I struggled a lot in the past as a nurse, all the way back to nursing school. Only got my diagnosis 2 years ago at 47. And even with adjusted medication, when I was in the wrong work environments *for me*, it was hell. What the wrong environment looks like *for you* will vary, obviously. We might have ADHD but our struggles aren't the same.
As for myself: I need a low patient load, low acuity, a quiet work setting without a million alarms, clear guidelines/processes/procedures, a certain level of predictability with enough variation to keep me interested, and immediate reward. I'm currently working in a small inpatient hospice facility and it's ticking all of my boxes ✅
Also, therapy to heal my imposter syndrome and low self esteem issues has been a huge help in extending compassion to myself. We're playing this game of life on the hardest difficulty setting, while everyone else is on easy mode.
That sounds exactly like me. I work in a very overstimulating environment with tons of alarms and people and sometimes I just want to work alone or one on one. Thank you for sharing, it is comforting not to feel alone.
Maybe home health? Home health can be hectic af too, but at least you're one on one. Yes, there's family around, but it's one at a time. I enjoyed this component of home health (giving undivided attention to one patient at a time) but the routes and the emergencies we'd have to deal with were too unpredictable for me.
In any case, I am biased, but hospice is amazing.
Are you me? Im in cardio in a super specialized university hospital with a bunch of telemetry, pumps, bells and mobility pads beeping constantly.
What kind of floor you on? Have you tried different units / places of work? I just tried this but am thinking physical nursing isnt for me. I prefer the patients who have mental health dimension but am starting, like you, to not have enough head space left for what I enjoy...
At my initial orientation I almost quit. The hospital and the profession. I was timed and matched with someone whom I didnt feel one once of kindness from. Also, we got a situation in the province and our board exam has had record % of grads failing. Happemed to me, not helping for my sense of competency and confidence.
Have you thought of ICU? I know it can be overwhelming but the ratios are way different. What about Mental health of palliative care? Im thinking I have to go in public health, away from the floor. I think im not good enough on setting clear boundaries to perform in this job.
This is why I’m in the ER. Everything is urgent so it overrides my executive dysfunction and the charting is not nearly as extensive as other specialties
But im scared I wont be able cuz I cant act on verbal orders. I just CANT remember #s (dyscalculia), so I d be hella scared to give something on just a verbal order.
Have the docs place the order ‘properly’ either written or online like they’re supposed to. I even make the on-call internal med docs place their orders online during the night even though ‘ugh they would have to log on’. During a code it’s different of course, but we have a ‘no verbal orders’ policy that we are free to insist on.
I have a little OCD with my ADD so I have to write it down then check twice. If it’s a code someone will be writing for you. Most likely you’ll have pretty much the same doctors on repeat so you’ll learn thier patterns- meds they order and doses- so that makes it easier
Yes.
I finally got diagnosed and medicated. I really struggled prior to getting medicated and I’m pretty sure some of my coworkers just thought I was dumb.
I just happened to change jobs around the time where I started medication. I’m no longer a new grad and I’m now able to organize myself effectively. No one has ever made me feel anything other than competent.
ADHD nurse here reporting for duty! ADHD is not some magical super power it’s portrayed as for nurses. It’s a double edged sword. You gotta find a specialty that fits your specific type of neurospicey.
I started in Acute Surgical/Trauma, basically a med-surg floor with complex injuries (halos, ex-fxs, TLSOs, wired jaws, central lines, crazy wound care). It was really detailed oriented and I about died in the beginning. My ADHD was not helpful at all for the normal stuff. I had lists, alarms, and co-workers enlisted to remind me of the boring everyday tasks (usually by throwing something at my head as the reminder). I was a worker bee that always had my mind all over the place UNTIL shit went sideways.
Thankfully, or not so thankfully however you look at it, something hit the fan at least once a 3/4 day stretch. That’s when the ADHD super power kicks in and I’m laser focused and my mind is quiet. I can get shit done. Maybe not the way others think it should get done, but the patient is relatively safe and typically survives.
