A work conundrum

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Image by Arek Socha from Pixabay

To set this up, I’ll give you a bit of background.  A) One of my jobs (although technically it’s contract work rather than a job) is as an injection nurse.  I administer certain kinds of recurring injection medications to patients, and I teach patients how to self-inject various biologic medications.  B) I have a tremor as a side effect from lithium.  This tremor gets worse when I’m tired, over-stimulated, stressed, uneasy, or just generally feeling unwell.

Anyway, yesterday evening I was seeing one of my regular patients for her monthly Abilify injection.  I had taken a prn dose of propranolol an hour before the appointment to help keep my tremor under control.  On the last few visits, I’ve been clumsy preparing injections, and the last couple of injections have been a little bit shaky.  But yesterday evening, my hand started shaking considerably just as I was sticking the needle into her.  She didn’t say anything, but I imagine it must have hurt.

That brings me to the question of whether I should be doing this job.  I don’t accept many patient assignments to begin with, in part because travel time isn’t paid fairly.  Also, I’ve been hesitant to take injection training patients, since that would involve my shaky hands being on full display, and it would require me to remember and spout off all the teaching points for meds I don’t deal with that often (most of them are non-psych meds).  And now I’m concerned about administering injections.  It’s not like yesterday was a totally isolated incident; I’ve been fumbly for a while now, and I’ve had a noticeable decline in work-related functioning over the past year.

In making a decision about this job, I need to prioritize patient care over and above what I want to do for my own sake.  I have a professional obligation to ensure that my practice is safe and effective.  I really shouldn’t be doing injections if I can’t do them properly, it’s as simple as that.

At the same time, there’s something scary about the thought of limiting myself to just my other job, which I don’t like.  And this isn’t the kind of thing where I could request an accommodation, because a) I’m not an employee, and more importantly b) there is no form of accommodation that would stop me from being shaky while sticking needles into people.

I need to think about it some more before I make a decision, but either way I don’t think it’s going to feel very comfortable.

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26 thoughts on “A work conundrum

  1. islaluing says:

    Hello!
    I’m so sorry you have had this experience, it’s rubbish to have the effects of meds end up being the limiting factor in your work.
    I’ve been trying to work through a possibly similar sense of frustration/regret/helplessness due to work limitations caused by pain/meds. I’ve been trying to ask myself if I would feel differently if it were a result of a straightforward, societally-acceptable injury. I think I’d still have regret and sadness, but I don’t know if I would feel the same level of self-criticism lurking in the background (why can’t you just get better?!).
    In my case, it seems to come back to a lack of acceptance that the damage exists and it is real.
    I’m taking time now to try and think outside of the box of capability I’ve always existed within. I hope you are able to work through your conundrum without too much pain,
    Isla

  2. kbr0632 says:

    Oh Ashley. I am sorry to hear this. I don’t think lithium, but I have been having these terrible shakes/tremors too. And not sure why. So I understand having them and wondering if others notice…or think anything about it. Maybe…give it some more time…and think about things. You don’t have to make a decision today..do you? Do you have patients that you are close with..that you can tell them what is going on? Or I guess that might not be good. ??? Like Luftmentsch said…you probably already know your decision..but working up to it…. Give it some time…you will know what to do..and will feel good about that decision.

  3. Invisibly Me says:

    That’s definitely a difficult position to be in, and you’re right about patient safety needing to come first while there aren’t really any accommodations that can be made for that kind of job. Obviously this needs to be your call, but I think you perhaps already know the answer. If you decided to call it a day with the injections, then In place of this perhaps another avenue to explore will open up in the near future so you’re not relying on the second job.. xx

  4. sophienaylor1 says:

    This is quite the conundrum! I know the goal in these situations is always to have a straight answer, but in this situation there isn’t one. No-one can tell you whether to leave your job – that’s completely your choice and only YOU know what you should do. I will say that the fact you’re considering it may be time for you to take some time off is quite telling, and it is important to remember to think of the patients over yourself (which I can tell you are doing.) Maybe go back to the doctors and ask them what they think and if there’s a stronger dose of propranolol they can start you on? Good luck!

  5. Johnzelle says:

    Thanks for sharing. Sounds like patient care is priority one; however, allow me to reframe this. The tremmors make this job overwhelming, so giving it up reduces your stress and reduces chance of pt injury. Sending positive vibes your way as you make this tough decision 😺

  6. Meg says:

    This makes me so sad!! But I did some research and found loads of chat threads about nurses who have tremors and how they work around it! I wish I had some sort of wise words, but I think you offer great patient care! I’d rather have you giving me a shot than a mean nurse with a condescending attitude any day. I bet your patient didn’t say anything because she wasn’t really bothered by it! No one can be perfect, but you try so hard that there has to be some merit from your efforts!! I say jump into internet searching and talk to people and find a better solution!! There must be one!!

  7. M.B. Henry says:

    So sorry to hear the tremor has made things difficult. These decisions are never easy! 🙁 I hope whatever decision you make, though I know it will be hard up front, makes you more comfortable in the end. Sending warm thoughts your way!

  8. Barb says:

    I think everyone has already said what’s on my mind, but I just had an image of you trying to give me an injection and not succeeding because I have the tremors, too!

  9. Stormy Dormy says:

    You’re job sounds very noble and worthwhile – I’m sure you’ve achieved so much good while you have been there. It’s also about taking care of yourself and your needs – it sounds difficult being in a profession where your health problems are visibly and physically affecting your ability to do the job as well as you’d normally be able to. You’re doing the right thing by thinking about this – I would suggest looking into other things you’d enjoy doing before fully leaving (if that’s what you choose to do), or to take some time off to do so. Don’t worry too much! x

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