Nurses and Mental Health

An increasing number of nurses report mental health issues. Some of these relate to treating and caring for patients during the COVID-19 pandemic.

These problems, however, predate 2020. Lack of employer support, long hours, and high patient ratios have led to burnout and nurses leaving the profession.

Mental health issues can range from temporary conditions, such as anxiety or depression, to lifelong conditions, such as bipolar disorder. For many mental health conditions, treatment can mean a huge change in quality of life.

Unfortunately, many nursing boards aren't set up to adequately address mental health conditions. Rather than find needed support, nurses may find themselves brought up on disciplinary charges.

Nurses may fear getting treatment out of concern that such treatment would reflect negatively on them. They may not want to risk being labeled “unstable” or have their career derailed by misconceptions about mental health.

Not getting treatment may increase the risk of performance issues at work. It may result in a small issue ballooning into a big problem.

If you have a mental health condition, you deserve treatment and support, not punishment. If you're now facing disciplinary issues that relate to your mental health condition, contact the Professional License Defense Team at the Lento Law Firm. Call us at 888-535-3686 or fill out our online form.

Burnout and Lack of Support

Social media is full of stories about nurses who are burned out or believe being a nurse causes mental health problems. A recent survey found that 50 percent of individuals who decided not to pursue a nursing career made that decision based on these social media stories.

Thousands of nurses are leaving the profession due to mental health issues. Just in New Jersey, nearly a third of nurses left working in patient care between 2020 and 2023. This number matches with a nationwide survey that found about 33 percent of nurses expect to switch careers.

This puts more pressure on the nurses who remain, which in turn increases the risk of burnout, mental and physical exhaustion, and mental health problems. These issues can increase the risk of patient error, to say nothing of the mental and physical toll it takes on nurses.

Numerous Issues

The Covid-19 pandemic worsened already existing problems in the nursing field. Lack of support from employers, increasing demands on them during their shifts, and work-related stress that can create or exacerbate mental health issues are just some of the problems:

• Nurses have a significantly higher suicide rate than the general population
• Substance abuse, which often relates to mental health, accounts for 40 percent of disciplinary hearings
• The Covid-19 pandemic increased depression, anxiety, insomnia, psychological distress, post-traumatic stress, and burnout in nurses
• Current industry practice focuses on punishment rather than support for those dealing with mental health or substance abuse issues

This last point indicates one of the biggest problems about mental health issues with nurses. Nurses work jobs that can be high-stress and take an emotional toll, but they don't get the support they need to counterbalance these work-related issues.

Instead, nurses with mental health conditions have to go it alone. They're the ones who shoulder the blame for industry-wide, systemic problems.

Moral Injury

Nurses aren't just suffering from burnout, which can often be addressed with time off or increased self-care, but from moral injury. Moral injury, first used in the military community, refers to either doing or witnessing something that goes against a person's beliefs.

For nurses, many of whom entered the field out of a desire to help, the current medical system and its emphasis on profit over patients puts their beliefs at odds with their daily work. When entering the profession, nurses assume a duty of care to their patients.

Increasing patient ratios, lack of medical equipment, and the expectation that doctors and nurses should focus on the cost rather than care can all negatively impact a nurse's mental health. As a 2023 report from McKinsey states, given the level of burnout in the nursing profession, the healthcare system at large needs to address the problem and provide adequate support for nurses.

Without that support, nurses face added mental health burdens and the increased risk of making a mistake or otherwise facing disciplinary action. It's a vicious cycle, but the good news is individual nurses have avenues to defend themselves and protect their careers.

Americans with Disabilities Act

The Americans with Disabilities Act (ADA) is the cornerstone of protecting disability rights in the United States. When many of us think of the ADA, what comes to mind is accommodations and access for physical disabilities, such as ramps and handicapped parking.

The ADA also protects conditions that aren't visible, such as mental health. This means that employers cannot discriminate against employees because of a mental health condition, and employers must provide reasonable accommodations.

The U.S. Department of Labor emphasizes that mental health accommodations should be based on the individual and may take time to develop. A list of common accommodations can be a good starting point when discussing needed accommodations with an HR department or supervisor.

Mental Health in the Workplace

Nurses who are suffering from PTSD, depression, or other mental health conditions cannot be fired due to their mental health condition. What some employers may try to do is find other grounds to “justify” a termination.

Employers are limited in how they can ask employees about health conditions. Nurses and other employees aren't required to disclose a disability.

Hospitals and other employers may ask about a mental health condition when:

• A nurse requests a reasonable accommodation to perform their duties
• They have made a job offer, but employment hasn't started if they ask everyone in the same job category the same questions
• Applicants or employees have the option of not responding to a question, such as an employer tracking an applicant pool's disability status to assess its recruiting and hiring
• Objective evidence exists that, while working, a nurse is unable to do their job or poses a safety risk
• Disclosing information on a disability if necessary for benefits, such as FMLA

Whenever an employee informs an employer about a mental health disability or disorder, employers must keep that disclosure confidential. You may discuss your mental health condition with a coworker, but an employer cannot.

An employer cannot use information about a nurse's mental health condition to discriminate against them.

