New Grad RN with lupus/First Job

[Ashlee245]

Hi all,

i am new to all nurses, and have been reading posts on here for some time. I am really struggling with a recent decision Ive made to work as a RN on a busy post surgical unit, I have been in remission of systemic lupus for 5 years, used to take plaquenil 200mg 1x day, my main symptom was the butterfly rash on my face, and rashes to the body during times of stress or sun exposure, over the years i have felt fine, after my initial flare up , no flare ups since 2011 and i have made it through an accelerated nursing program with with no problems. I now have moved to a new location , accepted into a great residency program and working 12 hr shifts 3x a week. I have always had a dream of working on a hospital unit, keeping busy, and having a profession i would be continuously learning and helping others . Now six months into my nursing residency i am experiencing extreme fatigue , joint pain, neck and shoulder pain and overall anxiety and stress. I have visited a rheumy in the new hospital i work in and i her advice was mainly lifestyle changes (i.e eating better, exercise and taking a muscle relaxant to sleep for the neck and shoulder pain) , and she also suggests going back on medication to prevent future flare ups, she asked about modifying my work schedule but i signed a contract to work for 2 years full time. I would love to exercise more but i just don't have the energy, after working 12 hour shifts I am drained and I need sleep/rest for 12 to 18 hours just to recover and be able to resume my normal activities. Before going to work , i sometimes cry because of how tired i am and i just dont know how my body will make it through the shift, .Its hard taking care of sick patients when you feel miserable/tired and just want to go home.I have tried splitting my 3 days up so that i am able rest more in between and it helps slightly, but my energy levels are extremely low, i have been taking fish oil, vit d , and women's vitamins and nothing works, I am worried about how much longer i will be able to work on a busy floor such as mine before the stress and physical exertion of the job will cause my lupus to affect other parts of my body. If this position is going to require me to have to go back on medication , im contemplating my decision and I would like to try working part time or moving to a nursing position within the hospital that isnt so strenuous, but im not sure how well that will go since i signed a contract. Any other lupies out there have advice?

[motor_mouth, MSN, RN]

Not lupus, but I do have symptoms of a few different autoimmune disorders. The horrible fatigue part of it all started ~6 months after I got my first RN job also. I am on Plaquenil now and that seems to be helping in a general way. Nursing in general is stressful, and being a new grad more so. Only you can know if it's too much though.

[traumaRUs, MSN, APRN]

Moved to Nurses with Disabilities.

[Horseshoe, BSN, RN]

I don't have an autoimmune disorder, so I'm just wondering aloud:

When I have had periods where I didn't exercise much (or at all), I had much more fatigue, many more musculo-skeletal problems, and other various ailments. I have chronic neck/back issues, fwiw, hx of neck surgery and ddd. When I go back to an exercise program, all my general fatigue levels, physical ailments and overall aches and pains get worse at first. Over time, as I get stronger from the exercise, my endurance improves, as does my general fatigue and all my chronic pain issues. The reason you feel so tired between shifts may be because you are out of shape.

You may not be able to exercise as vigorously as a healthy athlete, but your lack of exercise may, over time, actually exacerbate your symptoms. Even just taking a daily rigorous walk, riding your bike around the neighborhood, yoga, or other similar exercise may help immensely. Yes, you feel completely drained after working a 12 hour shift. But some of that may be due to your lack of physical strength as a result of not having an exercise regime rather than the fact that you have an autoimmune disease.

Give it some thought...you might be able to turn things around with the proper amount of and level of exercise. Finding the right activity at the proper intensity level could really help you in the long run.

[pixierose, BSN, RN]

First off, I'm so sorry you're going through this. I don't have lupus but another autoimmune disorder, and have been through stretches where I'm absolutely wiped out, among other symptoms. When you wake up after 13 hours of a 'good' nights sleep, only to still be so tired you could sleep for 13 more ... it's a miserable stretch of time.

But I have to say, even though Horseshoe doesn't have an autoimmune disorder, she hits a great point: the less you exercise, the absolute worse the fatigue. You may not be able to do something truly strenuous like a bike ride, but a walk or a yoga class are really good activities for people with autoimmune disorders. Moving will help your mood too -- at least, it did for me. Overall, the more I got around, the less fatigued I felt. The hardest step was always the first one: getting off my sofa.

I hope it eases up soon (and I'm throwing the middle finger at your lupus! Autoimmune disorders ... always picking the perfect time to mess with your life)

[miranda819, BSN]

I hope you find a way to continue to work. I have an autoimmune disease called dermatomyositis. I am on methotrexate, plaquenil, and muscle relaxers. I have been unable to work for over a year now. I desperately want to go back to work, but I don't know if I ever will be able to. Right now I'm under doctors orders to stay home. The only advise I can give you is to listen to your body. Good luck, I hope you have a balance to keep working.

[Axgrinder]

Does your hospital have Reasonable Accommodations Commitee? You could check with them if so. Sit down with your rheumatologist and decide what would work best for you overall, then get a MD's note stating what you need for health reasons.

I had to medically retire from nursing for ten years due to SLE. I thought I would never work again, but here I am over two years returned to nursing.

I worked ICU and just couldn't do it physically any more. I get it, it's hard to be therapeutic as a nurse when you feel so drained yourself. But take heart: the are ways to tweak your work environment. Have you ever heard of the ADA? Check it out - it's against the law for an employer to discriminate against an employee with a disability.

I left bedside pt care for telephone triage nursing, and guess what? I love it, and discovered I'm really good at it too. I work from home (in my pajamas), my co-workers are a great group of nurses, and I have a super boss too. Plus, it's the fastest commute I've ever had! Everything I had hoped for (and everyone said I wouldn't be able to find a work from home nursing job).

Check out the ADA online, and discuss a possible 504 accommodation plan for work with your MD. See if your hospital has a Reasonable Accommodations Committee, and go from there. If you are part of a union talk to them too. I think you may be able to cobble together something workable for yourself to make things easier. Good luck!

[Me2kuul, ASN, BSN]

Hi! I have an odd combo of rheumatoid arthritis, and lupus (i have a random sprinkling of symptoms from both). To combat the fatigue, I take iron, vitamin C, vitamin D, cinnamon tablets, multi-vitamin, and a B12 complex. I never would have made it through nursing school preceptorship without those supplements lol. I never do a hardcore workout on the days I have long shifts, but I do complete cardio on my days off. Try yoga, pilates, or similar stretching workouts on days when your body is still fatigued. I also try to sleep for 12 hours, like you suggested, on my days off, and avoid caffeine. I'm currently in the graduate nurse hiring phase, and I had to turn down positions in med/surg & ICU. I was a tech in both of those departments in nursing school, and I know my body cannot handle it. Have you ever thought about switching to pediatrics, women's health, or mother baby? I feel your pain!