Should ADD RN be given "disability" allowances? - page 2

Hello...I've posted before about my 12 yr history of problems with med errors (either giving them way late or forgetting them all together), and am at a crossroad of finding other avenues of nursing... Read More

  1. by   disComBobUlated86
    Faith, I actually had an instructor/prof point the same thing out to me.(I just completed my 3rd year of my 4 year BSN program) Like you, my teacher knew of my ADD. Even though I know it can catch you off guard to get an eval of "disorganization" (I'm nearly straight A's other than that), it's actually a good thing. You're in school still, in your first clinical even, you are NOT expected to be perfect, ADD or not. And as far as your instructor being aware of your ADD, I usually inform professors/instructors. Although they may flag that in their mind, this can be good. The extra attention may mean they might pick up on your needs quicker, meaning they can give you instruction and alert you to areas that need improvement. Although "spacey" isn't really the best way I've heard it described, at least this evaluation led here, realizing you needed some tips. Since my "disorganized" evaluation I have been able to search for some methods etc. Although I'm still looking for new ways all the time what advice I can give you so far that has helped is this:
    a) post-its and colored pens and hilighters (i am a HUGE color coder) and the post it's on your sheet can stick out at you...make check boxes for what needs to be done. and hilight new things.
    b) before you go to do a procedure, review the steps in your head or outloud with your instructor. it'll put them fresh in your mind and reviewing them, you're more likely to remember "name band". especially focus on those silly little things.
    c) sometimes the instructor sitting there makes me feel clumsy or like i need to go faster. try not to get flustered, they're doing the same to every student. take your time, do it YOUR way as long as the important things are followed (ie sterile if needed, id band check, gloves, handwashing) it doesn't matter if you're as speedy as a seasoned nurse
    d) keep index cards with normal labs, math equations, and conversions in your pockets at clinical. a lot of hospitals have these references but it's good to have your own. and you'll be the most popular person in clinical group.
    e) use your instructors, ask them for suggestions if they point something out to you
    f) if you need to repeat instructions back to make sure you got them right, do it. don't be afraid to be annoying by saying "NS @ 75 right?" it's better to repeat and verify then to have to go back and ask later or to do it wrong.

    That's all I have for now. It's a continuous process of finding multiple little tools and tricks until you have the right combination. Oh and last thing I can say is let your instructors know you've taken steps to rectify the situation. Talk to a lab RN if you have one, or let them know, hey I just wanted to run something I want to try by me. Or oh, I just wanted to let you know that I thought about the eval and I'm going to try____. They'll respect you, because you're probably working harder at it than anyone. Good luck in school. Email/Message me if you ever have anymore questions :-)
  2. by   BelleKat
    being licensed as an rn means that you need to be capable of passing meds without errors and functioning as any other lisensed rn. this sounds harsh but you need to find ways that work for you that help you to do these things. if not the other staff members or charge would have to monitor you too(somebody would have to) and that is just not fair.
    such as a diabetic nurse does not have a lesser load but she has to be able to monitor within herself the s/s of hypo hyperglycemia so that she can function and so her job as per her job description.
    so you need to figure out what you need to do for yourself so that you can pass the meds out safely,you need to know your limits,if you are being interupted too much while passing meds let it be known that you shouldn't be interupted except for emergencies or something(i don't know what setting that you work in). instead of using add as an excuse(i don't mean to insult you or anything,i'm trying to help) please see it as something that you need to master(dunno right word) by whatever means necessary so that you can give safe care to a reasonable pt load.
    good luck in your endeavor,you can do it!
  3. by   LM19050
    Quote from ukstudent
    I want to preface this with the fact that I have ADD. That said I don't think there should be any allowances made. I had a huge problem while in nursing school with some of my classmates being given special consideration for tests due to ADD. They could take it in a small room away from other and not have the same time limit as the rest of the class (I refused to do this). I kept thinking that if they couldn't deal with the stress of a test how were they going to cope with a patient coding, ask for more time in order to collect themselves before starting cpr!
    Like I said, I have ADD and have trouble making sure that everything has been done (such as meds) if I haven't written it down. My 'brains' have every med and every action needed for my pts written down for each hour. I make sure that it is reviewed for new orders and checked on at least once an hour. I know that without my 'brains' I would be lost. Before quitting have you tried having written reminders of what to give and when, it can really help in organizing your day.
    I think special allowances should be made because the teacher and the nurses don't understand what the hell is going on with people who have ADD. And certain teachers will think you are dumb. This has nothing to do with caring for a patient and giving them CPR, bc that's an emergency response. I don't know why you would conflate the two. Being new to the clinical setting is very hard and some people need to be taught differently to understand things better.
  4. by   LM19050
    Quote from bellekat
    being licensed as an rn means that you need to be capable of passing meds without errors and functioning as any other lisensed rn. this sounds harsh but you need to find ways that work for you that help you to do these things. if not the other staff members or charge would have to monitor you too(somebody would have to) and that is just not fair.
    such as a diabetic nurse does not have a lesser load but she has to be able to monitor within herself the s/s of hypo hyperglycemia so that she can function and so her job as per her job description.
    so you need to figure out what you need to do for yourself so that you can pass the meds out safely,you need to know your limits,if you are being interupted too much while passing meds let it be known that you shouldn't be interupted except for emergencies or something(i don't know what setting that you work in). instead of using add as an excuse(i don't mean to insult you or anything,i'm trying to help) please see it as something that you need to master(dunno right word) by whatever means necessary so that you can give safe care to a reasonable pt load.
    good luck in your endeavor,you can do it!