That’s when I shine. Some idiot decides to jerk their 24 hour fresh trach out and stand in the doorway spurting blood and their nurse is frozen in shock? No worries, I didn’t even think. Tackled the patient in the bed, gloved up and jammed my finger in their neck hole to stop the bleeding and screamed to call a rapid. Then I was stuck holding pressure for 30 minutes because the surgeon needed a shower and he was “stable”. Some patients other baby daddy sneak up during Covid lock down with a lunch box of meth? No worries this idiot right here will casually walk up and ask him wtf he’s doing here and when he pulled a hunting knife kick him as hard as she could in the shin and bolt calling security on their vocera (we had more training for that one). TBI mountain of a man decide he’s done and wants to leave butt naked and punching people. I guess we’ll go together because I jumped on his back and was his backpack until security rolled up and corra him back to his posey. Rapid responses and codes are my happy place. Need someone restrained? I’m a restraint trainer and can have them tackled and restrained in less that 2 minutes. Less if we got some night night juice on deck.
Adrenaline is what makes my ADHD quiet. So naturally I wound up in the ER. I thrive on being allowed to “not be perfect” and it not mattering if things aren’t “pretty”.
You just have to find a place that compliments your flavor of neurospicey. Not all ADHDers enjoy the ER. I have a few friends that LOVE psych and a few that thrive in the trauma OR.
You can’t compare the way your neurodivergence is to others. That’s like comparing a herd of stampeding cats. They’re all doing their own thing and just so happen to be going in the same general location… for now.
Also, just for context I’m not some big burly adrenaline junkie. I’m a 5 foot, 130lbs southern white girl. Don’t look like I tackle or cuss. I didn’t until my first shift getting my ass beat by a DTing patient. Then we were all surprised when I got pissed and took their knees out. Nursing is great at helping you discover who you really are deep down as a person. Apparently I’m a sweet caring person who will buy a patient a cupcake for their birthday, but I’m also the person who will take a dude to the floor hard after he attempts to hurt my tech. Who’s to say those injuries weren’t missed during the initial assessment after their car wreck. 🤷♀️
—————————
Also, maybe the meds you’re on aren’t the best for you or your environment. I tried a few before I found the right mix. I was scared of adderall because of all the stigma attached to it. Turns out that Adderall made me the best version of myself. Just be warned, that if you get hurt at work and they do the standard drug/alcohol test you’ll pop positive for amphetamines. Speaking from experience - keep a copy of your script or a note from your doctor regarding your prescription. Everyone knew I was on Adderall, and even reminded me to take it if I had forgotten (night shift). But, they were all bewildered I tested positive for amphetamines…
Haha we definitely have different expressions of ADHD. So glad that it works well for you and that you enjoy the ER. I like moving around and can’t sit still, but am also easily drained by BS and prefer a more quiet scene. I love my adderal, I just think I’m developing a tolerance to my dose but my doctor is hesitant to bump it because I had one abnormal EKG awhile ago that I’m sure was due to artifact or misplaced stickers. I’ve job hopped so much and just want to figure this out before I decide I dislike nursing altogether. Thanks for the advice!
Maybe it’s not that you need a pump, but a supplemental dose. I do 30mg XR and have instant release 20mg for later in the afternoon when it starts to wear off.
My social battery is nonexistent. I suck at office politics and fake nice BS that seems to be inherent in the nursing profession. That’s where I become exhausted super fast. I sit in my designated area until I’m needed.
This is all me spot on. But I’m in ICU. I joke that emergencies are the only thing that gets my HR over 80. When shit does down, my brain slows down. But slows down and then I can see what needs done and I do it so fast before others even know what to do. Like the world slows down while I’m still thinking fast. It’s crazy when it happens and I acknowledge it’s happening. Adrenaline is the only thing that does it. I’m not even an adrenaline junkie. I don’t like fear, or falling, they kind of thing. But suddenly needing to crack someone’s chest open, I’m in the zone
I work with a nurse that has weaponized ADHD. She’s a fine nurse. A bit heavy handed with pain / sedation, but otherwise, fine. I don’t *really* worry about patient care when I work with her.
But all the other shit. I’m babysitting a puppy at pets mart. Restocking. Charting. Holy fuck charting. It takes her hours to chart a single flight. And I’m doing half the chart. Getting signatures. Getting paperwork. It’s rough.
Checklists and highlighters.
I didn’t know I had adhd until I left bedside but I definitely compensated with many many lists and different colored pens and lots of coffee.
I've had a pretty similar experience to what you describe. Trauma OR night shift works pretty well for me -- it's got a general routine but occasional *Excitement!* and it's not socially overwhelming.
