The version my story is that I was diagnosed with ADHD/ generalized anxiety disorder when I was a junior in college at a prestigious University. I grew up with a loving the dysfunctional family that was affected by the disease of alcoholism data and I learned a lot of poor coping strategies/ negative thinking patterns that grew into perfectionism and a pleasing. My whole life I have struggled with a lot of learning difficulties, attention issues and anxiety, however I am a very hard worker and basically pushed through my whole life. I was never a straight a student that I always at least past and/or B's and was in advanced classses. The problem with "pushing" is that it works until it doesn't. I spent so much energy to focus on simple things like keeping track of my, and other executive functioning related tasks, that I become easily exhausted and then switch to paralysis.
10 years ago when I was finishing up nursing school I tried medication...but my psychiatrist was not very good and it was never adjusted. Therefore it didn't feel "helpful enough." when I got diagnosed I utilized by University disability Resource Center to receive accommodations for my testing anxiety which was incredibly helpful. Over the years I have been in talk-therapy, Al-Anon, and Adult Children of Alcoholics, as well as done a lot of reading about how to change my perspective. Mindfulness Based Stress Reduction helped, but I didn't keep up with the practice. . I have done a lot of self work on perfectionism, shame, self-compassion. I'm very introspective and self-aware. I got through nursing school and then weaned myself off of the medications. For the next 8 years I worked as a nurse. I struggled with time management, boundaries and poor work life balance. I left that toxic job and decided to go back to school to pursue my nurse practitioner degree. I am utilizing the disability Resource Center and constantly learning about ways I can help myself with my learning struggles. For example I use with dictation to help with my and attention related to typing, I have my computer read my notes to me, I receive extra tests time which helps slow down my brain during exam, and I am working on receiving the transcripts of my online lectures
Now that back in school and working I'm struggling with executive functioning task initiation and task switching. procrastination really bad. If I know that I can get away with not completing a task by a deadline I will push that task without even realizing it.. like say that I know I need to get my charting done by midnight I will take the same amount of time to do it whether I have 2 patients or 5 patients because subconsciously I know that I do not have to get it done in a timely manner. i try to "trick myself" into thinking it's due sooner, but it doesn't work. Same thing with paper writing. I have convinced myself that I write better/am more efficient under pressure and so I work "better" when it is due that day rather than when it is due to weeks from now.
In the last few months I've been having a really hard time keeping up with my charting both at and in school and just constantly stressed /anxious. My normal coping strategies just weren't cutting anymore. I increased my frequency of my talk therapy, and exercising more consistently, and working with my health care provider to begin medication again. I am taking 10 milligrams Lexapro daily, 20 milligrams of Adderall XR daily, with an afternoon boost of 10 milligrams Adderall IR.
Even though I have less she then I used to about being neurodivergent,.. have a lot of fears and concerns about sharing my diagnoses with people in power in my field. Specifically I worry that if I shared my diagnoses I will be criticized or blamed for "mistakes" that everyone is at risk of making when they are overwhelmed or stressed. I actually had a nursing professor tell me explicitly not to disclose my disabilities to employers.
Accommodations in the workplace? I'm curious if anyone who is either an RN or a mid-level provider has been able to receive accommodations in the workplace. Have you been able to ask for a scribe, or other accommodations that have helped with yourtime management difficulties resulting from your ADHD? I would be willing to disclose my disability to my workplace if it could actually help.
Personal time-management strategies- How do you manage ADHD overwhelm? Task initiation difficulty? Managing the day to day stresses and inconsistencies within your day?
Basically I am looking to connect with other healthcare providers that struggle with the things I struggle with. I would appreciate anyone who can reach out to me and share your experience.
There's nothing special about healthcare people having this problem. It crosses all professions. And the truth is you will be held accountable for your performance, just as I am as a teacher.
You need therapy and a coach. You sound really overwhelmed, which really undermines our esteem and confidence, which creates more panic and fear which further undermines our esteem and ability to concentrate.
You need to get to a psychiatrist ASAP.
And you need to get to a therapist ASAP/and or an organization coach (plenty of those online and probably in your city as well.)
The basics are you need to maximize treatment. And relieve some of the pressure. And you need to protect your esteem and not feel so alone.
THEN you can get clear on accommodations. Ask for all the accommodations that you want. Don't worry about the long-term impact. That's self-defeating and putting step 10 in front of step 1.
But yes, there are nurses who report overwhelm on this site, but also lawyers, teachers, doctors, parents, moms, dads, ministers. Heck ADHD interferes with the work life of criminals! And of course students are a top category.
I wish I had an answer for you but it's early days for me and I'm at the stage of deciding whether medication titration is worth continuing as I begin a Masters. If I hear or see anything I feel is helpful I will reply again.