    ummm and that's what an accomodation for add is, it's a way to be on an equal playing field with people that don't have it....nobody is using it as an excuse, it's an actual disability and you have no idea what you are talking about. as a nurse you should be finding out more about this disorder as i'm sure some of your patients have or will have it. i certainly hope you haven't had to care for people with disabilities.
  5. by   xtxrn
    I'm disabled (and off work for the last 7 years, being my own private duty nurse- lol). The last job I had, things got really bad with my medical situation, and I looked through the ADA stuff.

    The facility is only required to make allowances that let someone get their job done in a way that anybody else would do ( and isn't an undo hardship on the facililty- there's where they get ya with the $ for another person to work to pick up what someone else can't)- ie.- chairs that are ergonomically sound for back issues, time for diabetics to test their blood sugar/eat, if a desk job, dimmer lights or allow tinted glasses to avoid glare for photosensitive seizures, wrist rests for carpal tunnel, etc. If they do those things, and the person can perform like someone who doesn't need those things, it's required. (unless the rules have changed !). I didn't fit into those categories- there wasn't anything they could do to make it possible for me to get my job done.

    Is there anyway that med adjustment would help OP???
    Last edit by xtxrn on Jul 24, '11 : Reason: clarification
  6. by   ellen 12
    Quote from bellekat
    being licensed as an rn means that you need to be capable of passing meds without errors and functioning as any other lisensed rn. this sounds harsh but you need to find ways that work for you that help you to do these things. if not the other staff members or charge would have to monitor you too(somebody would have to) and that is just not fair.
    such as a diabetic nurse does not have a lesser load but she has to be able to monitor within herself the s/s of hypo hyperglycemia so that she can function and so her job as per her job description.
    so you need to figure out what you need to do for yourself so that you can pass the meds out safely,you need to know your limits,if you are being interupted too much while passing meds let it be known that you shouldn't be interupted except for emergencies or something(i don't know what setting that you work in). instead of using add as an excuse(i don't mean to insult you or anything,i'm trying to help) please see it as something that you need to master(dunno right word) by whatever means necessary so that you can give safe care to a reasonable pt load.
    good luck in your endeavor,you can do it!
    nursing is meant to be all about caring. it's seems all too evident to me that nurses seem to too often fail to extend a level of care to each other. expectations that are placed on nurses ability to cope no matter what - are unrealistic and unfair and unkind.
  7. by   xtxrn
    Quote from ellen 12
    Nursing is meant to be all about caring. It's seems all too evident to me that nurses seem to too often fail to extend a level of care to each other. Expectations that are placed on nurses ability to cope no matter what - are unrealistic and unfair and unkind.
    Very true- nurses are often more critical than the general public. It's sad, and unfortunately, not something that most people will be open to fix, since they need to be right more than understand others. And employers are often the worst, with demands to work when sick enough to be risky to have around.
  8. by   RNfor918
    Americans with Disabilities have reasonable right to accommodation (research "Americans with Disabilities Act"). What you are asking for is not reasonable. An example of something reasonable would be the use of a calculator for a nurse with a Specific Learning Disability in Math who struggles with dosage calculation. You have to be able to perform the essential duties of your job- the employer cannot change essential duties for you. Medication administration is an essential function of your position, and making a med error could result in a patient dying. Having a documented disability would not be an acceptable excuse. Why not focus on your strengths and seek out an area of nursing that works with your abilities and talents rather than struggles?
  9. by   xtxrn
    http://add.about.com/od/adhdinadults...t-and-ADHD.htm