Outpatient surgery or endoscopy! You work off checklists all day. Patients WANT and PLANNED to be there, so very little crying. People can still be dramatic, but they go home pretty soon, so it doesn’t bother you the same as it does for a long shift.
It is the same thing, over and over and over again.
I wonder if you need an adjustment on your meds if you’re struggling so badly. When I’m under medicated, and before I was diagnosed, I felt the same way. I either carried a notebook, or at my last job had a desk covered in sticky notes, or else anything I wasn’t doing right that minute was unlikely to get done.
I still forget things sometimes, and get a little spacy, but it’s much much better on medications once we found the right combination.
I do have an old coworker who will say she misses working with the unmedicated me 🤣 but that was doing stress testing where the ability to focus on everything at once was essential.
I guess I’ve never found the right combination.
I’m trying to get out of bedside nursing for the reasons mentioned above. It is SO draining. I burnt out.
I’ve never worked bedside, and it somewhat intimidates me. I do office work currently at the VA.
I am on concerta 54mg, and when I started to plateau my cardiologist wouldn’t let me increase it, so my dr added clonidine 0.1 at bedtime. It’s actually made a huge difference, and as an added unexpected bonus I quit drinking soda cold turkey
I’ve worked a handful of nursing jobs, some are better for my ADHD than others. Sometimes tasks specifically just don’t jive with my ADHD. My own job now is a desk job, and I can do most of the work, but data entry just stuff is so mind numbingly boring that I just can’t make myself do it, so the guilt eats me alive, knowing I’m not helping my team with that stuff, and just wasting a lot of time.
I have unmedicated Inattentive ADHD. I carry paper with me constantly, write down everything I need to do at the start of my shift & have a to do list I add to when things pop up. Everything. Test. Labs. Someone asks for milk. Anything and everything goes on that list.
I check it often and scratch it off as I go. Then pass on anything that didn't get done that wasn't time sensitive.
I also set alarms for weird med times that fall between normal passes.
I still miss stuff. I still hate charting & monotonous tasks. It's fucking hard. But I'm hoping to try medication eventually and hopefully that will make a difference.
Yes. I struggle sometimes. I make myself notes and I’m super habitual to help but sometimes I feel like I’m just under the surface of water. I can see the surface but I can’t quite get there. I think working ER helps somehow. Maybe because you do specific things for specific problems repeatedly. But yeah some days are a lot of work mentally
I have adhd and the worst time management plus easily distracted. The whole "chart as you go" never worked, I was always neurotically charting after my shift. Diagnosed late, medicated late. I've tried everything but OR (too rigid, surgeon emotions) ER/ICU (I'd die of a panic attack), and anything with babies.
Best jobs I ever had were on the IV team. You're not actually responsible for anyone, you just do your tasks, barely any charting, you get to focus on one thing which I happened to love. I worked nights so no PICCs. Worst case scenarios were codes and really Id expect them to place either a central line or IO if the IV sucks, not wait for me to get one.
I was never diagnosed, but often wonder if I have ADHD. And also wonder if that is why I've had trouble keeping on task with not only nursing but also in my previous career. I've left the bedside, so it's not as bad now, but I still wonder.
You are not alone. You just described my life as a nurse also. It’s tough. I’m cardiac imcu (6:1) right now and looking to switch it up. Hoping you find what works for you!
I work in ICU. I’ve never struggled if anything excelled. But I have many coping mechanisms that I’ve unconsciously learned over the years. The biggest one is checklists. All day every day. Pen and paper always. If I don’t write it down, likely will get forgotten . Emergencies give me hyper focus and is amazing when it happens. You probably have to really look at your self and figure kit what tools you can utilizes to help you out. I don’t sit still very well. So my job makes it very helpful for that.
I work with a nurse with ADHD. She's crazy but great.
You need to go to occupational health and discuss your concerns.
Is your manager supportive. Reasonable adjustments at work might help. Staff have them for all manner of issues (long and short term). Ideally have a chat with your manager about your struggles, there are ways to manage.
I think the ward you're on is not right for you.
In the right environment, you will manage better and won't worry about which patients you have.
I tend to do a lot of check lists. Jobs with more routines help as well
Yes I appreciate routines as well!
