In this blog, Nicola Taylor RVN highlights the difficulties she has experienced while nursing with neurodivergence, and what can be done in practice to help others, as well as providing helpful resources and adjustments.
There still appears to be much confusion around the term ‘neurodivergence’. Simply put this refers to anybody whose brain is wired differently to ‘average’ or those considered neurotypical [1]. Dyslexia, dyspraxia and other specific learning difficulties (SpLD) such as attention deficit disorder (ADHD) and dyscalculia fall within the autistic spectrum. Therefore, a few autistic symptoms may be present in those with SpLD [2]. So, anybody with anything listed above could also call themselves neurodiverse [2]. These SpLDs will affect every person differently, but there are often over-arching similarities and core symptoms as well as co-occurrence. The common viewpoint about dyslexia is difficulties spelling and getting left and right mixed up, but people with the condition will be able to attest to almost every aspect of their life being affected by a set of information processing difficulties, short-term working memory, or sequencing and directional difficulties [3], which do not just affect literacy but also day to day living [4]. I will try to highlight the difficulties I have experienced while nursing with neurodivergence, what can be done to help, and why sometimes it makes me a better veterinary nurse.
Neurodiversity in training
Historically, autism is significantly underdiagnosed in women and girls, due to the classic triad of impairment [6] presenting differently. This is part of this diagnostic profile, and the characteristics of which are more easily identifiable in boys [7]. The diagnostic criteria has changed to include the female expression of autism rather than favouring the male expression which had been studied historically. The Royal College of Veterinary Surgeons (RCVS) demographic study 2022 states that 96.8% of registered veterinary nurses (RVN) are female [8], so there may well be a significant population of RVNs that are managing their symptoms independently without support, not aware that a diagnosis is possible.
As someone diagnosed with dyspraxia and dyslexia in childhood but recently becoming more aware of the nuances of an adult Autism diagnosis, the process of completing my training and becoming an RVN was not an easy one. Within an academic environment, I struggled with long days made up of long lectures, accurately reading from the board, introduction to medical language, and academic writing. Within my training practice, I was thriving with hands-on learning, repeated routines, the opportunity to discuss my college work with the veterinary surgeons and impromptu anatomy lessons during bitch spays. My learning difficulties meant that getting stuck in and applying what I was learning to my patients really made it stick, as well as boring my college cohort while relating my cases back to the lecture at any given opportunity. In any academic setting, neurodiverse people can either thrive or fall behind, depending on the range of difficulties and whether support is available and accessible. The Equalities Act 2010 has made education establishments more aware of the reasonable adjustments they can provide to those with a diagnosis, and how much difference this can make to the learner [9]. For exams, these adjustments can include coloured paper, recording devices, word processing, extra time, supervised rest breaks and prompts, to name but a few. Anything provided within an exam should also be made available within lectures or the classroom learning environment. Provisions can differ between higher education (HE) and further education (FE). FE is responsible for putting adjustments in under their own budget and HE has grants available for Disabled Students’ Allowance (DSA) which needs to be applied for by the learner. To qualify for any Reasonable Adjustments, a diagnosis is often needed, this can be achieved by an assessment undertaken with an educational psychologist or a specialist teacher with suitable qualifications.
Reasonable adjustments in the workplace
Once in employment, it is possible for reasonable adjustments to continue within the work environment [10]. This can be achieved by a Workplace Needs Assessment; sometimes provided by your employer or by Access to Work [11]. Some people can be hesitant to declare a diagnosis of SpLD or autism to their manager. Should any qualities of the person’s work be questioned, HR would have to show that reasonable adjustment for that employee has been offered and adequately explored before any disciplinary action could be implemented [12]. Therefore, in contrast to popular opinion, being open with an employer can lead to a diagnosed person having additional levels of protection regarding their difficulties.
During my training, I was employed at a busy general practice. Within this environment there were several things that I struggled with that I attributed to my combination of dyslexia and dyspraxia. In hindsight many of these struggles could be due to historically undiagnosed autism as well. Now I am registered and working within a busy referral practice, there are still things I struggle with that are attributed to dyslexia, dyspraxia and autism.
