Adjustments for neurodivergent nurses: a guide for managers

Neurodivergent nurses are already on your ward. Doyle (2020) estimates that around 15 to 20 per cent of people are neurodivergent, and no equivalent figure exists for the Australian nursing workforce. Many bring pattern recognition, sustained focus, and an empathy grounded in their own experience. Where the working conditions are wrong for them, the extra checking and self-monitoring they do is labour the workplace should be carrying.

What the law requires

The Disability Discrimination Act 1992 (Cth) covers discrimination in employment at section 15. The duty to make reasonable adjustments comes from the Act’s definition of a reasonable adjustment, which operates through the direct and indirect discrimination provisions at sections 5 and 6.

Two exceptions are available to an employer: the inherent requirements of the job (section 21A) and unjustifiable hardship (section 21B). Two things about them are worth knowing before you rely on either.

  • Section 21A applies only once reasonable adjustments have been made. Section 21A applies where a person could not carry out the inherent requirements even if reasonable adjustments were made. The section also requires you to take account of the person’s training, qualifications, experience, and how they have actually performed in the role.
  • The burden of proof sits with the employer. Section 11(2) places the burden of proving unjustifiable hardship on the person claiming it.

This guide describes what the Act says. For a particular situation, use the advice sources at the end.

Much of this is also a work health and safety duty

Roster predictability, notice of change, breaks that are actually taken, and alarm noise appear throughout this guide as adjustments. They are also psychosocial hazards under work health and safety law, which means they are owed to every worker on the unit, triggered by the hazard itself, and requiring nobody to disclose anything.

Just because psychosocial risks are common at your workplace, it does not mean they can be treated as ‘part of the job’ and ignored.

Safe Work Australia, model Code of Practice for the healthcare and social assistance industry, July 2025

The same Code asks employers to give notice of shifts, particularly long, irregular or night shifts, so workers can plan their sleep, and to ensure workers have adequate and regular breaks. Acting on those is a duty you already hold.

Adjustments that commonly help

Information and communication

Written instructions alongside verbal ones. An agenda circulated before a meeting. Interview questions provided in advance. Written confirmation of what was agreed at handover.

Rostering and time

A predictable roster pattern. Reasonable notice of changes. A protected break that is genuinely taken. Where the service allows it, avoiding rapid shift rotation.

Environment

A lower-stimulation space to document in or to regroup. Noise-reducing equipment supplied by the service.

Process

A named person who owns the request, a written record of what was agreed, and a date to review whether it happened.

Most cost little or nothing, and JobAccess administers a fund that reimburses many of the rest. The barrier is far more often the process than the money.

When someone asks you

1. Treat it as an operational question

A request describes how the work is organised, and it belongs with rostering and workflow alongside any other operational request.

You do not need a diagnosis. Where you genuinely need information to work out what the adjustment should be, you may ask about how the work is affected, and the Act limits what you ask to what is relevant to the role and the adjustment. You can reasonably ask what someone finds hard about a task. A diagnosis, or medical detail you do not need, sits outside that.

2. Write down what was agreed, and by when

A 2025 British Medical Association survey of doctors found that 73 per cent of those who needed reasonable adjustments had not received all of them, and 43 per cent had paid for adjustments themselves. That is UK doctors and not Australian nurses, so treat it as an indication of the pattern. An approved adjustment that never arrives is a process failure, and process failures are fixable.

JobAccess publishes a free Workplace Adjustment Passport for recording this.

3. Set a review date

An adjustment that suits a role in March may not suit it in September. A short scheduled check costs less than a request being made again from the beginning.

4. Notice what happens to everyone else

Watch what occurs when any staff member asks for something in writing. Where that is routine, people clarify. Where it meets a pause, the cost of asking rises until people start guessing instead, which is expensive in clinical work.

Why the process matters as much as the answer

Ableism in the health professions is documented, including against clinicians with disability (Lindsay et al., 2023). That helps explain why some staff arrange adjustments quietly and informally instead of using the formal route. A process that feels safe to use is doing as much work as the adjustment itself.

Where to get advice

  • JobAccess, the Australian Government’s adjustment service. Free confidential advice line 1800 464 800, workplace assessments, and the Employment Assistance Fund, which reimburses the cost of many adjustments.
  • The Australian Human Rights Commission on disability discrimination at work, in plain English.
  • Your organisation’s human resources or people and culture team.
  • The Australian Nursing and Midwifery Federation (ANMF) or your state branch.
  • An employment lawyer, for advice about a specific situation.

Sources

This guide 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.