I really need some help and I have no idea where else to turn. I was diagnosed as a kid with ADHD but was told that I didn’t need medication. I was given a couple of tips to help me in school - use a timer, switch subjects often, sit in the front row, and have a close relationship with teachers. I used these techniques and managed if not thrived.
Fast forward 25 years and I am a RN in a Pediatric Clinic. Most of the time, I love my job. I love taking care of kids and making the clinic a comfortable place to be. I relate really well to kids. I even have a group of kids who will give me hugs when they see me. And this is after I have given them shots and by all logic they should hate me.
I usually start my dad by going to the gym to help regulate my system and I come home, eat breakfast, and get ready for my day. I usually get to work around 750( I come in early but I cant come in too early because then I get in trouble) and prep my charts for the day (add orders, make sure scheduling is correct, that kind of thing). I also set up little pieces of paper Sometimes I have nurse visits at 830 and 845, which I complete. The doctor I work with sees patients about every 20 to 40 minutes and we see 15-20 patients per day. I am responsible for rooming the patients, doing screenings, preparing and administering vaccines, and giving medications if needed. In between I am expected to answer phone calls and messages (what nursing calls “triage”), fax things, referrals, and do any extra paperwork. I am busy and am on my feet for most of the day.
A couple of months ago, I started forgetting things and spacing out more and making really stupid mistakes. As a joke, I filled out a Vanderbilt form (used to diagnose kids with ADHD) on my self. Turns out I have ADHD, mostly inattentive. I began to look into and read books. Just as I was figuring it all out, my new manager asked to speak with me. She told me that there were problems and I was gonna be written up. I told her I was just learning about how my brain worked. I started making more cheat sheets and signs around my desk. I thought I was improving. However about a month later, I got written up anyway for forgetting to put in vitals, not doing things correctly and not knowing certain facts (Sometimes when people ask me direct questions, I freeze and can barely remember my own name). This caused a breakdown and I took a couple of days off work. During that time, I saw my PCP, started Adderral, started counseling and found some nursing books to help refresh my knowledge so I would be able to access it more easily. I also got a referral to a psychiatrist who works with adult ADHD but the wait was still a couple of months. I founds some coping mechanisms for dealing with my anxiety (breathing techniques, fidget toys and ear plugs for when I am on the phone). I also tried really hard to ask more questions when I was unsure about something (which I was not doing before).
I thought things were getting better and then a couple of days ago, I got brought into my managers office again with complaints. In particular, I put the wrong date on something, I am asking the wrong questions and still making mistakes (one of which was very silly and I fixed it as soon as it was brought to my attention). I know that I make mistakes and always try to fix them and then do some research to help it stick in my brain better. I always admit my mistakes and try to learn from them. I am also taking too long to answer messages or start answering them and not finishing them. I explained that one of the previous complaints had been, I was not answer enough messages and I was trying to remedy that by answering more. However, because I had no idea when my patients would show up (basically there is a 25 minute window in which they can arrive), I often had to stop one task (the message I was typing) and go room a patient which needed to be done in a timely manner to keep the doctor on schedule. This then lead to a discussion on poor time management skills. I have had this complaint before from managers and in nursing school, but no one is ever able to tell me how to fix it or improve it. I often run through my logic with problems and why I do the things I do and just get shrugs and more mumbles about “performance,” “productivity” and “time management.”
I am looking into other jobs (both internal and external) but I am worried with all these problems at this job, it will affect my ability to even transfer with in the system. I do not know what else to do. I exercise, watch my diet (especially when it comes to limiting sugar), drink water, maintain good sleep hygiene, get enough sleep, I minimized caffeine intake, I mediate, take walks at lunch, take supplements, I am working with a counselor and my PCP. I plan on talking to HR as soon as I get an official diagnosis but I have another meeting with my manager on Monday which is before my initial appointment with the psychiatrist.
Sorry for the long message and to spew. I just do not know where else to go for help and I am tired of feeling like I am drowning. Any help or suggestions would be greatly appreciated.
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I also have Inattentive ADHD. I work in information technology, as a Service Desk Technician, so I also have to interrupt work I'm doing to deal with something more immediate.
Terms for this are "task-switching" and "context-switching". Studies have shown that people in general are bad at this, and people with ADHD are more heavily impacted by it. It's the nature of the work that we do, but it's definitely not how humans function at their best.
I was diagnosed as an adult, only a couple of years ago. Adderall did help, but switching to atomoxetine (a generic of Strattera) has helped me more.