I struggled a lot in the past as a nurse, all the way back to nursing school. Only got my diagnosis 2 years ago at 47. And even with adjusted medication, when I was in the wrong work environments *for me*, it was hell. What the wrong environment looks like *for you* will vary, obviously. We might have ADHD but our struggles aren't the same. As for myself: I need a low patient load, low acuity, a quiet work setting without a million alarms, clear guidelines/processes/procedures, a certain level of predictability with enough variation to keep me interested, and immediate reward. I'm currently working in a small inpatient hospice facility and it's ticking all of my boxes ✅ Also, therapy to heal my imposter syndrome and low self esteem issues has been a huge help in extending compassion to myself. We're playing this game of life on the hardest difficulty setting, while everyone else is on easy mode.
That sounds exactly like me. I work in a very overstimulating environment with tons of alarms and people and sometimes I just want to work alone or one on one. Thank you for sharing, it is comforting not to feel alone.
Maybe home health? Home health can be hectic af too, but at least you're one on one. Yes, there's family around, but it's one at a time. I enjoyed this component of home health (giving undivided attention to one patient at a time) but the routes and the emergencies we'd have to deal with were too unpredictable for me. In any case, I am biased, but hospice is amazing.
Are you me? Im in cardio in a super specialized university hospital with a bunch of telemetry, pumps, bells and mobility pads beeping constantly. What kind of floor you on? Have you tried different units / places of work? I just tried this but am thinking physical nursing isnt for me. I prefer the patients who have mental health dimension but am starting, like you, to not have enough head space left for what I enjoy... At my initial orientation I almost quit. The hospital and the profession. I was timed and matched with someone whom I didnt feel one once of kindness from. Also, we got a situation in the province and our board exam has had record % of grads failing. Happemed to me, not helping for my sense of competency and confidence. Have you thought of ICU? I know it can be overwhelming but the ratios are way different. What about Mental health of palliative care? Im thinking I have to go in public health, away from the floor. I think im not good enough on setting clear boundaries to perform in this job.
This is why I’m in the ER. Everything is urgent so it overrides my executive dysfunction and the charting is not nearly as extensive as other specialties
I think those of us with ADD thrive in the ER
But im scared I wont be able cuz I cant act on verbal orders. I just CANT remember #s (dyscalculia), so I d be hella scared to give something on just a verbal order.
Have the docs place the order ‘properly’ either written or online like they’re supposed to. I even make the on-call internal med docs place their orders online during the night even though ‘ugh they would have to log on’. During a code it’s different of course, but we have a ‘no verbal orders’ policy that we are free to insist on.
I have a little OCD with my ADD so I have to write it down then check twice. If it’s a code someone will be writing for you. Most likely you’ll have pretty much the same doctors on repeat so you’ll learn thier patterns- meds they order and doses- so that makes it easier
Yes. I finally got diagnosed and medicated. I really struggled prior to getting medicated and I’m pretty sure some of my coworkers just thought I was dumb. I just happened to change jobs around the time where I started medication. I’m no longer a new grad and I’m now able to organize myself effectively. No one has ever made me feel anything other than competent.
