New nurse with lupus

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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I recently graduated from nursing school and passed my NCLEX. But I have not began job searching due to my recent diagnosis for lupus. I'm worried whether or not I can do nursing. I plan to work part time and avoid working big hospitals and pursue mental health facilities, hospice, or skilled nursing care.

However nursing is known to be physically and mentally stressful. I'm worried because I'm struggling to tolerate the symptoms. I get mild to moderate flare ups pretty frequently. My symptoms are nausea, vomiting, muscle aches, fatigue, brain fog, headache, skin rashes, swelling, nerve pain, itching. Nausea and vomiting is moderately frequent so I struggle to eat and keep food in, which affects my energy levels.

From clinical experience, I noticed that whenever I work, I'll be physically fine but in a few weeks to months, my symptoms will get severe and I am so fatigued, cannot concentrate, and my immune system will start attacking a body system. Then I get hospitalized.

I literally do not know what strategies to use to cope with lupus as a future nurse? I started on plaquenil and I'm giving it some time for the effects to kick in. My plan to work part time and avoid hospitals is a start. But other than that I do not know how to avoid flare ups esp since they're so common. I feel so lost on what to do. I get so tired and either cannot concentrate and/or slowed thinking. I'm worried I wouldn't be able to give my patients the best attention.

It's hard for me to sustain any job because of this. Im hoping part time work and medications will help.

Im even debating if I should stop nursing all together because I'd earn too much money to qualify for low income medi-cal insurance. But I won't be able to sustain a job and pay for medical expenses. And part time positions generally do not offer health insurance or benefits. Should I even bother to work?

Any advice on how to cope would be helpful! Or any insight on my situation and whether mental health, hospice, or skilled nursing is a a good choice for lupus

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Specializes in Tele, ICU, Staff Development.

First of all, congratulations on passing your NCLEX and graduating nursing school—that's a huge achievement! Job searching as a recent grad with a new diagnosis of lupus is tough. 

Yes, you can work as a nurse with lupus. It takes close attention to your body, staying out of the sun, eating well, resting, eating nutritious food, and managing your health and condition.

Much depends on your situation, including your mental framework and desire to make it happen.

I would not necessarily decide not to work before you've given it a go because you can't get back this first year. Job opportunities decrease the longer you go without working. You put in considerable effort to get where you are, and it's worth your best shot.

You're not alone in facing this challenge, and I think it's wise to think about part-time work and specialized areas like mental health, hospice, and skilled nursing, which can offer more flexibility.

You're taking proactive steps by starting on Plaquenil and planning to adjust your career around your symptoms, which is excellent. But you're right—nursing is physically and mentally demanding, and it's crucial to protect your health as much as possible. Here are some strategies that could help you manage your symptoms while working as a nurse:

Work Schedule and Environment

  • Part-time. You've already considered this; finding a part-time position could be a significant first step. Part-time work gives you more time to rest and recover between shifts, critical for managing your energy and preventing flare-ups.
  • Avoiding large, high-stress hospital environments is also smart, especially if you're prone to flare-ups from physical and mental stress. Hospitals are demanding and often have long, unpredictable shifts. Mental health facilities, hospice care, and skilled nursing can offer a quieter, more structured environment to support your condition better.
  • Flexible shifts. Look for jobs with flexible hours that allow you to adjust your work schedule. Many smaller healthcare facilities, like outpatient clinics, mental health centers, or home care positions, may offer flexibility in hours and caseloads.
  • Listen to your body. It's essential to pay attention to your body's signals. If you're feeling symptoms like fatigue, brain fog, or pain, modify your work schedule or take breaks as needed. You may need to adjust your workload or take more frequent breaks during the day.
  • Stress management. Since mental and emotional stress can exacerbate lupus, try implementing stress-reducing practices like deep breathing, meditation, or gentle stretching throughout the day. These practices could help you manage stress while working and may help prevent flare-ups.
  • Hydration & nutrition. Since nausea and vomiting are issues for you, maintaining hydration and nutrition is vital. Consider eating small, frequent meals. Keep snacks available that are easy to tolerate when you're struggling with nausea. Sometimes, a high-protein drink or smoothie can help maintain energy levels when solid food is challenging to keep down.
  • Sleep & rest. Prioritize sleep and rest between shifts. Fatigue can be a massive trigger for flare-ups. Ensuring adequate recovery time is essential in managing your condition.

Finding the Right Specialty

  • Mental health nursing could be a good fit because its emotional and psychological demands often differ from those of other areas of nursing. It tends to have more predictable hours, fewer physical demands, and usually less immediate physical strain than bedside or ICU nursing.
  • Hospice nursing is another area that may align well with your needs. Hospice nurses usually have less physically demanding work and spend more time supporting patients. This could also help reduce stress, as the work centers around comfort care rather than acute care.
  • Skilled Nursing Facilities (SNFs) can offer a more predictable and lower-stress environment than hospitals. Although the patient population may be older or chronically ill, physical demands, such as lifting and moving patients, can still occur. Therefore, you'll want to ensure that the specific facility and role align with your energy levels and physical capabilities.
  • Consider pre-op admissions as a low-stress role.

Mental Health Support 

Therapy and support groups. Lupus is mentally and emotionally taxing, and seeking support can make all the difference in coping. Therapy, either in-person or online, can help you manage any stress, anxiety, or depression that might arise from living with lupus while working as a nurse. Connecting with other nurses with chronic conditions or finding a lupus support group might also be beneficial for sharing strategies and experiences.

Workplace Accommodations

Workplace flexibility. You could also consider requesting workplace accommodations if you work in a physically demanding setting. For example, you might ask for:

  • A modified work schedule (such as shorter shifts or fewer days per week).
  • The ability to take more breaks as needed.
  • Tasks that minimize physical exertion (such as paperwork or admin duties, if possible).

Taking It One Step at a Time

Don't rush into full-time. It's perfectly okay to take your time to build up your stamina. Even after you've gained some experience working part-time, you can reassess your situation and see if you're ready for a full-time position or need to continue with part-time work. The important thing is pacing yourself and adjusting as needed.

Conclusion

You don't have to stop nursing altogether if you don't want to—there are strategies, specialized areas, and adjustments that can help you maintain your health while still working in the field.

Take small steps, prioritize your well-being, and trust that you will find the right balance. You might also want to connect with others with chronic conditions and work in nursing; they may have valuable insights into what has worked for them.

You're taking an excellent, thoughtful approach by planning for your health, and you can find a way to make nursing work for you.

Best wishes,

Nurse Beth

Diagnosed with lupus, can I still be a nurse?

National Organization of Nurses with Disabilities

Lupus Foundation of America

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