The biggest improvements that I've experienced are 1) greatly improved working memory & short term memory, 2) reduced distractibility, and 3) gaining to ability to return my attention to a task after being distracted.
I know that I still have room to improve in my work skills. Diagnosed at 45, even though I function better cognitively, I have to realize that change isn't as easy as taking a pill. It'll take time and consistency to make improvements in my work routines.
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There is hope.
Something that you can do (only if you want to) is let your manager and HR know that you are aware have these areas that you have struggled with, and that you are taking action to address them.
You might ask for advice about how to handle continuing a task you had to stop in the middle of, since you have to deal with a patient's needs and preparation for the doctor. It should be okay to ask, "how would you handle this?"
(Advice I've heard or read many times is that you don't have to say you have ADHD, to explain why you have certain struggles. You can just talk about the struggle. Most people appreciate humility, and are understanding that we each have our own strengths and limitations.)
Since I noticed my D-Amphetamine Salts XR 25mg are not working as well, I wonder about the Straterra. I also saw the comments from @BlessedLady and might check into my hormones too...Hmmm. My short term memory is terrible and working on a computer doing literature reviews and writing is becoming impossible. My practica is all I have left for my Master's Degree and my professors are trying, but aaaack!
Have the medication discussion with your doctor or psychiatrist.For me, Adderall was never fully effective. It treated my ADHD symptoms partially, but an increased dosage had no additional benefit, and instead introduced a concerning side effect (tachycardia, elevated heart rate). That side effect was why my doctor agreed to my request to try atomoxetine,a non-stimulant.
Your doctor might first consider adding a second medication, like Guanfacine or Wellbutrin. It's a strategy that's been reported as working well for some people. Or might try a different stimulant medication.
Consider what else might be causing your ADHD symptoms to increase. How's your sleep? Are you experiencing more stress than usual? Are you feeling anxious or depressed? Have you been less social that usual? Have you had a significant life event or change in life circumstances? (E.g. a new baby, a new relationship, or a breakup, a death of someone important to you, a move, a job change, bad feedback from a professor or your academic advisor, change in health status, change of routine, is your degree taking longer or significantly harder than you expected...)
You know yourself and your life status well. I'm sure you'll know if a change of circumstances preceded or coincided with the medication losing effectiveness. Sometimes, a person's body just develops a tolerance to a given medication, requiring an increase in dosage, or change to a different medication.
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Statistically, stimulant medications are more effective at treating ADHD than non-stimulant. They also act faster and leave the body faster, so they are easier to do a trial of.
By the nature of the type of medicine that Strattera is, it can take several days to a few weeks to become fully effective. For me it took under two weeks. Withdrawal takes time, too, and can be unpleasant.
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(I ran out in January, and my withdrawal added to the mild depression that I was already experiencing...the cause of the depression was life circumstances, not the medication withdrawal. I'm now back on atomoxetine, plus a low dose SSRI, and in counseling. I'm back to feeling my best.)
This was going to be my comment also! I am peri-menopause and my symptoms have gotten so much worse over the last couple year. Include that with what health care providers have gone through during the pandemic and post pandemic and it is a disaster. First thing today I would call your PCP and or councilor and get FMLA with a documentation of the stressors that have happened to you. They can back date it to the days that you called out for the anxiety. This will buy you time and protection until you get the diagnosis and medication to help stabilize you.
Don't switch jobs - everything in health care sucks and then you will be tasked with not only dealing with your symptoms but also starting and learning a new job. Point out to your manager your previous work record and let her know that you are having medical issues of your own and you are working with your provider to get them addressed.
I have no answers other than I thought this story was about me. I am not a Nurse, but I wish I could be. I was in a part administrative part reception. Doing payroll. I also did the data entry for the entire department of 250 college student workers who filled about 350+ positions.
Answering phones, greeting guests, doing payroll, processing paperwork was ending up becoming harder and harder the longer I worked there.
I won't rehash how I was working and living, because you described your situation and it was exactly like mine.
My main concer was I was not quite 50 and I had 2 panic attacks that sent me to the emergency room. After my last review I ended up going on long term disability. My health was not worth sacrificing.
You have my support, I know. I also have ADHD -Inattentive Type which along came with Anxiety, Depression, and later found out that I have Hypersomnia. Now, I think I am tracking better. I am thinking clearer. However, when I did test with my psychologist, I found out that I am smart, I just learn slower and (Executive Processing Disorder) have problems with retention.
