Wide charcoal banner on a smooth dark gradient. Left side, a cream chip reads KNOW YOUR RIGHTS in tracked navy capitals with a rainbow offset shadow, a short six-stop rainbow rule sits to its right, and a tracked mint eyebrow further right reads 02 OCT 2026. Below, a large cream headline over two lines reads "What was agreed should not leave with the manager.", with "agreed" set letter by letter through a brightened six-stop rainbow, and a muted cream standfirst reads "Adjustment passports, and the reporting that makes the gap countable." Right side, three cream chips stacked vertically, each with a rainbow left edge and navy capitals, read "What it records", "What gets counted" and "Why publishing it works". Bottom left, the NDNA logo lockup: the full-colour rainbow stethoscope-infinity mark, then NEURODIVERGENT NURSES AUSTRALIA, with ndnurses.com.au in mint beneath. A six-stop rainbow bar runs the full width, flush to the bottom edge.

Adjustment Passports: How Some Health Employers Record What Staff Need

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Neurodivergent nurses tend to know in detail what makes their practice reliable. A particular handover format. A written medication check at a fixed point in the round. Night shifts grouped in blocks. That knowledge is hard-won adaptive practice, and it is usually held nowhere except in the nurse’s own head and in an informal understanding with one manager. When the manager changes, or the nurse moves ward, the understanding leaves with them and the whole conversation starts again.

What an Adjustment Passport Does

An adjustment passport is a written record of the workplace changes already agreed between an employee and their line manager. Across the National Health Service (NHS) in the United Kingdom it appears under several names, including health passport, workplace adjustments passport and reasonable adjustment passport. NHS Employers publishes guidance on the model and the Royal College of Nursing offers a version to its members. NHS Lanarkshire introduced a reasonable adjustment passport from 1 September 2026 for staff returning to work after long-term sickness absence, which is a narrower use of the same instrument.

The mechanism is plain and the purpose is specific. Where a passport is in place, a nurse who moves role, changes manager or transfers between organisations does not have to explain a neurodivergent cognitive profile from the beginning, or make the case again for changes that have already been working. The document travels with the person. What it removes is the repetition, which is the part of adaptive labour most obviously structurally misplaced. Doyle (2020) sets out a biopsychosocial account of neurodiversity at work in which outcomes turn on the fit between a person and their working conditions, and a passport is one way of holding that fit steady when the conditions move.

Reporting That Makes the Gap Countable

Passports work better where the employer is also counting. The NHS Workforce Disability Equality Standard has required trusts in England to report annually against ten metrics since 2019, comparing the experience of disabled and non-disabled staff. One metric asks disabled staff whether their employer has made reasonable adjustments to enable them to carry out their work. In the 2024 data analysis report, 74.5 per cent said yes, up from 73.0 per cent the year before, which leaves roughly one in four saying their employer had not.

A figure like that is uncomfortable to publish, and that is most of its value. It converts a diffuse impression into a number a board has to look at once a year, and it makes progress and stagnation equally visible. Environment-level measurement of this kind is also what the research asks for: Hedlund and Jordal (2025) examined work environment and health among nurses with ADHD and autism, treating the environment as the thing to be measured.

Neither instrument is exotic. A passport is a form and a conversation. A reporting standard is a survey question and a published table. What both do is shift record-keeping off the individual nurse and onto the employer. What the Australian duty to adjust actually requires is set out in Reasonable Adjustments in Nursing, how to open that conversation in How to Ask for Reasonable Adjustments, and a comparison of the Australian and United Kingdom duties in Adjustment Duties Compared. For advice about a particular situation, a union, an indemnity insurer or an employment lawyer is the right place to go.

References

Doyle, N. (2020). Neurodiversity at work: a biopsychosocial model and the impact on working adults. British Medical Bulletin, 135(1), 108-125. https://doi.org/10.1093/bmb/ldaa021

Hedlund, Å., & Jordal, M. (2025). What about neurodiversity among nurses? A cross-sectional exploration of work environment and health among nurses with ADHD and/or autism. WORK: A Journal of Prevention, Assessment & Rehabilitation, 80(3), 1287-1295. https://doi.org/10.1177/10519815241289852

NHS England. (2025). NHS Workforce Disability Equality Standard: 2024 data analysis report for NHS trusts. https://www.england.nhs.uk/long-read/nhs-workforce-disability-equality-standard-2024/

This post contains general information only and does not constitute legal, medical, or professional advice. Information is accurate to the best of the author’s knowledge at the time of publication. For advice specific to your situation, please consult an appropriately qualified professional.

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