Advise for Nursing Student with tremors!

[DH1234]

So I am currently in my 3rd semester of nursing school, and this will be my second semester of clinicals. More importantly, I have essential tremors, and I am looking for advice on how to better control it especially while doing tasks such as drawing up medication, giving an injection, and starting an IV. I have given a few injections during clinicals, and I never injured my patient in anyway but I do shake still. Also, my instructors at the time were understanding about my tremors because I made sure to be honest and tell them about it. However, I heard the instructors I would be having for this rotation were kind of mean, so I know that I am most likely going to be scared to tell them, and it might increase my anxiety making my tremors worse. I am honestly so desperate for advice on how to control these hand tremors. I just want to become a good nurse but these hand tremors are discouraging me, and I feel like my hard work in school will be a wasted if I can't control them. If you deal with tremors as a nurse or knows someone who does, I would greatly appreciate if you share your story on how you dealt with it. And prescribed medications are not an option for me right now because I do not have the best of health insurance.

[Double-Helix, BSN, RN]

A medical condition like this would be considered a disability. If you want your instructors to consider your disability when evaluating your practice, you need to disclose this per the ADA.

You also need to consider whether your tremors are an inconvenience or a safety concern. Are there skills that could put your patients at risk if you attempt to perform them with a tremor? IV starts/phlebotomy come to mind since you have a needle directed at a patient. In terms of drawing up medications, I would practice this skill in you classroom/simulation lab and try some different techniques to stabilize your hands and the vial.

[Eris Discordia BSN, RN]

My neurologist prescribed me nadolol for mine as a nursing student...and it helped significantly. They weren't gone, but I could easily work with them.

Now, decades later, I take propranolol for them. And I can float an IV in 23 week baby still. For me, I really needed meds.

[medbullet]

First, as previously mentioned, you need to decide if this is actually a safety issue.

If this is a safety issue for your patients OR YOU then you have no choice; a beta blocker is the best treatment and very effective for essential tremor.

Additionally, I understand you're insurance situation might not be ideal but this is your career and if you don't respect yourself and your patient's safety enough to make a tough choice then healthcare is not for you.

If you need to, or just want to start taking a beta blocker for this you can get it very cheap. Get a 90 day script for double dosage so you can split them, and order generics from a mail order pharmacy.

If you decide that you want to or have to get by without meds then focus on these things.. you know that stress can exacerbate the tremors so:

1) Embrace your condition. Own it; it doesn't define you. Don't hide it or shy away. Joke about it. Confidently display that you can jump any hurdle in front of you but, unlike everyone else, YOU can do it with a tremor

2) Get some supplies that just expired, and have an IV starting party with your classmates. Do dexterity drills. Ask your supervisor/precepter to give you every procedure you can possibly get. Even if you never become an expert at procedures WHO CARES! Sure it's important to know what you are doing but it's a very small percentage of your overall job, and as long as you are safe and as long as you make it clear that you're dedicated and persistent, this will say a lot about your character and it will go a long way in terms of your career.

3) GOOD BEDSIDE MANOR!! If you have a good relationship with your patients I guarantee those nerves won't kick in nearly as bad.

4) LOOK CONFIDENT!! Trust me, it changes how the people in the room react to you. If you own the room, you're always on the ball, and you inspire confidence and trust; no one is going to care about a little tremor AND having a room full of people who are confident in you and trust you will definitely cause you less stress than having an uncertain patient and his/her entire family staring at you silently while you work...anxiety building..

Things to remember whether you're tremors are medicated or not:

You are not performing surgery; phlebotomy and IVs don't require remarkable dexterity and, as long as you're competent intellectually, worst case scenario you're still NOT going to kill anyone if you miss a superficial vessel. Of course this doesn't mean that you should treat your patient like a pin cushion but remembering this will hopefully help you relax which should improve your performance.

When you're new it is easy to get nervous and feel rushed when doing simple procedures which can cause you to rush, make mistakes, miss that easy vein. Get over it and take your time.

[neuron]

If you have tremors, this could be exacerbated by anxiety, so if you are being watched, such as if you are giving a bolus feeding (g-tube feeding where you have to hold the 60 ml syringe straight up for 10 minutes and 'wait' for the feeding to go down) and make you look nervous when you are not. Just be honest, but don't disclose it as a safety issue.

Have the neurologist prescribe something. Or maybe something to control anxiety (not sure if St. John's Wort (OTC) would help you, but they have quick release tablets that I took in nursing school), if you don't have health insurance right now.

[AnnieNP, MSN, NP]

Follow up with your primary for proper diagnoses and possible treatment.

[Lucydog14]

My daughter takes propranolol . It really helps.

[waterdrifter]

I was diagnosed with benign essential tremor after a childhood accident. I was prescribed Propranolol and it helps immensely. It is the only medication which is approved by the FDA for BET. I suggest going to visit your PHP and inquiring about it. I take 20mg BID and my tremors are barely noticeable now. Just remember to check your heart rate before taking it.