Reasonable Accommodations

The ADA requires employers, including hospitals, to provide employees with disabilities with reasonable accommodations. This begins during the application process and continues through employment.

Reasonable accommodations are modifications to enable someone with a disability to perform a job. Individuals are still qualified for their jobs but simply require adjustments that enable a person with a disability to do their job.

For example, a hospital requires that security guards stand for their entire shift. A guard is otherwise able to perform all of the job's responsibilities but needs to sit occasionally due to an old injury. The guard requests the accommodation of a chair to minimize standing for long periods.

Types of Accommodations

For work, the ADA defines three general types of reasonable accommodations:

Modifying the job application process for a qualified applicant

• Modifying or adjusting a work environment or the manner or circumstances in which a position is usually performed to enable a qualified individual to perform the position's essential functions
• Modifying or adjusting benefits and privileges to ensure employees with disabilities have equal access as similarly situated employees
• Employees cannot reject an applicant due to requirements that aren't essential to the job or add requirements to prevent an otherwise qualified individual from applying to a new job or being qualified for a promotion.

A common example of this type of “added” requirement is stating that a desk job requires all applicants to be able to lift 30 pounds. Such a requirement may prevent otherwise qualified individuals from being hired despite lifting 30-pound objects not actually being required for the job.

For nurses with mental health conditions, reasonable accommodations could include specific shift assignments or additional breaks. Such accommodations don't affect a job's essential responsibility, and nurses shouldn't be disciplined or otherwise punished for requesting such accommodations.

In the mental health arena, a supervisor or other individual who knows about an employee's mental health condition may invent requirements for a job or promotion that they know the person would be unable to meet. The point of these new requirements is to prevent a person with a mental health condition from qualifying for the job.

Alternatively, they may invent requirements or responsibilities that make it more likely for a nurse to run into disciplinary issues. These alleged disciplinary issues can then be used to suspend a nurse or claim they're ineligible for promotion.

Temporary Conditions

Some mental health conditions are short-term or may improve with treatment. A mental health condition doesn't have to be permanent or long-term to qualify for support. The ADA also covers short-term disabilities.

A disability also doesn't have to be substantially limiting. Especially with mental health conditions, symptoms may not be consistent. A nurse may need support one day and may not be on his following shift. This doesn't mean a mental health condition isn't real or a nurse is incapable of performing his duties.

Medication at Work

Whether a nurse can take medication or a prescribed, legal drug before or during his shift depends on the type of drug and any side effects. Nurses should only take drugs prescribed by a doctor. A prescription can also show that the nurse had a right to take that drug and that it was legally obtained.

When a doctor prescribes a drug, nurses should ask about any side effects and if they would affect their ability to do their jobs. They should also inquire about the dose.

In general, a nurse can work if a medication or other prescription would not affect their ability to work and provide care to patients. Nurses should check their hospital's policy on medication and prescriptions while working. In some cases, a nurse may need to request a transfer to another position when taking medication.

If a nurse is unsure if a drug is safe or how it would affect their work situation, they should contact the Professional License Defense Team at the Lento Law Firm.

What the ADA Doesn't Cover

The ADA does not cover the use of illegal drugs. Employers may drug test and hold employees who use drugs to the same standards as other employees. This can include the misuse of controlled substances.

This differs from individuals who have completed drug programs or have been wrongly accused of using illegal drugs. In these situations, the ADA may protect individuals.

A nurse with a mental health condition who uses either illegal drugs or drugs without a prescription may face disciplinary action or dismissal from a job. This is the case even if drug use was outside of work hours.

Marijuana Use

Marijuana use is an especially complicated subject and highlights several of the challenges that nurses face with mental health disorders. Even if a nurse uses marijuana in a state where the drug is legal, for example, a nurse may still face disciplinary action.

Cannabis can have medical benefits. Individuals with depression, insomnia, and anxiety report a decrease in symptoms from using marijuana. The downside is that regular marijuana use has negative cognitive effects, including damaging long-term memory.

The research behind the benefits of marijuana remains mixed, especially for treating mental health issues. A 2017 review found that only three conditions had substantial evidence of beneficial therapeutic use:

• Treating chronic pain
• Reducing chemotherapy-related
• Decreasing spasticity associated with multiple sclerosis

What these studies mean is that even if a nurse believes or knows that marijuana is helping their mental health condition, they may have trouble providing evidence. The research on marijuana is new enough, including how it can help mental health conditions, that a nurse facing disciplinary action may have difficulty finding evidence that establishes a connection.

The Legal Maze of Marijuana Use

The legal side is even more confusing. Some states have legalized it for medicinal and/or recreational use. In 2024, the U.S. Justice Department released plans for rescheduling marijuana under federal law. This change acknowledges that marijuana has beneficial medical uses.

The use of marijuana by employees and whether employers can regulate employee drug use remains a constantly changing question. Depending on the state in which they do business, companies set their policies regarding marijuana use.

For example, beginning in 2024, California restricted employers' ability to regulate whether an employee uses marijuana outside of working hours. The state also recognizes disability as a protected characteristic, meaning an employer cannot discriminate against an employee for having a mental health condition.

