Welcome to this collaboration blog between Nursing Uncensored and our friend Jami whom you probably know Jami from her popular nursing podcast First Do No Harm. Well, in this post, as the title alludes, we are going to discuss some tips for a very specific demographic of nurses, but I want to cover something before I just dive right into the top 10.

I always have such a fun time chatting with Jami. I hope to one day have a post-pandemic meeting in real life.

First, The Fess Up

I have a big disclaimer before we get going. I am undiagnosed, or rather self-diagnosed, with Attention Deficit Disorder. I have multiple members of my close family with diagnoses and I have many symptoms which I have learned to manage over my life (some successfully and some we could debate). I don’t plan to seek a diagnosis since my symptoms have only a nuisance effect on my life and I can manage fairly well with disciplined behavioral practices.

I’m curious to see how I feel as I learn and explore more about this diagnosis in adult women. Most of what I know about ADD applies to young people, and mostly boys. I’ve been listening to Jami’s new show The Neurodivergent Nurse and I’m happy to share my thoughts with her on this episode that we did together over on her show.

What I am able to share with all of you is what I interpret as my symptoms and how I deal with them while I’m on a 12-hour hospital nursing shift. The first order of business is for me to lay out some of the symptoms I struggle with the most so we’re all on the same page here.

The Usual Suspects

Being Easily Distracted or Overwhelmed

If I get too many projects or tasks going at once, I can lose things in the shuffle. Barring an emergency, I try to finish things before I move on.

It can also be easy to get lost in competing stimuli on the unit. There are usually lots of people talking, alarms sounding, phones ringing, call bells...sensory overload can sneak up really fast. In my early days of nursing, if I had multiple people come up to me with requests at once, it made me feel like yelling “one at a time people!”

Losing things

Misplacing small items is a special gift of mine. From my pen to stethoscope, to notes and even my work phone, it’s really easy to set things down and walk away, only to spend the rest of the day saying things like “ I JUST had it a second ago”.

Running Late

Doesn’t matter if we’re talking about showing up for a shift, or a scheduled x-ray, I gotta work to not be the last one there. Decades of feeling rushed and embarrassed when walking in late have caused me to take extra precautions now.

Being Disorganized

I’m a chaotic mix of a type A princess and a complete slob. The document I want is either neatly filed in my binder with a colored tab, or it’s crumbled at the bottom of my bag covered in toothpaste.

Losing track of time/blow time chatting

“I’ll be there in 5 minutes,” I say with the intention of finishing this story I’m telling. An hour later, I panic realizing it’s been 55 minutes. It’s an innocent ADD brain mistake, but the consequences are still the same when you’ve got a waiting patient...or 3.

These are just a few negative traits of a brain that goes through periods where it’s like a TV flipping through channels. I’ve found ways to counter these problematic habits with more helpful ones to make me a more organized and effective bedside nurse. These habits have taken practice and personalization over years which continue still. Not all the things I suggest will work for all people. Pick up the pieces that sound like they might work for you.

Here are 10 Tips for Nurses with ADD

Have a Structured Brain Sheet

A prime time to be all over the place and forget things is during nurse-to-nurse handoff. This is a polarizing topic for many people but I almost always get better report from nurses with structured brain sheets. Some may hate me for saying it, but those who just write on a blank piece of paper usually give me report that makes me feel ill-prepared, over-stimulated, and hectic to start my shift.

I’m biased of course. My report sheet, appropriately named my Brains, helps tell a good patient story to the oncoming nurse without making me sound like a complete spazz. It also helps me be sure that I don’t come onto a shift without asking for all the info I need to get going safely. I also use my report sheet and the med sheets I printed out to jot down notes which help me remember things I’ll chart later. If my paper Brains aren’t good, my real Brains suffer. Get a brain sheet that is tailored for your unit/population.

Jami has shared her ICU Nurse brain with us for you to download and print.

Adrianne has her brain sheet for you, too.

Live Chart (...at least a little)

Some may not know what I mean by “live chart”. This is specifically for those using electronic medical records with computers at the bedside. It’s when you do a thing for a patient and then immediately log it in the EMR. This is a hard one to remember sometimes, and I don’t live chart everything every time, especially since my patients often want to go back to sleep, but I use this strategically. Let me explain. I use live charting as a timestamp.