I know this doesn't help your situation, but see if your insurance covers counseling. Maybe there is a department that works with giving you accommodations. Or seek the help of an ADHD Coach.
Hi there, this is only something to consider for long term, don’t want to add stress by suggesting a huge change, but wanted to tell you I have worked with nurses at a healthcare software company. They tested the software as Quality Assurance Analysts and I was a technical writer who worked on the release notes and user guides. We worked closely. They had deadlines, but not as timely as yours as in you worked in minutes, they hours. I have also worked in healthcare briefly as a skilled nursing OTA and have a bit of empathy for how hard that task switching and load demand would be. I have inattentive ADHD too. Possible career change in related field and function like this that would use your expertise and allow accommodations more easily? It sounds like you are doing a good job of taking care of yourself. Whatever you do for work, wishing you the best and good luck. I am grateful for having lots of flexibility in how and when I get my work done as a financial industry business process consultant (uses my technical writing background but more advanced as I am now almost 53).
can you answer all emails during last customer of the day, answer phones while taking a walk outside, switch your lunch time so you have an hour without other workmates?
I'm sorry to hear that you are having such a hard time. First, I would like to congratulate you on being diagnosed as a kid and working hard to overcome the disability of ADHD. When I was a kid I didn't get a diagnosis. No one even figured something could be wrong. Also, am primarily distracted and inattentive.
Medicine changes your life. With the skills that you have in managing your ADHD. Your world is going to change because when you get that medicine you're going to suddenly be able to apply it all so quickly! I am very excited for you. Hang in there! I would challenge the phrasing that you do not need medicine. Everybody that has ADHD pretty much needs medicine in conjunction with behavioral training. You've had a lot of behavioral training, I can't wait to see what happens when you finally get medicated! When I was diagnosed in my 30s and I got medicine, my life changed so drastically. I don't even know who the old person was!
Just wanted to leave a positive note about my experience getting on medication as an adult!
My mom is 95 (in two weeks) and I am certain she has ADHD. She is from a generation that did not believe in ADHD, but now she does. She feels badly that she didn't get help for me sooner. I tell her I'm grateful for everything she did for me and I am sure glad we know now! I went to 14 colleges (straight A's) but could not (and cannot) take more than one class at a time. And I am SO glad my medication works most of the time.
It’s interesting how medicine has made a difference for you, I have been diagnosed since 2 weeks and am using Kinecteen (18mg), but the only effect that I see is a little less lethargy and that’s all!
I'm not sure about this, but have you talked to your provider to see how long it takes for that drug to come up to speed? You may be feeling impatient with a drug the may take several (or more) weeks to ramp up. But your provider would know about that, and as I'm sure you've heard, it takes some perseverance to find out which drug and at which does works best for you, so hang in there!!
BlessedLady regarding peri-menopause or menopause and how it can dramatically affect ADHD symptoms in women.
In addition to looking at changing positions within your hospital or nursing field. Research employment laws with disabilities including ADHD. A sit down with Human Resources might be useful if you can negotiate support, modification in responsibilities or a move to another department or position.
Every clinician i see agrees i have adhd but won't treat with stimulants because I'm "over 50". It's like my quality of life doesn't matter. They are concerned with liability.
What's worse, when I started seeking help almost 10 years ago, I was 45.
I was also told this “even if you have it, I won’t treat you with a stimulant because you are 50.” Fast forward to this week. New psychiatrist: “I have patients in their 70s on stimulants.” (I think he is a fellowship trained specialist in geriatric psychiatry—not sure how I got scheduled with him but so happy I did). I just started Adderall at 50.
I remember reading a post on a forum but a nurse with ADHD, who had worked out a partnership with another nurse. The nurse with ADHD has hyperactive traits, and thus is very driven towards physical activity. (If I remember right, the partner nurse was content staying at the desk more.) The partner nurse took the lion's share of the paperwork duties.
It was a symbiotic arrangement that worked well for them both as a team, and it especially worked well as an accommodation for that nurse with ADHD.
(I may not remember the particulars right, and I can't remember if that was on this forum or another one I've been on.)
Do you have a colleague that you can partner with like that?
I just wanted to thank everyone for your support. I had a bad day at work. I got my final write up which sucked but seeing all the supportive messages when I got home was wonderful. I don’t feel so alone! Thank you all so much!
Sorry to learn that you got your final write-up. At your work, does that mean you're on notice that if you have any more slip-ups you'll be dismissed? It does that mean you've already used up your last chance?
