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  • Writer's pictureChristie Roberts

Neurodivergence in Nursing

Updated: Dec 3, 2023

To start: some introductions. Hi, I'm Christie, I used to be a nurse, and I was diagnosed with autism in December 2021. I've been on a real journmey to learn about autism, but it's been brilliant to learn about how my brain works. It's made a lot of things 'click' and I feel like I learn something new every day!

(these are my texts to my care co-ordinator after I had just opened the letter confirming my diagnosis. it was her who had suggested that I might be autistic, and started the ball rolling to get an assessment- forever grateful for her!!!)


A lot of media will report the stereotypes of autism, which are usually negative. Things like... that autistic people can't to communicate, that autistic people don't function in social situations, that autistic people have low IQ or are academically slow, that autistic people don't feel emotions or can't empathasize with people... the list goes on.


I've overwhelmingly found that autism has actually given me a set of skills and personality traits that really suited me to working in healthcare- but it's not without challenges. In this post I hope to highlight some of the benefits and difficulties, using my own experiences and the experiences of others with autism who work in health and social care. I will also link to some interesting research and useful resources.


*nb: in this post, I will be referring to 'autistic people' rather than 'people with autism'. It's common with neurodivergence to prefer identity-first, rather than person-first language, as neurodiversity is a fundamental part of who you are! I also use 'allistic' to refer to a non-autistic person*


1. Emotions and empathy

I think this quite from Atypical sums up a lot of what I think about this point:

"People think autistic people don't have empathy, but that's not true. Sometimes I can't tell if someone's upset, but once I know, I feel lots of empathy. Maybe even more than neurotypicals"

Like the quote says, autistic people may struggle to recognise specific emotions in others (which probably comes from our own alexithymia- or inability to recognise and describe emotions) and therefore we might miss emotional cues. However, this doesn't mean that autistic people don't have emotions, or empathy. In fact, a lot of the most empathetic nurses I've worked with have been autistic.

Autistic people may show different emotional responses, compared to allistic people. For example, anger or frustration may be expressed by crying, but this may be misinterpreted by others as sadness. Allistic people may stuggle to recognise and interpret the emotional responses of autistic people, and autistic people may struggle to recognise and interpret the emotional responses of allistic people (interestingly, greater rapport and understanding is seen between pairs of autistic people compared to an autistic-allistic pairing- Fletcher-Watson and Bird, 2020).

Hyperempathy may be experienced in autism, and can make it more difficult to work in emotionally-charged environments. This is described as being too in-tune with others emotions, and subsequently mirroring these. This particularly happens with negative emotions and can lead to emotional dysregulation and contribute to burnout.


2. Attention to detail

Autistic people often describe a strong attention to detail. In healthcare, this can be useful for spotting things that others might not immediately recognise, like a change in breathing pattern, or a patient looking more unwell. This is potentially due to sensory hypersensitivities, which could mean greater awareness of visual or auditory changes.

Another proposed theory for why autistic people have such good attention to detail is the 'bottom-up' approach used in our brains- or, a tendancy to notice the small parts of an object or system, which then forms part of a wider system noticed later. In reality, this could mean things like quickly noticing small changes in body language, which are then build up to understand what has changed in the person overall.


3. Pattern recognition

Somewhat linked to attention to detail, but autistic people often excel at pattern recognition. That is, seeing themes and trends where other people may not. For me, this has been particularly useful in uni work. For example, conducting thematic analysis in my dissertation, I found I could make associations from words that were seemingly unrelated. And in data analysis and epidemiology, I can look at data sets and find trends or repeating patterns in the numbers.

Clinically, this could present as being able to recognise signs and symptoms in one patient, and finding similarities with previous patients- this could help in diagnosis and management. There's a real strength in being able to see things in one situation (or even just having read about it) and applying it to another situation.


4. Organisation, routine and structure

Given that many autistic people struggle with change and unpredictable situations, you'd think that healthcare may not be the ideal career. From shift work, to potential emergencies- there's scope for a lot of change and unpredictability. However, most of healthcare is very process-driven, most shifts will follow the same routine, and there are certainly many areas that are very structured.

In my career I worked in Intensive Care and then in Clinical Research. ICU suited me because the routine of each shift was fundamentally the same, day or night. Every shift starts with safety checks and a patient assessment. Every hour you check observations and fluid balance. Every 4 hours you roll your patient. In between those times, you give medications at set times. It was perfect. The only time that it wasn't was if that routine was distupted, like when a doctor gives you 5 minutes warning that your patient is going for a scan- this genuinely used to throw me off for the rest of the day. Firstly because it disrupted the routine and any schedule I had made, and secondly because it was an unexpected change to those routines. Clinical Research also worked for my autism, because everything runs according to a protocol, and it's the same every time. There is literally a guidebook for what you need to be doing and when for each patient!

Given that healthcare is unpredictable, you do need to find a way to cope with unexpected change and find a way to self-regulate any overwhelm that might be associated with that.


5. Social justice

A strong sense of social justice and intolerance of unfairness can mean that autistic people care incredibly deeply for people, whether they know them personally or not (I see a lot of injustice for strangers twitter, and I feel as outraged and disappointed as if it was someone I knew). This can go much further than what patients present with and making sure that they get appropriate medical care, and could include making sure that care is culturally competent and cognizant of individual factors like gender and sexuality, or wanting to impact the wider social determinants of health like suitable housing, access to adequate food, and decreasing levels of poverty and deprivation. The issue is- these are big factors that one nurse can't feasibly tackle by themself. And believe me, the more I learn about this in my public health degree, the more it infuriates me. As do most of the decisions made by the current UK government...