    http://newideas.net/adhd/ada-america...ility-act-adhd

    There are a LOT of links on this topic.... bottom line? What you're asking (reduced patient load) is NOT reasonable.
  10. by   Piglet08
    I also have ADD, inattentive flavor.
    No, I don't think accommodation should be made. I don't think it CAN, in many cases; the job is what it is, the shift is what it is, and you're responsible for what you do. If someone has a disability like MS, I can see trying to avoid giving her the five-hundred-pound patients, yeah; that kind of accommodation is one thing; if a disability affects areas like nursing judgment and patient safety, which it appears is the realm we're discussing here, there is just no way to "accommodate" that.
    If you've made a lot of med errors, you need to look at yourself with a seriously critical eye... not critical in the "beating yourself up" sense, but in the analytical sense.
    You may be trying to do a job you're not fit to do, and that doesn't mean there's something wrong with you. The shoe doesn't fit. Try another shoe.
    I'd rather be dinged for and have to explain a med being given late than have to deal with having made some more serious med error. Yes, "right time" is one of the five rights, but it's the one I feel has to bend sometimes in the name of safety.
  11. by   Piglet08
    .... "MORTAR BOWL"???????

    Did I read that right? Is someone having to crush pills in a mortar bowl?

    Yes, we are all responsible for safely administering meds. However, med errors almost always can be found to have roots in systems errors. If you aren't keeping your meds in an individual package in order to keep them individually identifiable right up until the moment of administration after the fifth, or sixth, (or whatever YOU need for safety) and final crosscheck, then you're the victim of a system that dates to the Dark Ages and is unsafe to the patients and to your license.
  12. by   Pfiesty
    HM2Viking RN wrote: "Oh how true.....ADD is both a blessing and a curse.....It is a blessing because as an individual I can think outside of the box..."

    I love this! ADD is a blessing and my entire contingent of relatives are so creative due to the ADD. I have always designed my own organizational tools to make it work for my RN job. But I consider the ADD more a strength and less a disability or liability!
    Last edit by Pfiesty on Jan 28, '12 : Reason: add cite
  13. by   Piglet08
    "I think special allowances should be made because the teacher and the nurses don't understand what the hell is going on with people who have ADD. And certain teachers will think you are dumb. This has nothing to do with caring for a patient and giving them CPR, bc that's an emergency response. I don't know why you would conflate the two. Being new to the clinical setting is very hard and some people need to be taught differently to understand things better"

    We're 'conflating' the two because not giving meds in a safe manner can LEAD TO a code situation. This has everything to do with caring for a patient. And the OP was asking about performing the job, not about a learning situation. And the OP was not new to the job, either. I don't think that allowances (other than as many rehearsals and practice sessions as one needs in order to not have butterflies) in a learning or testing situation are in the nursing student's best interest anyway, exactly because once one is licensed and in a position to kill people, there will be no such safety buffer around. The Real World, in Real Time, will not respect ADA considerations. (If you think a TEST is stressful, wait 'til your patient is coding and you are expected to tell the code team his H&P from memory. ) It will be real-time big stakes and part of nursing school should be learning what one needs to do in order to handle it - or, to learn that you can't handle it and need to do something else. And I think everyone posting similarly appears to understand ADD pretty well, and there's no lack of compassion being shown here. Yes, nurses can be too hard on each other, but I'm not seeing that in this thread.

    A nurse has to find ways to keep his/her practice safe. Multiple med errors is not "safe"; I don't feel the OP is a bad person or a "defective" person, and have no intention to vilify her. But if the med error situation can't be repaired she needs to find another job. Her position is not a good fit for her.

    Yes, our job is about compassion... among other things. I would hope administering safe care is our first priority. I think saying that "nursing is all about caring" is the sort of touchy-feely stuff that minimizes our skills and education in the minds of the public. I know a couple of nurses that are very warm and fuzzy and "caring", and a couple who are socially inept and have a clumsy bedside manner and can sound mean but their critical thinking skills ROCK. Guess who I'd pick?

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