If I’m going to be in a room for a few minutes, I’ll log into EPIC - like if I’m waiting for a patient to use the bathroom, but I don’t want to go very far away because they’re a fall risk. I’ll help them back to bed, chart their output, and perhaps not chart anything else during that encounter.

I don’t hate some of the recent updates. moo.

Later when I’m doing my full charting, I can go back to that time in Epic and finish charting everything else I did for that patient in that encounter, like repositioning, perhaps a coccyx wound re-cream, a hot pack reapplication, maybe a pain reassessment, or whatever else I did for them.

And because I know I went to the room next door right after that I know approximately what time I was in there. So if I live chart things periodically, it’s like leaving a trail of breadcrumbs so I can reconstruct my night easily when I’m charting.

Have Reliable Note Taking

Speaking of post-it notes, let’s be real about those little pieces of frustration. You’re going to lose them. You’re going to drop them. They’re going to stick to everything except what you want them to. Don’t kid yourself with the sticky-pads. And don’t write on your hands. Definitely don’t write on a glove and expect to save it. Yuck! And writing on scrubs is for emergencies only...and only if you don’t wear black scrubs. Basically, have something else for all your notes and scribbles.

I solved this problem with a reusable notepad attached to my body for every shift. This is not sponsored (I’d love for it to be!), but I am a huge fan of the Scribe Pad, which was created by a Speech Pathologist. It’s a credit-card-sized dry erase board that I wear on my badge reel every shift. I write on it with a fine point wet erase marker (dry erase would smudge off too easily).

When I need to clean it off, I just run an alcohol pad or wet paper towel over it. It’s double-sided and I’ve been using it for over a year now. There’s no turning back. I stopped messing with tiny bits of scrap paper and my flitting brain never has to retrace steps looking for an important note I jotted down.

I encourage you to try the wet-erase life. There’s nothing in it for me, but tell them Nursing Uncensored sent you.

Wear Your Tools

Most people with ADD know the feeling of “losing” the same item 10 times in 20 minutes without leaving a room. This means that the hospital unit is nothing but a huge arena for losing shit. Every nurse knows the peril of losing a favorite pen or - worse - a brain sheet.

My solution is in tethers and pockets. Yes, folks, tether items to your body or designate pockets for frequently used items: my aforementioned Scribe Pad falls under this category, along with several other things like my pen, mini safety scissors, and a host of other tools, like Stink Balm that compulsively go in the same pocket every time. Now my muscle memory makes me reflexively reach for them.

Pre-tethers, I can't tell you how many times I lost those damn tiny scissors. After several sad losses, I stopped buying new ones and just put them on a reel and pinned it to my damn shirt. Now I don't wander off without them. but I do often wander off to later find them swinging from my shirt - a clear sign that if they hadn’t been on that reel I’d have walked off without them again. Not everyone wants to walk around with their treasures swinging from their shirt, but a few key items can make a big difference in your shift. Since I have so many little things, I’ve become the self-titled @gogogadgetnurse, after my favorite 80s cartoon, Inspector Gadget.

Keep Better Track(ing)

Keeping with the theme of not losing things, let’s talk tracking devices. These are now normal devices in this digital age, no longer reserved for spy movies. I have 4 tracking devices, not including the tracking on my phone and tablet. One tracker is on my stethoscope. I have used it to make my misplaced stethoscope play a little tune until I locate it. I’ve found the darn thing under blankets, hanging from a chart rack, on a doctor’s desk, and in the locker room. That thing is expensive and if not for my tracker it’d be gone.

The same type of tracking device is on my keys and miraculously helped me find them buried in 6 inches of snow just a few months ago. It was a really lucky thing I had that tracker that day. I also have one in my wallet and one on my bike.

Trackers are small, affordable, and made for people like me who wander off without their shit all the time. I use the Tile trackers, which have the key chain versions, as well as slim ones for wallets, and sticky ones for adding to whatever you want. Here’s my affiliate link for a multi-pack to get you started, or a single one. I’ve built my collection over time and I’m glad I have them.

Say It Outloud

As nurses, we are always juggling a thousand tasks at once, stacking up on the to-do list in our minds. For me, it’s inevitable that I forget something and have to backtrack to get things completed. This can add a lot of steps to an already exhausting shift. So what do I do besides all the things I just listed? This can be used in a few ways, but it’s one basic concept - say important shit out loud - most of the time this will be a summary or a recap of a given situation or set of needs.

When I’m about to leave a patient's room, I ask if they need anything. I try to make it a one-time gather so I’m not responding to another call light in 5 minutes.

