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ADHD in the OR

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Specializes in Perioperative / RN Circulator. Has 1 years experience.

I'm a new (December grad) nurse 4 months into orientation as an OR circulator / intern. Six month orientation and 2 year commitment.

Due to Covid-19 stopping elective procedures and lack of PPE we were pulled out of the OR from mid March to late April and told we were rebooting our orientation We did classes and alternative assignments like Covid-19 screening during that time.

That's the background. Here's the current situation. They expected me to be ready for service line rotations 3 weeks ago. Instead I've been given formal coaching twice due to mistakes I've made. and told I'm not ready. I'll be evaluated again the week after July 4.

Looking over all my errors I see two main themes: first is lack of preparation. I've been given materials to study at home but I usually just get home, glad to be done with work, toss them on my desk, and never look at them again. I've just told myself I can pick it all up on the job; and clearly that isn't working for me. This I will address by putting in the time before and after work to be properly prepared.

Second is that I get so focused on one thing that I miss other things. Like I was charting a case recently and the surgeon asked me to adjust the lighting which I did but missed that he also needed additional instrument sets.

I'm adult diagnosed ADHD (ADD) and just take buproprion because my last doctor was reluctant to RX controlled substances for it. One aspect of how it affects me is being zeroed in on one thing and neglecting others. I felt that OR with only one patient would be better than keeping up with multiple patients; but it requires a lot of multitasking at times plus the proverbial OR ear that I'm still developing.

I have a new HCP and will address medication changes for my ADD with her; but don't expect any benefit from that soon enough to really help. Also I prefer not to bring up my ADD and meds with my manager (but tell me if I should be?). I stay off mt phone in the OR. I'm going to be doing the extra work I should be doing. I am working on focus on circulating and leaving charting for after the case if necessary.

Any other tips or alternative suggestions for be successful in the OR with ADHD?

Finally, I'm mature enough to accept if this isn't the place for me; but I really think it is. When I'm good I'm very good and multiple people have praised my work, my enthusiasm, my problem solving ability. The issue is that I haven't been consistent enough. I want to get this straightened out so I will be successful.

Thanks for your advice and ideas

tiggertiffany, ADN, RN

Specializes in Telemetry/Med-Surg/Periop101. Has 4 years experience.

From one adult with adhd to another, I make lists for myself so I remember where I left off. I’m training in the OR as we speak so I don’t have much advice under my belt except encouraging you not to say anything to your manager about having adhd as many stereotype you. I learned that the hard way in nursing school. ♥️

Val.RN, ADN, BSN

Has 6 years experience.

, Hey, I am the OR nurse for three-plus years by now. I have never been diagnosed with ADHD; however, I think I have at least some of it to a certain degree. I started in OR back n 2016, and I was pregnant couldn't handle and lost a job. Well, I tried hard, but the expectations were " ready in 2 weeks" after I started my first rotation. (The same situation six months training, two years commitment). It was a lot of bullying among nurses, a very toxic environment, etc.... and pregnancy did not help to learn that fast. After that, I started with four weeks old baby, traveling to work two-plus hours one way and pumping milk on my way and back from work. I survived, and I believe I am an excellent circulator by now.

Advice:

1. Please do yourself a favor, wright notes ! doctor preferences, positioning, instruments, sutures, etc., can not emphasize more, even you may hate it will get you prepared better for the next, similar case.

2. Make a routine to get ready for a case.EVery time does the same way... either you start to get prepared from opening a computer, writing board, then making sure equipment is ready, troubleshooting or whatever it may work better for you! Stick to it.

3. Put your chart aside if possible, and concentrate on your immediate needs, adjusting light, connecting cords, opening supplies,, only start your table if your team and a patient are taken care of.

4. When you chart, still keep on eye on your patient ( anesthesia) and a team !

They are your priority, not a chart!

5. last but not least make sure your patient save, all the time !!! from the time of your interview to the time he/she leaves an OR, questions, chart review and Critical Safety belts, make sure you would never leave a patient unattended or unstrapped even for 1 second. Seen patient falling from the OR table before, not fun.

You, manager, don't have to know your business, as long as you can function. Who cares what the diagnosis is??? It can hurt your rotations.

I went through hell and worked hard, and now I am very confident in my abilities

Any questions ask I will be happy to help.

good luck

V.RN

I commend you for dedicating yourself to this rough job...!

I agree with the above folks. You do not need to share your diagnosis.

I am diagnosed with ADD and interestingly I have a similar story to yours. Started as a new grad (after precepting) in the OR in September and had 3 months of training then was told “to fly” at the end of January. March 17 was my last day because I’m per diem and I finally came back last month. Needless to say, I’m a bit rusty.

what do I do? I take notes on everything, and then rewrite my notes. Having to try to study after an exhausting shift isn’t the best but I find getting to work early just 15 minutes, finding out which cases I have, and reviewing the notes I have for them helps a lot. If I have no notes, I go talk to charge nurse or any other nurse I feel comfortable with. (Had a falling out with my preceptor so steer clear of her). Another thing I try to do is to look at the preference cards to try to remind myself of what else needs to be done. Oh! And it pays to be a little OCD... I know replacing one acronym for another isn’t the greatest advice, but checking for completeness a million times can’t be too bad!

