Supporting the needs of neurodivergent nurses in the workforce

Neurodiversity is thought to affect around 15% of the population, with dyslexia making up two-thirds of that statistic (Penketh, 2018; ADHD Aware, 2022). Neurodiversity relates to hidden disabilities of the brain, such as dyslexia and dyscalculia, dyspraxia, attention deficit disorder and autism (Penketh, 2018). This umbrella term relates to the different ways a brain works and interprets information.

The Royal College of Nursing (2023a) suggested that there is estimated to be a greater prevalence of neurodiversity among healthcare staff, pointing towards a need for workplaces across healthcare to make adjustments to enable neurodivergent staff to be supported when carrying out their nursing responsibilities.

Neurodiversity in the workplace

The Royal College of Nursing (2023a) noted that neurodivergence includes several neurodevelopmental conditions, and some people may have more than one condition. Many neurodivergent conditions are part of a spectrum, so people can have varied experiences and difficulties, and therefore different needs.

From a legal perspective, being neurodivergent can amount to a disability under the Equality Act 2010. Where this is the case, employers have a legal obligation to make reasonable adjustments to the workplace, which may involve removing barriers or providing additional support for a worker or job applicant with a disability. Any failure to make reasonable adjustments could be considered unlawful discrimination and leave the employer open to a claim from an individual.

The National Autistic Society (2019) and Royal College of Nursing (2023a) both encourage employers to adjust their recruitment and workplace practices to help people with autism to be able to carry out their job responsibilities at the highest level. Making reasonable adjustments can benefit not only those with autism, but also other employees and the wider workplace. The Royal College of Nursing (2023a) stated that managers must make it clear that they welcome applications from neurodivergent staff and those who may need reasonable adjustments.

Neurodiverse needs in the workplace

Each neurodivergent person has their own strengths and areas where they need support. For example, certain people with autism may, but do not necessarily, have some of the following attributes:

• a logical or methodical approach to problem solving
• an ability to focus intensely
• task oriented and persistent
• good accuracy and attention to detail
• accurate memory
• reliable, have integrity and a strong sense of justice
• strong visual skills

However, the above attributes are not unique to people with autism, and are very frequently seen outside of the neurodivergent community. There is a depth of misunderstanding around the implications of neurodivergence, precisely because everyone on the spectrum is different. When it comes to the workplace, just as those who are not on the spectrum can perform a job, subject to the right skills, so can those in the neurodivergent community.

The Royal College of Nursing (2023a) stated that, while the neurodivergent nurse is the best person to know what will work for them, along with recommendations from diagnostic reports, they still need to meet all the professional requirements to be safe and effective practitioners and meet standards of competency.

Reasonable adjustments

An awareness and understanding of autism among managers and colleagues is useful when it comes to making reasonable adjustments. This would include an awareness of what it is like to be autistic in the workplace, along with possible adjustments and strategies that can help. Creating a generally supportive and inclusive culture is also essential to facilitating the comfort and wellbeing of all staff, including those who are neurodivergent.

A reasonable adjustment means adapting the working environment to enable an employee to be able to perform their job comfortably and to the best of their abilities.

Adjustments will depend on the individual’s neurodivergent characteristics and needs, and whether a particular adjustment is considered reasonable. Whether an adjustment is considered reasonable depends on what an employer considers to be effective, practical and economic, as well as the required resources and availability of any financial support.

The Royal College of Nursing (2023a) offers guidance on neurodiversity to managers. Some suggestions for reasonable adjustments include:

• giving nurses a dictaphone for note taking
• allowing changes to working patterns
• installing automatic doors
• putting in place disability leave in addition to sick leave
• allocating a workspace away from noisier areas
• providing dual screens to increase the visible working space
• adjusting lighting levels

Additionally, the National Autistic Society (2023) endorses more sophisticated assistive technologies, such as the Brain in Hand application that can be programmed with helpful processes, reminders, timetables, anxiety tracking and management strategies. Tools such as this can help to link the person with their manager and support network and provide an overview of how they are progressing.

Changes to work processes could also benefit the neurodivergent nurse, this may include:

• changing how people communicate with colleagues with autism
• providing agendas ahead of meetings
• following up face-to-face meetings with an email outlining the agreed action points
• giving a clear timeframe for action points to be completed

Changes should focus on reducing confusion and promoting greater understanding in the workplace.

Bullying or harassment in the workplace

The autism employment gap report (National Autistic Society, 2019) noted that 48% of the people with autism surveyed reported bullying or harassment in the workplace, and 51% reported other discrimination or unfair treatment as a result of being autistic.

This problem can be compounded by the fact that differences in communication means that people with autism may not always recognise they are being bullied until this either becomes severe to the point of being obvious or a colleague recognises what is happening.

Bullying is a long-term issue and can leave someone with dangerously low confidence and self-esteem, which could lead to long-term unemployment, greater dependency, mental ill health and legal action. The Royal College of Nursing (2023b) stated that bullying or harassment is never acceptable, and employers must have workplace policies in place that deal with this risk. Additionally, managers must offer support and avoid perpetuating differences between neurodivergent staff and their colleagues.

Conclusions

In the same way that people who are outside of the neurodivergent community all have different characteristics, experiences and manner, so do people who are neurodivergent. Consequently, it is important to meet their needs and make reasonable adjustments to create a workplace that is fit for all.