days at a time. So you don’t go to work one day, but then you’re trying to figure out do you call out again on the second day? Because you’re still sick. But sometimes you have to go to work because you either don’t have enough hours to cover you next day off or you don’t have any more available sick days so you’re at risk of getting written up. You’re just kind of stuck.
Alice (7:53): That’s a terrible situation. On the one hand, you don’t feel good and in good faith, how can you go to work and take care of someone when you don’t feel good yourself? Yet on the other side you have leadership and unit demands, pestering you and let’s just be honest, you can’t see migraines. You mentioned that you would go to work, try your best and sometimes you’d have to leave because you felt so horrible. What was that like with your colleagues? Was there any tensions on the unit?
Lisa (8:53): People are planning their workflow around the staffing they have, so if they know they have X amount of employees there, they know they can project their night a little bit easier. But if they’re losing staff in the middle of a shift, they have to adjust to those things. And sometimes the workflow doesn’t allow for that, but you still have to adjust and it puts a strain on everybody. Eventually they’ll start to look at you like you’re a flaky employee that doesn’t want to commit and they might even have regrets about hiring you. Your reputation is on the line because if you’re working your way through the ranks and you’re trying to use people as references, they’ve formulated opinions about you because they don’t think you’re a committed employee. So not only are my employer and coworkers impacted, but my family is too from taking care of me when I’m sick.
Alice (10:03): Right. So the Federal Family Medical Leave Act, this is something that generally provides 12 weeks of unpaid leave during a 12 month period, usually for the care of someone else or for your own serious medical condition. I’ve had to take it because I’ve had minor surgery, and that’s a planned thing. I knew I was going to be off from this day to that day and once I was out, I was out of the mix. Migraines can be very serious, they’re debilitating as you’ve talked about, so you took a form of family medical leave. Can you tell us a little bit about that? I don’t think as many people are aware or familiar that this option actually exists until they’re down to the wire.
Lisa (10:56): I was one of those people that didn’t know it existed but wished that I had, because I probably could have saved my attendance record and even the faith in my capabilities to show up to work. My employer could’ve had more confidence in me because they would’ve understood my situation a little better.
Once I moved away from just seeing my family primary doctor for my migraine management, I was referred to a neurologist, and that’s when things started getting a little better for me as far as managing my migraines. It’s also where I discovered that they have, under the FMLA (Family Medical Leave Act) umbrella, an intermittent leave that you can. This is essentially an intermittently reduced work schedule, so you’re not fully off of work, you’re not on disability, but you’re allowed to call in sick based off of the doctor’s recommendation of how many times you have what they call a “flare up,” or something involving whatever your health issue is.
For me, since my migraines would last 2-4 days, that could be working just 2 days out of a week. I work 3 12-hour shifts, so I could be working 2 shifts in a row, and if I’m having flare ups for 2 days, then that’s considered 2 days. So I can call in those 2 days if I need to. Once I discovered this, it totally changed my entire situation, for at least being able to hold onto my employment and call in when I need to and just take care of myself. I wasn’t putting myself or my family at risk of losing my job.
So I took advantage of the intermittent leave. It’s a form that has to be filled out by your provider. There’s a series of questions that document, not everything about your condition, but just how many days they feel you need, how frequent this is happening for you, things like that. They also have it where if you need to call in sick within the 2 hours of reporting for work, then you should be able to do that, but they have to indicate it on the form because it’s very specific.
Alice (13:05): You are helping so many people right now. There are so many people who are struggling with some form of illness, or maybe it’s not even them but it’s their child or significant other. They’re ill and they’re torn from wanting to stay home and take care of their family member because this really is my primary job, but I also have this other job that I need to pay rent and buy food, but I can’t really go there because I’m having to be here. You’re just being torn between two very important things. We love being nurses and taking care of people, but at the end of the day, you and your immediate family should be your priority when it comes to who is your number one patient.