The benefit of this approach is that on an individual level, autistic healthcare workers will try to provide the most comprehensive, sensitive and holistic care possible for every patient. If something bad happens, people with autism may be more likely to challenge any wrongdoings and escalate things to put them right. This can be further emphasized by a lack of autistic appreciation of hierachies (which often don't really make any sense) and so they will go to whoever the most appropriate person is to deal with the issue- not necessarily just the person on the next rung of the ladder.


6. Communication

Communication may be something that autistic people struggle with- I certainly do. Personally, I rely heavily on scripted conversations, and find small talk incredibly uncomfortable. I am prone to misunderstanding communications, both written and verbal, if its ambiguous and can require more time than allistic people to process information, particularly verbal info due to auditory processing difficulties (to the point that I have my email signature as 'I am autistic- please be clear and direct in replies, and allow for adequate processing time').

Communication is a key tool in nursing. Fortunately, it's widely recognised that a majority (somewhere between 60 and 93%) of communication is actually non-verbal, such as body language or facial expression! So if conversation isn;t your strong suit, no worries- people probably aren't actually taking that much of it in anyways.

The NHS lists 'seeming blunt' as one of their main signs of autism. This is rarely a conscious thing, and probably comes from a neurotypically accepted norm of what conversation should be like. Bluntness could be translated into honesty and a direct communication style, which many more autistic people may relate to. This direct and honest communication is a massive benefit in healthcare- from being clear when delegating tasks, to having difficult conversations with patients. This communication style may lead to more transparency and openness in conversation.


7. Hyperfocus

Hyperfocus is defined as a phenonemon whereby someone becomes completely absorbed in a task, and can lose track of everything else around them. It's seen in autism and ADHD and can be useful in the workplace as it can mean that you pick up skills or knowledge super fast. Hyperfocus usually happens for special interests or tasks that are particularly enjoyable, but can be applied to pretty much anything (I sometimes get hyperfocus whilst writing uni essays, and can go for hours on end with absolutely no distraction. It's dreamy). People may go into a hyperfocus zone when engaging in something they perceive as challenging, such as learning a new skill or detail-focused tasks. A potential drawback of this could be that a task is so engaging that it can be difficult to change tasks when needed.


8. Special interests

Some of the autistic people I've spoken to in healthcare have described going into their job because it was a special interest, or found that their job became their special interest after starting. In particular, nurses who specialised in an area were not only incredibly knowledgeable professionally, but also incredibly passionate about what they do. There's no reason that your job shouldn't become a special interest, as long as you're still able to step away from work and take a break when you need to. Otherwise, you end up living and breathing your job and this has the potential to lead to burnout work-wise and autism-wise.


9. Self regulation

One of the biggest (and maybe hardest?) skills to learn with being autistic is how to manage your self, your emotions, your social battery, your sensory profile and more. Particularly for late diagnosed autistics, this learning journey can feel huge and overwhelming- but there's so much joy and relief when you finally piece some things together! In the workplace, this can mean that you have to advocate for yourself- for example, asking to a 5 minute breather if you're getting overwhelmed. You may find that you mask intensely at work, particularly if you're not open to sharing your diagnosis (I would definitely advocate for openness, but recognise that it can be really scary, particularly if you're new to a team or don't feel comfortable around some people). And after work, you may find that you need to cancel social plans to let your battery recharge. I've definitely found that being autistic and introverted, yet working in an extroverted, people-facing job, means that I need time to decompress after a shift- after a 13 hour shift, this usually looked like me laying on the sofa in the dark for an hour or so just to reset my systems. I give myself permission to do this, because that's what allows me to get up the next day and go back to work.



I wanted to add a final section on reasonable adjustments that could be applicable for those studying or working in healthcare enviornments. Some ideas include:

  • Altered working hours- eg starting later in the morning, working later into the evening. This may not be possible if you're doing shift work.

  • Flexible or hybrid working- eg working from home some days.

  • No night shifts

  • Information or instructions given in a written format or demonstrated, rather than just verbal.

  • Quiet space for taking breaks or adjusted/regular break times.

  • Use of sensory aids- eg earplugs, screen filters, coloured paper.

  • Potential need for additional time off for appointments or sickness. NHS sick policies are notoriously rigid, and will usually only allow 3 absences before an escalation is triggered- so speaking to occupational health to get approval for more flexibility could be useful.

Employers are required to make reasonable adjustments under the Equality Act (2010) to ensure that workers with disabilities, long term physical or mental ehalth conditions, and neurodivergence are able to do their jobs without being substantially disadvantaged. You'll need to negotiate what's feasible and reasonable with your team. Further discussion with occupational health may be required to work out what's necessary and possible within your job role.


Resources:

Some useful social media resources that I have found, that have guided me in the writing of this post:

Support and Understanding for Neurodivergent Nurses (SUNN) on twitter, instagram and facebook- Chloe (@chlojackonhermac) has created an amazing network for supporting neurodivergent nurses, as well as providing information for neurotypical colleagues. They've also just released their first podcast episode (you can listen here ) and it's well worth a listen!

NeuroDiverseNurses on twitter- this account posts really helpful links and holds tweetchats that can help you learn more about neurodiversity.

creative_activism_ on instagram- Lucy has been so helpful in providing information that has informed this post. And more generally, has been such a star in helping me to understand my own autism!

neurodivergent_lou on instagram- they create some really useful graphics that clearly summarise a huge range of topics around autism.

The RCN have an page with loads of resources and information for HCPs, students, managers and mentors, as part of their peer support service- definitely worth taking a look, and sharing with your teams.


References:


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