Clinical Handover Is a Designed Artefact: Why Structure Helps Every Nurse

Many neurodivergent nurses give unusually good handover. They arrive with a written summary, follow the same order every time, state the plan plainly and name the thing that does not add up. Research with nurses who have ADHD or autism reports high satisfaction with the care they give, alongside high quantitative demands at work and low managerial support (Hedlund & Jordal, 2025), and a recent scoping review describes strengths including deep focus, relationality and novel perspectives, with workable challenges around documentation and multitasking (Deterding et al., 2026). Handover sits exactly where those strengths and those challenges meet. It is the densest information transfer of the shift: a whole ward’s worth of history, risk and plan, delivered in a few minutes, usually by voice, often in a corridor. Almost nowhere is it designed. The format is inherited, the location is wherever people happen to stand, and the pace is set by whoever is running late, and the problem that produces is a structural one.

Handover is already an organisational obligation

In Australia, clinical handover is governed by the National Safety and Quality Health Service (NSQHS) Standards, published by the Australian Commission on Safety and Quality in Health Care (ACSQHC). Standard 6, Communicating for Safety, requires the health service organisation, in collaboration with clinicians, to define the minimum information content to be communicated at clinical handover based on best-practice guidelines, the risks relevant to the service context and the particular needs of patients, carers and families, and which clinicians are involved (action 6.07). It requires clinicians to use structured clinical handover processes that include, among other elements, preparing and scheduling the handover, having the relevant information available, and ensuring that responsibility and accountability for care transfer (action 6.08). Structured tools such as ISBAR (Introduction, Situation, Background, Assessment, Recommendation) are listed in the Commission’s guide for hospitals as ways to structure handover, because unstructured handover is a recognised safety risk (ACSQHC, 2017).

This matters for neurodivergent nurses because it moves handover out of the category of personal preference. The format, the timing, the place and the written support are things the organisation is already expected to decide. A nurse who asks for a printed handover sheet alongside the verbal round, a handover held in a quiet room with the door shut, or a fixed order of information that stays the same whoever is leading it, is asking the service to do what its own accreditation standard already describes. Requests of this kind also sit within the reasonable adjustment provisions of the Disability Discrimination Act 1992 (Cth).

Where the labour currently lands

When handover is left to habit, the work of turning a rapid verbal stream into a usable plan is done by each receiving nurse in the first twenty minutes of the shift. For a nurse whose neurodivergent cognitive profile may include differences in auditory processing, working memory or attention, that work is larger. The adaptive labour involved, rewriting the sheet, asking again for the plan, checking the chart to confirm what was heard, is real work, and it is structurally misplaced: the system produced an unusable artefact and the individual is repairing it. Doyle (2020) describes neurodivergence at work in biopsychosocial terms, where the environment is as much a variable as the person, and handover is one of the clearest examples in nursing of an environmental variable that could be fixed once, for everyone.

The design choices are ordinary. A written summary that matches the verbal order. A consistent template across the unit. Handover held away from the corridor and the phones. Time built into the roster so it is never squeezed by a late arrival. A convention that questions are taken at the end of each patient before the round moves on. None of these is neurodivergent-specific. They are the features of a well-designed handover, and they lower the load for every nurse in the room; the neurodivergent nurse is simply the person most likely to have noticed the design was missing.

NDNA has argued elsewhere that the conditions of clinical work are chosen, whether the subject is sensory-friendly clinical environments, psychological safety in clinical teams or the documentation strategies dyslexic nurses develop. Handover belongs on the same list. A health service that treats it as a designed artefact, with a defined content set, a fixed structure, a written companion and a quiet place to deliver it, is meeting its own standard and reducing the burden of adaptation carried by its neurodivergent staff at the same time. For advice on an individual situation, the Australian Nursing and Midwifery Federation (ANMF), a professional indemnity insurer or an employment lawyer are the right places to go. The design work belongs to the organisation.

References

Australian Commission on Safety and Quality in Health Care. Communicating for Safety Standard, National Safety and Quality Health Service Standards (second edition). https://www.safetyandquality.gov.au/national-standards/nsqhs-standards/communicating-safety-standard

Australian Commission on Safety and Quality in Health Care. (2017). NSQHS Standards Guide for Hospitals. https://www.safetyandquality.gov.au/sites/default/files/2019-05/national-safety-and-quality-health-service-standards-guide-for-hospitals.pdf

Deterding, K., Halabi Najjar, R., Roach, A., & Cloyes, K. G. (2026). Neurodivergence Among Nurses in the Workforce: A Scoping Review. Journal of Advanced Nursing, 82(10), 9028–9044. https://doi.org/10.1111/jan.70541

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

Disability Discrimination Act 1992 (Cth). https://www.legislation.gov.au/C2004A04426/latest/text

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.