It was one particular job I had, and the manager at that job, that caused me such anxiety that I needed counseling (where I got my ADHD diagnosis. When the manager decided to write me up, he threw everything, big and little, into that write-up. It was clear that he was looking for any reason to dismiss me.
(That was after 9 months on that job, but I was at that organization 6 years before that and only had good reviews...and the only areas for improvement clearly pointing to my ADHD. I wound up working for that difficult manager for three long years... spending 2.5 years actively trying to get another job. I got another job in the same organization, under another manager, and outlasted the difficult manager by one year there.)
The plus side is that I've moved on to three better jobs since then. The cons are that I had to move on to change jobs in three consecutive years. (Let go from the first, had to leave the second because I was moving.)
Now I'm almost three months into a great job where I make good use of all my tech skills...it's not perfect though, but no job will ever be perfect, and I know that I'll never be the perfect fit for any job. ("Perfect" is an impossible standard, after all. The best mentor I've ever had at any job taught me that "perfect is the enemy of good.")
Your manager may have an unrealistic standard. If so, that's their problem, and they will only find themselves dissatisfied.
Whenever I've been in a supervisory role, I put my "mentor" hat on, and do my best to take every opportunity to train and encourage employees. Instead of the "carrot and stick" approach of too many managers, I take missing-the-mark as an opportunity to say, "You did so well on all these other things.You were so close on that one! Let's see if we can do to help you do better next time!"
I m 45, menopausal from 36, diagnosed at 41 after my anxiety and depression triggered by a divorce and a very demanding nurse manager for 4 years at a clinic. The stress from feeling inept, incompetent and defective is overwhelming and anxiety driven by always doubting yourself, not remembering if you completed a task or forgot what you were planning to do because your so much in demand. People really don’t understand the set reasons a nurse go through daily or the added burden of those stressors with a neurodivergent mind. A profession where time management, expediency and accuracy are essential with a narrow learning curve are rewarding but anxiety inducing in inexplicable ways. Even though I’m on Vyvanse which was recently increased to 75 mg and Wellbutrin increased to mad dose of 450 daily, the mind fog and forgetfulness can be debilitating. I’ve been working flex shift at ED for over a year now and the excitement and constant patient turn over has improved my attention span, that face pace also hinders me with charting esp since I don’t keyboard. I do therapy but it’s half assed and expensive as my weekly copay and monthly medication management can cost about $240 monthly not to mention $130 for Vyvanse copay. I’ve just had an initial consult with psychotherapist that specializes in CBT/DBT and ADHD . I have my first real session upcoming. I know that I digress with this story but I wanted to just let you know that your not alone. I could have gotten a letter of accommodation to HR, but I think my nurse manager didn’t care about anything but productivity, so I left that job as I thing she would find something else to complain about. This move helped with the crippling anxiety about going to work, the constant self doubt and rejection sensitivity dysphoria. Not to mention the dread and fear leading to depression that plagues you regarding time management and decking executive functional skill and bring our worst critic. I applaud your self help strategies and not succumbing to self sabotage and procrastination. I know I didn’t provide any sage word of wisdom like the other members, but I just wanted to tell you again that you're not alone and we’re hear to provide assistance and support as we all are trying to find skills and modifications to thrive in a neurotypical world. You don’t have to give up your career but just chose a different Avenue or specialty of healthcare as being a nurse is quite essential in all areas of healthcare. It’s a daily struggle as you know, especially when diagnosed later in life. I wish you strength and a less chaotic mind.
I feel for you so much, I’m an ex health care worker. You don’t say exactly who has raised these issues, which frankly sound to me minor and somewhat out of proportion. It sounds like you are an ideal colleague, and there in for me was the problem. Keep strong and get advice from your union. Hard to work well with a feeling of someone over your shoulder…. And it’s hard to keep the whole routine going. From my experience though leaving wor was a big mistake
Hi, I am in healthcare and completely get it. I’m so sorry for what you’ve experiencing. I’m wondering if a different clinical job would work towards your strengths. Would you thrive in an urgent care or ED where you’re on your feet, walking between rooms, doing more procedures (giving meds, starting IVs, doing labs, etc) instead of phone calls and the clinic work? Peds RNs are in incredibly high demand, and I wonder if, especially once you’re more optimally treated and feel greater mastery over some additional skills and ADHD hacks, you might feel comfortable finding the right fit. Please don’t give up. I bet you’re a wonderful nurse with a ton to offer. And my last job was like drinking from a fire hose—-sometimes the expectations are impossible. Hugs to you
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