I know this probably sounds too simple and I resisted using it for so long because it seemed too easy or like just another hack that would fail, but I've had great luck using a POM timer for task initiation and switching. It doesn't work perfectly every day but if I'm facing a pile of boring/repetitive/tedious tasks I know it's a timer day.
You can set up the time any way you like, I was told to start with 10 minutes on task and 5-minute breaks and ramp up the "on task" time as I was able to focus longer.
I make it a game, pick the task I least want to do, start the timer and see how much of it I can knock out before the break bell goes off. Usually, I find that a) it takes a lot less time than I estimated to actually complete the task and b) once I've started finishing is easy.
This works best if you have your task list split into manageable steps which is something I have to do anyway to avoid paralysis. Also as a bonus, I started using my 5-minute breaks to walk away from my computer and do a couple of minutes of house work. It could be as small as washing a couple of dishes or folding 3 shirts, but those little bits add up and give me momentum on my least favorite chores while getting me moving around.
I've described this workflow to a couple of non-ADHD friends and family who said it sounds chaotic and they could never work like this, but I've had some of my most productive days ever when I use the timer like this.
Pomodoro timer helps me too (I have an app for it on my phone) - I use it at home to help me get started on a task I might otherwise procrastinate on (like working on finances) or be tempted to get distracted from - when the timer is going it makes me feel like I have to focus (instead of getting distracted with email and web surfing etc) and I focus better with less distraction - I like the idea of using the breaks for chores as I have a lot of trouble making myself do chores too... I often do 30 jumping jacks during part of my break and then do something fun like work on a jigsaw puzzle I have out till the timer goes off - or sometimes I walk around the house and get some steps in...
I'm not a nurse but I do work in healthcare - I'm a physical therapist and work in a hospital setting. My struggles at work are actually the reason I sought help and learned I had ADHD - I had no clue...
I have had such a struggle - unable to keep up with productivity expectations, trouble with time management, prioritization - too slow... My boss had to write me up for not meeting productivity... she is caring and supportive but I guess didn't know what else to do - she had tried so many things to help me - watched me work, given me tips and strategies... I guess they are the kinds of strategies that work for neuortypicals...just do these things and you should be good... but I had a hard time implementing the stuff and still wasn't making it - and she was getting pressure from HR about my numbers... anyway in the process of all this she and her assistant recommended I try counseling...
My counselor is the one who recognized ADHD as a possibility but I didn't recongize it at first even after reading the symptoms list... however with time my counselor became almost 100% sure I had it but wanted me to get tested officially... I just got my diagnosis last month at age 45. And as I have learned more about ADHD I can see it much better and it helps explain my struggles to me...which is validating - that isn't some character flaw holding me back...
I have told my boss about the ADHD - in my case it helped because it confirms there is a problem other than me not getting it together... she already believed in me which is the reason why she didn't fire me... she was trying to stand up for me with HR and having a diagnosis made it much easier for her to do so. My counselor wrote a very general accommodation letter before I got my official diagnosis - telling them she was pretty sure that was what I had and asking them to accomodate me telling them I was in process of confirming the diagnosis which would open the way for possible medication to help. My boss was able to take the letter to HR which I think helped. My counselor says getting accommodations in place can protect your job... I was afraid HR would eventually make my boss fire me - now I guess they can't.
My counselor was planning to make a more specific accommodation letter for me - we talked about some accommodation ideas that might help... but then I started medicine and she kind of wanted to see how that would help before making the letter. I'm on Strattera/Atomoxatine - and it takes awhile for it to work and especially as my psychiatrist is building up the dose very gradually...
I'm trying to accomodate myself some by going to find a quiet place to chart - I used to chart at the nurse's station and sometimes it was hard to concentrate with other conversations and stuff going on around me - I know that might not be an option for nurses though because you have to watch you patients - with us when we are done with our visit we do not have to stay and watch them...
Before I knew about the ADHD and before counseling I used to stay 1-2 hours after I was supposed to go home trying to catch up my charting - and hoping to make up for my inefficiency at least partially - and I still wasn't completely making productivity enough to feel safe.... well my boss found out I was working off the clock and she said that was absolutely not allowed - I had to be on the clock when working even if it was only charting....so that crutch was removed... it is nice to get home earlier - but now I struggle with getting overtime too often and too much because I have to finish before I go home and it requires time management to juggle it right to get out on time and means I have less time to see patients.... my notes take way too long sometimes and I struggle with transitions - lose time with them somehow...
I also struggle with procrastination, difficulty initiating tasks, perfectionism, being too detailed in some areas I am hypervigilant about and hyper-focus on...overwhelm, ...
