New grad with inattentive ADHD

[Nurse Beth, MSN]

Hi Nurse Beth!

I am a new grad nurse with Inattentive type ADHD. So far during my orientation on 12 hour overnights (neuro unit) I’ve been working on creating strategies to help myself stay attentive and not forget anything. Do you have any tips? Have you worked with people like this? Are there accommodations for me? Should I pick a more manageable type of nursing like a clinic? Thanks!

Dear New Grad,

There are many very good nurses with ADHD.

Inattentive ADHD is a subtype of ADHD. It manifests with symptoms of forgetfulness and a tendency to procrastinate. A diagnosis requires six of the following 9 symptoms:

• fails to pay attention to detail
• difficulty holding attention in tasks
• does not appear to listen when spoken to directly
• does not follow through on instruction and fails to finish work
• has difficulty organizing tasks, poor time management
• procrastinates or avoids tasks that require sustained mental effort
• loses things necessary to complete tasks
• easily distracted by stimuli
• often forgetful

Without knowing which aspects are most challenging for you, here's some tips. Create a routine. When you pass meds, for example, always perform it in the same exact manner. For example, when passing meds:

Check for allergies. Scan the med. Scan your pt's ID. Administer the med. Document.

• Routines and checklists prevent errors. Changing the sequence or skipping steps- variance in any way- results in errors. In the above example, if you document before the patient takes the med, and are interrupted, you may not be sure if it was administered or not.
• Set time goals. For example, complete patient assessments by 2100. If during that time you become distracted by say, talking to a patient or family, stick to your time plan to stay on track. Setting an alarm can help you avoid distractions.
• Consider a planning grid. Think of a table with columns by the hour across horizontally (1900-0700) and pt room numbers listed vertically on the left-hand side row. Make an X in the cells where a task is due, for a certain pt, such as meds due at 2100, and fingersticks at 0600. You could easily make one up and print several out on half-size sheets of cardstock.
• Use a brain. A nursing brain organizes your thoughts because you have a lot of information coming in. Jot down lab results you need to act on or pass on in report.
• Continue to use whatever coping skills that got you through nursing school.
• Do a "time-out". Before you go into a room, stop. Take a breath. Ask yourself "Do I have everything I need?" Anticipate what might go wrong, and plan for it. "Do I have an extra IV catheter?"
• Batch your tasks. If you are going in to check on an IV, grab some tissue you noticed was low earlier, and while there, do a quick neuro reassessment.

I wouldn't say that clinic nursing is necessarily more manageable. Some nurses with ADHD thrive in high intensity settings such as ICU where they focus on 1-2 patients, or in home health (later in their careers). Passion-fueled, high-intensity jobs such as ED nursing are often excellent settings for the nurse with ADHD.

Last of all, be kind to yourself. Find the strengths that come with your ADHD.

Best wishes,

Nurse Beth

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