The New Grad Experience of a Neurodivergent Nurse
Written by: Mackenzie Judd, RN
The ADHD Iceberg
My leg bounced as I quickly explained a memory while I watched the clock. We had 10 minutes left in our session. I had 10 hours-worth of memories I wanted to bring up all at once. She gently cut off what I was saying.
“Kenzie, have you ever been screened for ADHD?” The question brought a wave of emotion from my core up into my throat. I had wondered for years, but had been dismissed by both loved ones and healthcare professionals when I mentioned ADHD.
I was a few months into nursing school and had quickly started to develop more difficulties with focus, motivation and completing tasks at home than ever. Chores were something I could usually force myself to do through anxiety-based motivation. As I healed that tendency, I struggled more than ever with productivity. I now understand this experience is called executive dysfunction, a common symptom of ADHD.
I would stare at piles of laundry for hours, feeling hopeless because I couldn’t complete it. An inbox of 10,000 unread emails; some very important and completely forgotten, wasn’t a rare occurrence. I forgot to eat and was drained and moody most of the time.
But my nursing school grades at the time? I had a 4.0 until my second to last semester of school, and graduated with a 3.78 GPA. I was able to focus and learn just fine. It was the most confusing, frustrating, imposter-syndrome-inducing experience for me to wrap my head around after a life of overachieving whenever I wanted to push myself enough.
Internal Conundrum
“I thought that I couldn’t have ADHD, because I do so well in school.” My leg bounced faster as I awaited the common dismissal of my long-time suspicions about myself. My therapist smiled and said,
“I want to show you something.” She shared an illustration of an iceberg, the top barely poking out of the water. The graphic was titled, “The ADHD Iceberg.”
“The common symptoms of ADHD are on the top of the iceberg. But the symptoms under the water are all common with ADHD too. Your symptoms were masked by severe anxiety for a long time, but I think you might have ADHD.”
The flood gates broke as I read through more of my mental health symptoms and difficulties on a single list. That session changed the way I looked at myself. I was kinder and more understanding as I did my own research, confirmed my diagnosis of ADHD, and started medication. It was also the beginning of a long road in learning how to advocate for myself as a nurse with a neurobiological disorder that isn’t always noticed on the surface; and oftentimes not taken very seriously.
ADHD is not limited to difficulties with sitting still, fidgeting, focus or cutting someone off while they’re speaking. ADHD is also anxiety, depression, mood swings, choice paralysis, burnout, executive dysfunction, difficulty with following verbal directions. It’s auditory processing disorder, hyper fixation, difficulty in close relationships, rejection sensitivity dysphoria, difficulty remembering to meet your basic needs, difficulty with working memory, problems with focusing on ‘boring’ tasks but not ‘interesting’ ones, difficulty sleeping, difficulty regulating emotions. People with ADHD also may have difficulty prioritizing, difficulty with memorization, difficulty with switching focus or between tasks, difficulty with tuning out distractions, difficulty with time management, and the list goes on.
It’s Normal
We are all told by professors, at clinicals, and our first jobs that we will feel overwhelmed when we first start out as licensed nurses. It’s normal! There is so much to learn it would be nearly impossible to not feel overwhelmed while you are transitioning into professional practice. The warnings and tips I was offered did not take into account the fact that I was going to have to adjust to a very overstimulating environment while trying to learn under high stakes.
My interests as I neared graduation included the ER, OR, and ICU. I ended up accepting an ICU residency position and was over the moon to take on this new challenge with a positive attitude and receptive to all the help and support I was offered to help grow. I also knew it was going to be important for me to explain how having ADHD causes me to learn hands on skills at a different pace than other new nurses, a slower pace.
A few weeks into my ICU orientation, I realized the environment wasn’t receptive to my explanations of why I need more support and a slightly slower learning pace. It’s important for my memory to develop a conceptual understanding before I am expected to operate independently. I never felt that what I was asking for was inappropriate, even if it wasn’t the unit culture norm.
Proving a Point
I felt capable of my job as long as I had the support I needed. After my first experiences of bullying in the workplace, the confidence to tackle my assignment and push myself crumbled. The foundation I had built under myself in school, the extra time I spent studying critical care on my own, and the desire to go further to help my patients feel cared for was ripped out from under me in the matter of a few traumatic months.
I oscillated between feeling numb, exhausted, and angry. I dreaded going to work. My executive dysfunction, depression, and anxiety were at an all time high. I was sleeping, eating when I had the motivation to make a food choice. I fought to become comfortable as a new nurse in an environment that I felt hyper-vigilant in. That was as far as my bandwidth could stretch.
After less than 6 months in the ICU, I accepted the fact that I was no longer working the job I had wanted so badly because I wanted to. I realized I was doing it to prove a point to those who made me feel like new nurses have no place in a critical care setting. The reality is, I was proving my point. I COULD hold my own on a critical care unit, with ADHD, whether the nurses around me agreed and helped me feel supported or not. As I started on my own, I was receiving great feedback, but at what personal cost?
I was experiencing both ADHD burnout and healthcare worker burnout at the same time. It was devastating and felt like a complete failure when I quit for the sake of my mental health. In my heart I knew it was much more complicated than that, and I needed to put my health before my determination. I decided to explore another one of the specialties that I really loved during nursing school, perioperative nursing.
Day One, Round Two
On my first day of orientation in an operating room, I quickly began my explanation of how I learn. Assuring my preceptor that I am very focused. I told her I’m very motivated to learn, but I have ADHD. It takes me a little bit longer to absorb and process everything. I was going to take a little while to start coming up with questions, and it’s best for me to just watch for a few days as much as possible.
Her eyes smiled and she looked at me as we walked at warp speed down the hall and said, “My kid has ADHD too.” I cleared my throat to tamponade the tears that wanted to escape my eyes. I immediately felt seen and safe. My preceptor stood up for me in my nervous moments and rookie mistakes throughout my first few weeks. She reminded others that I am ‘very smart, but new’. She is an amazing, experienced, kind, and passionate periop nurse. I strive to become a little bit more like her with every shift.
March marks my 12th month as a licensed nurse. My first year of nursing has been full of sky highs, and devastating lows. But one thing is for certain: I am a capable, caring nurse, passionate nurse…ADHD and all. If you are a neurodivergent nurse, remember this message from my new grad experience. Don’t be afraid to change your environment if it is not meeting your needs. It is ok to be firm about your learning needs. It is vital that you find a space to grow where you feel safe to do so.
Xoxo, Kenzie.
Meet Mackenzie, LPN, RN
Mackenzie is a perioperative, wellness and aesthetic RN, digital creator, self proclaimed science nerd, and advocate for nurses with ADHD, anxiety, and trauma. She is passionate about empowering new nurses through her own experiences as she grows into a seasoned nurse one shift at a time. As Mackenzie celebrates her first year as a Licensed nurse this March, her hope is for a future healthcare system where no nurse feels left behind.
Where to find Mackenzie
Instagram: @nursekenzie
TikTok : @NurseKenz
Edited by: Claire Lang, RN-BSN
This, all of this is amazing as a nurse who was diagnosed later in life with ADHD-when I went for my bachelors. I highly recommend reading Driven to Distraction as that helped me understand that I had so many signs but was masked for so long. Thank you for your story!