In my humble opinion, it honestly sounds like they’re not giving you enough time to acclimate to being a circulating nurse. Try to give yourself a little grace. It sounds like you know yourself and where to push where you need to be pushed!

best of luck to you.

Silver_Rik, ASN, RN

Specializes in Perioperative / RN Circulator. Has 1 years experience.

Thanks for the great replies. I have a progress meeting with my Periop education coordinator tomorrow and I'm anxious about it.

One point of struggle is I haven't had a consistent preceptor in over a month. I've gone 10 days working with 8 different circulators recently. Every time I have to think about how that particular person likes things done, or learn if I haven't worked with them before. I know it's the same with the surgeons, but this is adding a layer.

So, my education people agreed and suggested putting me back with someone on a regular schedule and were ready to put me with the nurse who was my mentor through nursing school. She's psyched up ready to teach me. Then my manager's boss says no, because I know her outside work, she's a friend of my wife and I.

I had another I worked well with for a week and said she would take me under her wing; but they havent let me work with her since. Finally after a few weeks of me trying to get them to assign me to her again they told me they only want to assign me to preceptors who will not hold back.

I need to get off here, calm down, get some sleep. I'll update how my meeting goes.

Silver_Rik, ASN, RN

Specializes in Perioperative / RN Circulator. Has 1 years experience.

I had my progress meeting. Instead of assigning me to a dedicated preceptor for 4-6 more weeks of primary orientation, I'm being moved to the next phase (service line rotations) starting Monday. I'll still be working with an experienced circulator RN, but I'm expected to run everything in the room - except the charting - with minimal assistance. They said I'm getting two weeks "pass/fail" to show I can do this.

My nurse mentor friend is going to prepare some tips to help me succeed. Plus I've been reviewing AORN Periop 101 modules, and reading in Alexander to get ready.

21 hours ago, Silver_Rik said:

I had my progress meeting. Instead of assigning me to a dedicated preceptor for 4-6 more weeks of primary orientation, I'm being moved to the next phase (service line rotations) starting Monday. I'll still be working with an experienced circulator RN, but I'm expected to run everything in the room - except the charting - with minimal assistance. They said I'm getting two weeks "pass/fail" to show I can do this.

My nurse mentor friend is going to prepare some tips to help me succeed. Plus I've been reviewing AORN Periop 101 modules, and reading in Alexander to get ready.

Ouch. Maybe take this as a sign that you aren't doing as bad as you thought? I mean, you would think if they'd given up all hope for you, they'd just tell you you aren't a good fit and reassign or let you go, but instead they're wanting you to push ahead.

Having said that, I'm not a nurse yet (I'm in my preceptorship, grad in Sept), so really, take whatever I say worth a grain of salt. I'm glad you posted this, though, as I'm interested in surgical nursing and have ADD as well. I don't really like working with adults (at least conscious ones, haha) and I really enjoyed watching a couple of cesareans done. Not at all like actual surgical nursing, but it was one of the few times in nursing school I felt like I was where I belonged. However, I also feel like I'll forget things or do something dumb, so I'm struggling. Plus, there's no OR residencies open this time around at the hospital I want to work at, so now I'm even more lost 😞 Guh.

Seeing Myself Out

Has 6 years experience.

On 7/9/2020 at 9:01 PM, Silver_Rik said:

Thanks for the great replies. I have a progress meeting with my Periop education coordinator tomorrow and I'm anxious about it.

One point of struggle is I haven't had a consistent preceptor in over a month. I've gone 10 days working with 8 different circulators recently. Every time I have to think about how that particular person likes things done, or learn if I haven't worked with them before. I know it's the same with the surgeons, but this is adding a layer.

So, my education people agreed and suggested putting me back with someone on a regular schedule and were ready to put me with the nurse who was my mentor through nursing school. She's psyched up ready to teach me. Then my manager's boss says no, because I know her outside work, she's a friend of my wife and I.

I had another I worked well with for a week and said she would take me under her wing; but they havent let me work with her since. Finally after a few weeks of me trying to get them to assign me to her again they told me they only want to assign me to preceptors who will not hold back.

I need to get off here, calm down, get some sleep. I'll update how my meeting goes.

OP, I'm rooting for you. I was a successful nurse for most part working in psych before getting into an OR residency. I probably have ADHD but was never diagnosed, and my residency instructor/preceptor for most of the bad days I worked was likely to have ADHD. However, our personalities didn't mesh well and we always butted heads. She set me up for fail and I ended up getting nervous whenever I worked with her and end up making more mistakes due to anxiety or getting too focused to impress her. Whenever I tried to defend myself she always accused me of arguing. Ultimately I was let go from the residency because her words outweighted my words, and management didn't care about me doing well when I was with other preceptors either. I was the only minority and LGBTQ+ person there too. I am working psych again as a traveling nurse, and I don't see myself doing another residency. If I get a staff nurse position in an OR, I really believe I can get running with a standard orientation as long as I don't have preceptor(s) who set me up for fail. I am older than some of the charge nurses, have more overall nursing experience, and higher education than many of them. As a former EMT I also had an easy time helping with anesthesia with unstable patients when my preceptors had no idea what to do and panicked. I do see potential to do well in the OR at the right place with the right people, but if I can't go back I won't lose sleep over it.