Sorry I don't have the accomodations thing all worked out yet - I've been scared to ask for some of the things that would help - feeling like it is unfair to my coworkers or that my boss might think some of them (especially the ones that would help the most) unreasonable... my coworkers are nice to me but I think they have been frustrated about me not being able to keep up - and they don't know why - I have only told my boss and one of my coworkers I am close to (and she struggles too - said she would be surprised if she doesn't have ADHD but she hasn't been tested) - so the vast majority of my coworkers don't know why I am not able to keep up...
Not sure you wanted a big long story - I get very wordy in my writing - too much details etc...
For me telling my boss was the right thing - but in my case I was already in trouble and getting talked to often - with hard meetings about my productivity... so it was a relief to have a reason for my struggles and it helped for my boss to know why... despite all the hard meetings she cares and wants to help me - I've been at this job almost 7 years and they haven't given up on me yet...
Although telling my boss was the right thing for me it might not be the right thing for everyone...
I look forward to reading what others write in response to your question and I hope you find solutions that work for you and have wisdom on whether to tell your boss or not - I think it probably depends on the situation.
‘Staying 1-2h after work to chart’. Guilty! I would hide with my charts in empty patient rooms so no one discovered me still there after my shift ( pre-diagnosis). I was so embarrassed that I was still there when everyone else just left so easily. I just couldn’t shift into charting headspace until I knew my patients were being looked after by incoming nurse. We try so hard. We are still excellent nurses, but to our personal detriment, often showing little compassion for ourselves. With high patient ratios it just pushes the limits of all nurses, but this is especially so for adhd nurses!
Just to say your experience with work and job security mirrors mine. In fact especially when one's job is on the line or heading that way you should tell them. They then can't come back anx say they didn't know if it gets to become an unfair dismissal case. Also, most managers want to help it's true.
Yes, very similar issues. Please see my discussions. I’m a previous NP who just finished a MN in research. It can be done. I only got help for all of this less than a year ago. It all works until it doesn’t. Then it’s sheer panic! Sounds like you’re doing some great things though! Find an area of work that doesn’t make you crunch time all day! Keeping to appointment times was brutal for me. My employer finally asked me to disclose my disability. Then they were obligated to accommodate.
Thanks for all of your responses thus far. Gettingittogether I have a psychiatrist, thank you for your concern. I've only been on medication for about a month and we are still adjusting it. It's the first week of a new semester, and it's the first semester I have "clinical rotations" so I'm trying to adjust.
While I recognize ADHD crosses all professions, I'm specifically asking for feedback from health care providers because of challenges I face as a nurse and future nurse practitioner because I am neurodivergent. I recognize I will be held accountable for my performance, as I should... I also am beginning to recognize that the time/productivity expectations may not be a realistic ask for me.
Yes, I am experiencing ADHD-overwhelm.
I am working on maximizing treatment, minimizing my commitments, and also tweaking my accommodations in school.
Thank you for the suggestion of getting an organization/ADHD coach. I'm looking into that now
Sounds like you're doing what you need to be doing.
My sister was a nurse with undiagnosed ADHD. Dang near killed her. She came home from work totally exhausted and fried--beyond just normal "busy nurse" fried. She'd have to go into chronic survival mode to get through a day and check and double check meds and all of that.
I hope some healthcare workers do weigh in for you. One tip I learned early on is that in almost any profession, there are jobs that are terrible for ADHD and jobs that are far less terrible for ADHD.
So one of our tasks is to go along and keep looking around for the type of job and position that might be right for us. Amazingly, these differences in job duties I'm talking about are for the same job, same profession. And keep asking (as you go along) what aspects of the job you like and you feel you have a knack for. Ultimately you want to go for that kind of specialty.
Anywhere here's an article I found giving tips of surviving nursing school with ADHD.
I am an RN of 17+ years. I was only (very) recently diagnosed so I struggled for many years without knowing what was going on with me. I will say that the only thing I can look at that has truly helped me when I’m what I call scattered and I can’t focus is to do some quick exercise. When I worked in the hospital I would hit the stairs. I’d just do what I had time for, maybe 3-6 flights up and back. It was the only thing that helped me survive night shifts. Based on what I understand now about ADHD and sleep, I would absolutely never agree to work night shift again. There is no way I could ever get adequate sleep on night shift.
I’m a clinical manager now and no longer do direct patient care. My deadlines are higher pressure for me than they used to be so I still move my body when I’m feeling stressed or can’t get a task started. I don’t have a lot of stairs at my current office but I have a safe outdoor area to go for a walk, so I usually do that. I’m confident these exercise breaks have been the only thing saving me from failure all of these years. I’m not someone who generally works out either, pretty much just in these breaks at work!
Hello, and so sorry you're struggling, you've become and RN and that's fantastic for anybody, let alone one of us! My dream is to become an end of life nurse, just can't imagine ever getting around to studying
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Feeling guilty about college accommodations. 
Recently Diagnosed with ADHD. 
How do you really know you are adhd when soooo many things can look like it? 
how do you discipline teens with ADHD?
