"Reasonable accommodations" for RN with ADHD & PTSD? And / or advice?

Nurses General Nursing

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Specializes in Critical Care.

Hey all, 

I've been a RN for 9 years (8 of those years are in ICU & pre/post/intra-op). I was diagnosed with ADHD 7 years ago & PTSD 3 years ago (and am prescribed ADHD, anti-anxiety, anti-depressant meds. Currently in therapy). 

That last few years have been difficult. Lost multiple jobs. Can see it's stress related - personal reasons and work place reasons. Work-related stress impacts me hard (poor teamwork, high turnover, gossip, bad reports during shift change, being accused of things I didn't do which leaves me feeling like I cannot trust my co-workers). I get distracted and "stuck in my head" when things like that comes up. 

When an actual problem (mistake was on me and I own it) OR a perceived "concern" would be brought up to my Nurse Director by co-workers, 90% of time I would just accept the feedback, and we'd talk about ideas that would help improve performance (FMLA or going part time for awhile).

I also came up with my own "toolbox" to help with stress management: regular exercise, creating routines, grounding techniques, timers, lists, good sleep/good diet /staying hydrated, arriving extra early to work, asking for "check ins" to see if I'm doing better or worse or the same, hobbies, spending time with friends, reaching out to EAP, reaching out to HR to inquire about options/resources... (I really wished HR would have responded to me... Reached out to HR for 3 months, told my Director I had been reaching out, but HR was never available nor replied to any of my messages). 

Lost last job due to performance issues - I was burnt out and already seeking another jobs before being let go. I don't want to keep losing jobs & I don't want to fail as a nurse.

I know that there are certain stressors that really "trigger" the ADHD and PTSD symptoms (such as being ganged up on/accused of something I did not do, being shouted at by co-workers, feeling like the "outsider"). I realize that I tend to "people please" and over - extend myself, and that can be taken advantage of (probably due to poor boundaries).  Personal problems, managing super sick patients, running a code, and even COVID didn't/doesn't stress me out nearly as much as, what often feels like, being bullied. 

I DO work hard, am creative, detail-oriented, flexible, love to learn, great with computers/anything "techy", am team-player focused, and receptive to feedback. I don't complain, gossip, and I show up with a cool/calm/collected attitude, no matter what is going on in or outside of work.

 

Now am currently job searching, and while I do that, want know more about when/if/how to ask for a reasonable accommodation, and what that would look like. Never explored the idea before... I usually just push myself to exhaustion and then blame myself and my confidence is certainly taking a hit. 

One idea was something like requesting regular check-ins AHEAD of time, or having a nurse mentor, or something like that. 

Also just open to general advice. Any ideas and thoughts are welcome. 

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Specializes in Critical Care.

Another idea: being allowed to keep a small pack on me. It was not allowed at my prior workplace to have any "fanny packs, back packs, etc" on you at work, unless it was specifically provided to you by the hospital. The ones provided to staff were flimsy, small, floppy... Mine totally fell apart because the material couldn't handle how much I used it. 

I want to be able to use a certain pack that I purchased recently that has no logo, is a little bit bigger, made with more durable, quality material. It straps to both my waist and a leg, so it doesn't "flop around" or "fall off" when in a rush (ex: to a code), it doesn't get in the way during emergency situations as it's more secure and fitted to body, plus has enough space to hold: personal phone, hospital phone, kelly clamps, scissors, stethoscope, tape, gauze, meds, report sheets, alcohol swabs, pens, sticky notes, etc. It also has compartments which helps me SO MUCH to stay organized. The hospital provided pack did not have that, so all items were always jumbled in a sack... 

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

I would say that if your ADHD is causing problems to the point where you have lost jobs and are seeking accommodations, then it's not very well managed, and you should talk to your prescribing provider about adjusting your meds. Well-medicated (whether that means increasing your ER dosage, adding a short-acting med to take later, or a combination thereof) should mean that your ADHD is not even a factor.