Protecting Your Job
Alice (13:51): It sounds like you didn’t know that intermittent leave existed, so you were just calling out a lot of the time, and every hospital, clinic or employer has a slightly different attendance policy. So if you haven’t already, please make sure you check out your attendance policy! That is one policy you want to be familiar with because too many missed-attendance instances could lead to disciplinary action. At any point in time, did you have to deal with that?
Lisa (15:26): I did, I was getting verbal warnings. They were being very nice about it and they were concerned because I was sharing with my employer a little bit about my situation, which you don’t have to do but because I had worked with these people forever, I did. At the end of the day you work for a corporation and everybody has these laws, but once I got into the intermittent leave situation, it kind of cleared all that up for me.
I do want to point out one thing. When you use intermittent leave, you are calling in sick. So it’s a sick call, but it’s categorized under the intermittent leave so you’re protected by that. Eventually though, you get to the point where you start to run out of hours whether it’s sick leave or vacation hours, because you’re likely covering with those hours too. Once you’re running low on hours and you’re still not well because it’s a chronic issue, you’re going to have to start making decisions. Do you just keep calling in with intermittent leave and eventually not getting paid? Because that’s the reality, everybody runs into that if you have this chronic health condition that isn’t resolved yet. .
That’s the point where I eventually talked to my provider about taking a disability leave, which is a whole other topic, but it’s what I had to do. Because if you’re missing this much work, you’re working 3 shifts a week and you’re missing 1 to 2 shifts a week because of your chronic condition, you probably should be off of work so you can fully address your situation and can get back in the game later. Just put all of your attention on your health, take care of yourself and yourself, so you can eventually report to work and be productive. Because if you don’t have your own personal health intact, then nothing else works in your life. But intermittent leave is there for the short term, or if you or a family member you’re caring for is trying to get through something.
Alice (18:11): You mentioned that you’ve been on your unit for a long time and they’re like family so you felt comfortable sharing some pieces of your health situation and what you were going through with your manager or whoever did the scheduling. Can you share with people, do they have to share the details of their diagnosis or their health issue, whether it’s themselves or their family member? Are they obligated to share that with their employer? And can you walk us through the paperwork?
Lisa (18:59): I’ll start with the forms, because the forms are set up to not indicate what your health problem is. It’s just supposed to indicate through a provider certifying the forms, because the provider signature certifies what is going on with your condition and not what your condition is. So the form is basically just certifying what you and your provider talk about, how much they feel you need to be off of work to address these issues. They fill out the forms and they’ll put it down to the hours of how many increments and hours you have to be off, or maybe even leave for an appointment. You should be able to leave for an appointment if you’re sick in the middle of your shift and it should not be counted against you. You can have it written down to be able to call within 2 hours of your shift, or maybe even 1 hour. So they will put everything on there to help you get through this so that your job is protected.
So you do not have to disclose your health issues to your employer. I did, but I can tell you that it doesn’t make a difference at the end of the day.
Advice For Nurses
Alice (21:56): What advice would you have for someone who has a chronic medical condition, or maybe a new diagnosis of something that could potentially interfere with work?
Lisa (22:18): I would suggest finding the right providers that you need to be seeing. In my case, I should’ve seen a neurologist years before I saw one. But me not really being at that stage in my career where I identified my condition matching a neurology condition, I just didn’t see one. Don’t be afraid to see a specialist early on and discuss the effects of your life. How this condition is impacting everything from work to family life, so they can get a clear picture of what is exactly going on with you. Also be sure to keep in contact with your doctor throughout this process, because the intermittent leaves are usually for a designated amount of time and you have to get it re-certified.
Alice (25:30): As a nurse who is maybe on a shift with someone who is experiencing this, what would you say to them? How would you recommend they handle this?
Lisa (25:58): People understand when you have something going on, and they tend to respect you more when you call out a little bit better, because they realize you’re sick.
Alice (26:29): This is where we as nurses need to have compassion for one another. Because we recognize that yes, you’re the nurse today, but you could possibly be a patient tomorrow or that night. And then for the colleagues who may experience working short or having to shuffle assignments around because a colleague is sick, it’s important that we have compassion for them too. We just need to exercise the same compassion that we have for our patients for our colleagues as well.