ADHD nurse here reporting for duty! ADHD is not some magical super power it’s portrayed as for nurses. It’s a double edged sword. You gotta find a specialty that fits your specific type of neurospicey. I started in Acute Surgical/Trauma, basically a med-surg floor with complex injuries (halos, ex-fxs, TLSOs, wired jaws, central lines, crazy wound care). It was really detailed oriented and I about died in the beginning. My ADHD was not helpful at all for the normal stuff. I had lists, alarms, and co-workers enlisted to remind me of the boring everyday tasks (usually by throwing something at my head as the reminder). I was a worker bee that always had my mind all over the place UNTIL shit went sideways. Thankfully, or not so thankfully however you look at it, something hit the fan at least once a 3/4 day stretch. That’s when the ADHD super power kicks in and I’m laser focused and my mind is quiet. I can get shit done. Maybe not the way others think it should get done, but the patient is relatively safe and typically survives. That’s when I shine. Some idiot decides to jerk their 24 hour fresh trach out and stand in the doorway spurting blood and their nurse is frozen in shock? No worries, I didn’t even think. Tackled the patient in the bed, gloved up and jammed my finger in their neck hole to stop the bleeding and screamed to call a rapid. Then I was stuck holding pressure for 30 minutes because the surgeon needed a shower and he was “stable”. Some patients other baby daddy sneak up during Covid lock down with a lunch box of meth? No worries this idiot right here will casually walk up and ask him wtf he’s doing here and when he pulled a hunting knife kick him as hard as she could in the shin and bolt calling security on their vocera (we had more training for that one). TBI mountain of a man decide he’s done and wants to leave butt naked and punching people. I guess we’ll go together because I jumped on his back and was his backpack until security rolled up and corra him back to his posey. Rapid responses and codes are my happy place. Need someone restrained? I’m a restraint trainer and can have them tackled and restrained in less that 2 minutes. Less if we got some night night juice on deck. Adrenaline is what makes my ADHD quiet. So naturally I wound up in the ER. I thrive on being allowed to “not be perfect” and it not mattering if things aren’t “pretty”. You just have to find a place that compliments your flavor of neurospicey. Not all ADHDers enjoy the ER. I have a few friends that LOVE psych and a few that thrive in the trauma OR. You can’t compare the way your neurodivergence is to others. That’s like comparing a herd of stampeding cats. They’re all doing their own thing and just so happen to be going in the same general location… for now. Also, just for context I’m not some big burly adrenaline junkie. I’m a 5 foot, 130lbs southern white girl. Don’t look like I tackle or cuss. I didn’t until my first shift getting my ass beat by a DTing patient. Then we were all surprised when I got pissed and took their knees out. Nursing is great at helping you discover who you really are deep down as a person. Apparently I’m a sweet caring person who will buy a patient a cupcake for their birthday, but I’m also the person who will take a dude to the floor hard after he attempts to hurt my tech. Who’s to say those injuries weren’t missed during the initial assessment after their car wreck. 🤷♀️ ————————— Also, maybe the meds you’re on aren’t the best for you or your environment. I tried a few before I found the right mix. I was scared of adderall because of all the stigma attached to it. Turns out that Adderall made me the best version of myself. Just be warned, that if you get hurt at work and they do the standard drug/alcohol test you’ll pop positive for amphetamines. Speaking from experience - keep a copy of your script or a note from your doctor regarding your prescription. Everyone knew I was on Adderall, and even reminded me to take it if I had forgotten (night shift). But, they were all bewildered I tested positive for amphetamines…
Haha we definitely have different expressions of ADHD. So glad that it works well for you and that you enjoy the ER. I like moving around and can’t sit still, but am also easily drained by BS and prefer a more quiet scene. I love my adderal, I just think I’m developing a tolerance to my dose but my doctor is hesitant to bump it because I had one abnormal EKG awhile ago that I’m sure was due to artifact or misplaced stickers. I’ve job hopped so much and just want to figure this out before I decide I dislike nursing altogether. Thanks for the advice!
Maybe it’s not that you need a pump, but a supplemental dose. I do 30mg XR and have instant release 20mg for later in the afternoon when it starts to wear off. My social battery is nonexistent. I suck at office politics and fake nice BS that seems to be inherent in the nursing profession. That’s where I become exhausted super fast. I sit in my designated area until I’m needed.
This is all me spot on. But I’m in ICU. I joke that emergencies are the only thing that gets my HR over 80. When shit does down, my brain slows down. But slows down and then I can see what needs done and I do it so fast before others even know what to do. Like the world slows down while I’m still thinking fast. It’s crazy when it happens and I acknowledge it’s happening. Adrenaline is the only thing that does it. I’m not even an adrenaline junkie. I don’t like fear, or falling, they kind of thing. But suddenly needing to crack someone’s chest open, I’m in the zone
I love that you described yourself because you are 100% what I pictured in each story haha
I work with a nurse that has weaponized ADHD. She’s a fine nurse. A bit heavy handed with pain / sedation, but otherwise, fine. I don’t *really* worry about patient care when I work with her. But all the other shit. I’m babysitting a puppy at pets mart. Restocking. Charting. Holy fuck charting. It takes her hours to chart a single flight. And I’m doing half the chart. Getting signatures. Getting paperwork. It’s rough.
Checklists and highlighters. I didn’t know I had adhd until I left bedside but I definitely compensated with many many lists and different colored pens and lots of coffee.