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Specializes in Critical Care.
klone said:

I would say that if your ADHD is causing problems to the point where you have lost jobs and are seeking accommodations, then it's not very well managed, and you should talk to your prescribing provider about adjusting your meds. Well-medicated (whether that means increasing your ER dosage, adding a short-acting med to take later, or a combination thereof) should mean that your ADHD is not even a factor.

Recently made adjustments. I requested the the ER meds (Vyvanse) be removed, because it was interfering with my sleep too much as it lasted too long. Felt like I had less control over sleep, appetite, feeling hydrated enough, and it just made me more anxious. Adderall IR (split in mini - dosages throughout the day) has worked the best. I feel more in control, it is consistent, doesn't disrupt sleep like the ER stuff did, etc. However, pills don't teach skills. Pills alone aren't a solution, IMHO. 

And remember, its a combo of ADHD and PTSD. It's complicated, and has been a hard, long road. Have been with the same PCP and Psychiatrist for 6-7 years, so they know me well and I know them well.

 As soon as I could, I moved over a thousand miles away to get away from family and their negative influences (drug abuse, alcoholism, gaslighting, verbal threats, physical abuse). The last time I saw immediate fam, I said something that was perceived as "disrespectful", which resulted in being cursed at and being attacked, got bruised all up and down, got a neck injury, which earned me PT and an ortho surgeon to monitor me. That put me outta work for months. 

Never had a substance abuse problem, am in therapy, am on meds, and focus on surrounding myself with good people and friends and other things that bring me joy. 

Just still working through the mental stuff and I am determined to find a way. 

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Specializes in Psych, Addictions, SOL (Student of Life).
BeatsPerMinute said:

And remember, its a combo of ADHD and PTSD. It's complicated, and has been a hard, long road. Have been with the same PCP and Psychiatrist for 6-7 years, so they know me well and I know them well.

I see you are seeing a psychiatrist which is good but do you have a therapist that you can work things through with. I have Complex Post Traumatic Stress disorder and much of my adult life has been a challenge. I stopped all my meds for depression, anxiety and sleep with the blessing from my psychiatrist and currently see a therapist which is a godsend. My hobbies are mostly physical . I like the toolbox idea as I use it with the high risk teens that I work with.

Hppy

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Specializes in orthopedic/trauma, Informatics, diabetes.

going through some similar issues. There is a website-JAN "Jobs Accommodation Network" There are all kinds of mods in there. There should be a disabilities department available through employee health or HR. 

I have a meeting on Thurs. to discuss and I am waiting on final assessment paperwork from psychologist. 

Sounds like the pack you need would be a reasonable accommodation. 

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Specializes in LTC & Rehab Supervision.

I understand where you're coming from the ADHD part...I was recently diagnosed in about last October and am on bupropion (Since I can't take Adderall due to my health problems) and I still have problems at work from it, along with my other mental health issues. Don't mean to take over the thread, but I can use some ADHD help too!

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Lynker said:

I understand where you're coming from the ADHD part...I was recently diagnosed in about last October and am on bupropion (Since I can't take Adderall due to my health problems) and I still have problems at work from it, along with my other mental health issues. Don't mean to take over the thread, but I can use some ADHD help too!

Weird that they would try bupropion and not one of the multiple non-stimulant medications that are specifically used to treat ADHD (Strattera, Catapres, there are a few others as well).

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Specializes in Critical Care.

#I.Do.What.I'm.Told. ?‍♀️

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

But....you don't have to "do what you're told." It is, after all, your body.

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Specializes in Critical Care.

IDK if it makes a difference to add this: I really am on my own. My fam r addicts, abusers, etc... So, I left & moved far away. I grew up believing my mind and body were not my own. I am reaching out to try to understand and know more about some realistic ideas, things I can do, to try & fix this, so that I can heal and move on. 

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Specializes in Critical Care.
klone said:

Weird that they would try bupropion and not one of the multiple non-stimulant medications that are specifically used to treat ADHD (Strattera, Catapres, there are a few others as well).

?‍♀️

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