The state still allows for drug testing, and employers can maintain drug-free workplaces. Individuals can also not be impaired while at work.

In comparison, Louisiana was in the national news after a nurse faced disciplinary action for smoking marijuana outside of work hours but without a medical marijuana license. A drug test that was required as part of a job application showed she had smoked. She not only wasn't hired but she was brought up on disciplinary charges despite not being employed at the time she smoked.

Legal Then, Not Now

Using marijuana to cope with mental health conditions remains controversial. For example, a nurse, while on vacation in a state that allows recreational use of marijuana, smokes. For this nurse, marijuana helps her PTSD symptoms.

This nurse lives and works in a state that doesn't allow marijuana use. Once back at work, the nurse is drug tested and faces potentially losing her job as well as disciplinary action even though she engaged in behavior that was legal when and where she participated.

In this case, there's no evidence she has an addiction. She wasn't high at work or, at any point, a danger to patients. Yet her entire career could be derailed because her system still had evidence of marijuana.

Can Nurses Use Marijuana?

It depends. Before engaging in the drug, nurses should know their state's laws and their employer's policies. For example, California law only applies to companies with more than five employees. A nurse working at a small doctor's office in San Diego isn't covered.

If marijuana helps with a mental health condition, nurses should follow legal procedures to obtain it and not use it during or before working hours. If necessary, they should obtain a medical marijuana license and a prescription from a doctor or other medical professional.

Unfortunately, supervisors or employers may use drug testing or other technically legal means to target a nurse who uses marijuana - even if the use is legal when it occurs. A supervisor may deliberately plan a drug test when a nurse returns from vacation. These types of “technically legal” actions can allow an employer to discriminate against a nurse with a mental health condition while remaining within the law.

If your employer is using such a method to derail your career or report you for disciplinary issues, contact the Professional License Defense Team at the Lento Law Firm. We help our clients build a case that shows that they are being unfairly targeted or discriminated against.

Licensing Requirements

The U.S. Equal Employment Opportunity Commission (EEOC) has guidelines on the ADA and psychiatric disabilities. For nurses with mental health conditions, the guide's commentary on professional licensing is useful.

In this guide, the EEOC states that if the licensing requirements discriminate against individuals with disabilities, these requirements may amount to disability-based discrimination. By depriving someone, such as a nurse, of a job because of licensing requirements that either do or could be perceived as discriminating against individuals with a disability, such as a psychiatric condition, an employer may be violating the ADA.

This example shows how, when nurses are facing disciplinary proceedings, they should consider whether a nursing board's regulations either directly or indirectly discriminate against nurses with mental health conditions. Requiring a nurse to complete a diversion program or substance abuse treatment may amount to discriminating against them because they have a disability.

The Disciplinary Process

Each state has a nursing board, and each nursing board sets policies. Individuals should check with their state board about that state's rules and policies. For those who practice in multiple states, they should be aware of each state's laws and how those laws interact.

Nurses should remember that some individuals, knowing they cannot discriminate against someone due to a mental health condition, may use other claims or accusations as a smokescreen. In these situations, a nurse should look into whether policies are consistently enforced. They should assemble any evidence that indicates, even indirectly, that they're facing disciplinary action due to a mental health condition.

Steps

Each state sets its own processes, but the general procedure is as follows:

• Complaint
• Initial review
• Investigation
• Formal charges
• Appeals

Diversion Programs

Many states have diversion programs for those with substance abuse issues or who otherwise qualify. In theory, these programs should be good. Those who complete the terms of the program won't face disciplinary action.

The problem is these terms put an enormous burden on a nurse. Most require nurses to pay for any required treatment even as they limit a nurse's ability to work. A nurse may be placed into a different job and denied promotion. These probationary periods can last for years.

For a nurse suffering from mental health conditions, these disciplinary processes are most likely to increase stress. This increased stress, in turn, can worsen mental health issues. That some nurses opt to leave the profession rather than navigate these onerous problems isn't surprising.

If you're facing disciplinary action, contact the Professional License Defense Team at the Lento Law Firm. We can help you defend your career and get the help you need without excessive strings attached.

Protect Your Career and Health

Nurses know the importance of caring for one's health. Yet the current toll on nurse's mental health hurts nurses and patients. For those with diagnosed mental health conditions such as bipolar disorder, the work-related stress of nursing may worsen symptoms.

Nurses need support, not punishment when dealing with mental health disorders and conditions. While those with mental health issues are technically protected from discrimination, the healthcare industry does little to meaningfully protect that right.

Given the unfair stigma around mental health, nurses may worry that disclosing a mental health condition may hurt their careers. If they do disclose, they may face trumped-up allegations or questions about whether someone with a mental illness can meet the required duty of care.

Having a mental health disorder has no relationship to a nurse's ability to do their job. If anything, it might make them more compassionate because they can connect with patients over the struggles of managing one's health.

If you're a nurse with a mental health condition, contact the Professional License Defense Team at the Lento Law Firm. Whether you're unsure how to request accommodations, believe you're being discriminated against, or are facing disciplinary charges, we can help you protect your career, your future, and, most importantly, your health. Call us at 888-535-3686 or fill out our online form.