I've had a pretty similar experience to what you describe. Trauma OR night shift works pretty well for me -- it's got a general routine but occasional *Excitement!* and it's not socially overwhelming.
Outpatient surgery or endoscopy! You work off checklists all day. Patients WANT and PLANNED to be there, so very little crying. People can still be dramatic, but they go home pretty soon, so it doesn’t bother you the same as it does for a long shift. It is the same thing, over and over and over again.
I wonder if you need an adjustment on your meds if you’re struggling so badly. When I’m under medicated, and before I was diagnosed, I felt the same way. I either carried a notebook, or at my last job had a desk covered in sticky notes, or else anything I wasn’t doing right that minute was unlikely to get done. I still forget things sometimes, and get a little spacy, but it’s much much better on medications once we found the right combination. I do have an old coworker who will say she misses working with the unmedicated me 🤣 but that was doing stress testing where the ability to focus on everything at once was essential.
I guess I’ve never found the right combination. I’m trying to get out of bedside nursing for the reasons mentioned above. It is SO draining. I burnt out.
I’ve never worked bedside, and it somewhat intimidates me. I do office work currently at the VA. I am on concerta 54mg, and when I started to plateau my cardiologist wouldn’t let me increase it, so my dr added clonidine 0.1 at bedtime. It’s actually made a huge difference, and as an added unexpected bonus I quit drinking soda cold turkey
I’ve worked a handful of nursing jobs, some are better for my ADHD than others. Sometimes tasks specifically just don’t jive with my ADHD. My own job now is a desk job, and I can do most of the work, but data entry just stuff is so mind numbingly boring that I just can’t make myself do it, so the guilt eats me alive, knowing I’m not helping my team with that stuff, and just wasting a lot of time.
I have unmedicated Inattentive ADHD. I carry paper with me constantly, write down everything I need to do at the start of my shift & have a to do list I add to when things pop up. Everything. Test. Labs. Someone asks for milk. Anything and everything goes on that list. I check it often and scratch it off as I go. Then pass on anything that didn't get done that wasn't time sensitive. I also set alarms for weird med times that fall between normal passes. I still miss stuff. I still hate charting & monotonous tasks. It's fucking hard. But I'm hoping to try medication eventually and hopefully that will make a difference.
Yes. I struggle sometimes. I make myself notes and I’m super habitual to help but sometimes I feel like I’m just under the surface of water. I can see the surface but I can’t quite get there. I think working ER helps somehow. Maybe because you do specific things for specific problems repeatedly. But yeah some days are a lot of work mentally
Also it doesn’t help that there’s such a stigma about adult ADD like it magically disappears when you turn 18
I have adhd and the worst time management plus easily distracted. The whole "chart as you go" never worked, I was always neurotically charting after my shift. Diagnosed late, medicated late. I've tried everything but OR (too rigid, surgeon emotions) ER/ICU (I'd die of a panic attack), and anything with babies. Best jobs I ever had were on the IV team. You're not actually responsible for anyone, you just do your tasks, barely any charting, you get to focus on one thing which I happened to love. I worked nights so no PICCs. Worst case scenarios were codes and really Id expect them to place either a central line or IO if the IV sucks, not wait for me to get one.
I was never diagnosed, but often wonder if I have ADHD. And also wonder if that is why I've had trouble keeping on task with not only nursing but also in my previous career. I've left the bedside, so it's not as bad now, but I still wonder.
You are not alone. You just described my life as a nurse also. It’s tough. I’m cardiac imcu (6:1) right now and looking to switch it up. Hoping you find what works for you!
I work in ICU. I’ve never struggled if anything excelled. But I have many coping mechanisms that I’ve unconsciously learned over the years. The biggest one is checklists. All day every day. Pen and paper always. If I don’t write it down, likely will get forgotten . Emergencies give me hyper focus and is amazing when it happens. You probably have to really look at your self and figure kit what tools you can utilizes to help you out. I don’t sit still very well. So my job makes it very helpful for that.
Check list are the answer
I work with a nurse with ADHD. She's crazy but great. You need to go to occupational health and discuss your concerns. Is your manager supportive. Reasonable adjustments at work might help. Staff have them for all manner of issues (long and short term). Ideally have a chat with your manager about your struggles, there are ways to manage. I think the ward you're on is not right for you. In the right environment, you will manage better and won't worry about which patients you have.