I also do this with people’s names, physician’s orders, things other nurses ask me to do for them, or you fill in the task of your choice. If it’s not a thing worth writing down, then at least say it out loud.

According to my google research, it’s a real thing called The Production effect. Science has already shown that we remember things better when we say them aloud. So who are we to refute science?

Give this one a try and see if it helps you cut back on forgetting things when you’re running your booty off on a busy shift. I mean, really, just try it when you’re out running errands, or when you’re studying (see all my blogs on studying*)

Tech It Out

I don’t care how tech-savvy you may be, you should be taking at least baby steps to use available tech to your advantage. There is a myriad of ways to make your work life easier with the technology available to many people on the job. However, I am not an out-of-touch elitist, so I don’t expect people without expensive gadgets to run out and buy them. I merely think you should be using what is already available to you or within a reasonable grasp for your budget.

I’m not going to go into great detail here about all the tech I personally use in my work life, but I will list a few things that I think will help a variety of nurses. First, if you have a phone or watch that allows you to set alarms and timers, you should absolutely be using those.

I usually set a silent alarm on my Fitbit watch for 5 times per 12-hour shift - 2100, 0000, 0200, 0400, and 0600 - time for completing and/or charting specific tasks at standardized times or other important moments. These just help me pace myself so that if I get really busy it’s like having a little someone go “hey bitch! It’s 2 am - have you reassessed the trajectory of the shift?!”.

I use apps that help me out - Micromedex IV compatibility guide, the translation service app on the phone my hospital provides, NurseGrid for scheduling and sharing schedules with friends, and other things like that. I’ll cover more tech items in a future post. Ask around your institution to see what tech other nurses are using specific to your population.

Silent Secret Sanitary Stimulus

I do sometimes find myself feeling fidgety or restless at work, but fortunately, I’m not a pen clicker. I know that nurses are already stressed and the sounds of my rapidly tapping foot on the floor are not making anyone feel relaxed. I do have a secret weapon passed down to me by my Gramma Frances.

My Gramma had a Worry Stone. This was an oval flat stone, that she would hold between her thumb and curled forefinger, and rub with the flat of her thumb. It was the fidget spinner of her generation - the thing that kept her hand occupied when she was worried about something. So find yourself something that you can sani wipe that won't get disgusting, that you can hold in your hand, inside your pocket, for the focus of that nervous energy. Just make sure it’s silent so your coworkers don’t beat you with it.

Ditch Excess

I just listed a lot of stuff to buy, wear, or carry, but now I’m going to tell you the opposite of getting more shit. I’m going to tell you that everything you carry should be something you need and use almost every shift or something you’ll be needing in the near future. Keep yourself as light as possible because the work is hard enough without adding shit to keep track of.

The amount of crap that accumulates in my pockets is astounding sometimes.

Don’t carry ten pens when you need 2, and a million scraps of paper - a chart that info and throw it out. One terrible night I remember getting really frustrated when I was digging through my stuffed pockets, I couldn’t find what I was looking for, was distracted by things I meant to put back but hadn’t, and I kept dropping things. I was super irritated. Don’t be like me. If you don’t need it, ditch it. Don’t walk around with overflowing pockets that make your brain want to explode when you have to find things.

10. Don’t Dodge Diagnosis (you know you love alliteration)

While it’s nice to have choices for behavioral modifications, for some of us, symptoms may be interfering with our day-to-day lives and we need more help. Maybe we’ve lived with these feelings or symptoms our whole lives without knowing what to call it or what it was, or maybe it’s only really been a problem we’ve noticed more recently in our lives, or perhaps it’s just become too much.

As healthcare providers, we deserve to have the compassionate, quality healthcare we provide for others. We deserve to have healthy bodies and minds. I encourage you to talk to a healthcare provider about what you’re experiencing and if you may benefit from some type of therapy or treatment.

Please visit this site for a lot of great links with Information about ADD/ADHD in adults to get you started learning more.

You can also check out the Attention Deficit Disorder Association, a community supporting others with ADD.

There is so much I do not know about ADD. I plan to keep learning about how I can control my symptoms with greater ease to be a better nurse and a happier person with this disorder. I’d be very happy if something I said was helpful for you. I encourage you to take what you can from what I’ve written, use it in ways that work for you, and keep doing your own research.

If you made it to the end of this incredibly long blog post, you have earned an incredible amount of respect from me.

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