| Challenges as an SVN: | Challenges as an RVN: |
| Being able to hold a phone conversation with background noise within a busy reception | Picking out necessary information or relevant conversation within a busy ward or room |
| Correctly sequencing numbers for data entry (during cashing up) | Task switching e.g. pricing or circulating while also monitoring an anaesthetic |
| Task switching | Writing information that is being dictated, at a reasonable speed, not missing the rest of the information while I’m still writing the first sentence |
| Being disciplined with allotted study time and not getting distracted by other clinical tasks | Maintaining a work life balance after expending all my energy to get through a tough shift |
| Prioritising protected time rather than saying yes to helping everyone | Perfectionism is seen as a positive, now feel internal pressure to maintain it to feel functional and meet my own unrealistic expectations of myself |
| Inability to recognise that I was still learning, I would make mistakes and that this is acceptable and expected from an SVN | Sensory overload (visual and auditory) |
| Degree of perfectionism to compensate and hide any difficulties contributed to fatigue and burnout | Degree of perfectionism to compensate and hide any difficulties contributed to fatigue and burnout |
Personal coping mechanisms
- Conducting a patient hand over outside of the ward if that area is too noisy and affecting concentration
- Ensuring I can remove myself from the practice for lunch, break from noise and socialising
- Creating my own routines and systems for various tasks
- Asking for help
- Closed loop communication for dictated medications or post-operative plans
- Annual leave planned with no more than 3 months between breaks to allow for regular rest
- Message or email myself tasks or data to remember
- Having days with no other staff members shadowing (SVN’s or new starters)
- Taken on a part time non-clinical role within my practice which allows office work one day a week
Energy pacing systems
Many neurodivergent people can fall into the trap of perfectionism in order to mask and hide any difficulties from living with autism or any of the SPLDs mentioned [13]. Unfortunately, a consequence of this behaviour pattern is the probability of burnout or chronic fatigue. Neurodivergent people are predisposed due to the additional mental strain and effort needed to maintain these unrealistic expectations of oneself [14]. For me, the adage of a swan gliding across the water, while the feet paddling furiously underwater to maintain momentum is how I would have described my daily life. Weekends were not spent pursuing a social life but recovering from the impact of the week. Energy Pacing Systems [15] can be a worthwhile skill to learn and implement in order to maintain a healthy work-life balance.
The spoon theory has been deemed useful in explaining the division of energy by those with chronic illness, mental health concerns and neurodiversity [16]. It details the amount of energy a person has for a day, and which tasks take the greatest energy to complete. Familiarising yourself with how much energy a task takes, or how much energy masking the difficulties experienced by performing that task, will allow budgeting of mental, physical and emotional resources [17]. Each person is different, and their spoon allocation will be personal to them.
As an RVN, a day in the wards would require all my spoons – not leaving any energy to maintain my Activities of Daily Living or any hint of a social life. Whereas a day in theatre may take half my spoons, allowing me to have a work-life balance. That does not mean that nursing in wards is inherently more difficult than in theatre, just that my skillset and abilities are more suitable in one area over others. Admitting that to myself has allowed me to not feel guilty about making appropriate choices for my career and knowing my own limitations.
Other examples could be that some dyslexic people may not manage to take minutes in a meeting, some ADHD people may struggle to sit still for the duration of anaesthetic and some autistic people may not be able to process information within a noisy environment. It is not always preferable or possible for an individual with a difficulty to avoid the tasks they find challenging completely. Creative solutions or Reasonable Adjustments may utilise delegation, assistance, or alternative strategies, and this can reduce frustration and fatigue. Being aware of the energy requirements needed for these common tasks within our profession can aid in employees and employers working together for the benefit of the business. This may well have an impact on staff wellbeing, sickness rates and improve retention.
What I would like to see in practice
In workplaces moving forwards, I would like to see a neurodiversity advocate that could work alongside the clinical team and a mental health first aider to ensure any nurse, patient care assistant, receptionist or veterinary surgeon can access the support they need to excel in their work.
Struggles
- Sensory overload
- Information overload
- Complex medical language
- Similar sounding drug names
- Incorrectly sequencing numbers (5.4ml instead of 4.5ml)
Strengths
- Problem solving
- Seeing the big picture
- Holistic view of the patient
- Empathy with patients
- Being meticulous in learning data and patterns
- Intuition
Reasonable adjustments
- Different fonts
- Coloured paper
- Recording devices
- Word processors
- Extra time or breaks during exams
- Scribe
- Lower-level desk lighting
- Day light lamp at desk
- Shift patterns appropriate for the staff member
- Working with a smaller team
- Consistent working pattern
- Longer training periods
- Supervised practice before working independently
- Neurodiversity training for other staff
Useful resources
| Dyslexia | The Dyslexia Association |
| Dyspraxia | Dyspraxia Foundation |
| Autism Spectrum Disorder | National Autistic Society |
| ADHD | ADHD UK |
| Disable student’s allowance | Benefits and financial support |
| Access to work | Access to work: disability or health condition |
Nicola Taylor RVN (Diagnosed with dyspraxia, dyslexia and autism)
Caren J Taylor BSc. PGCE (Cam) PG Dip SpLD, PG Dip (Counselling and Psychotherapy) (Specialist Teacher in Neurodiversity) (Diagnosed with dyslexia, autism and ADHD)
References
1 Baumer, N. & Frueh, J., 2021. What is neurodiversity? [Online]
Available at: https://www.health.harvard.edu/blog/what-is-neurodiversity-202111232645
2 The British Dyslexia Association, unknown. What is dyslexia? [Online]
Available at: https://www.bdadyslexia.org.uk/dyslexia/about-dyslexia/what-is-dyslexia
3 Holden, C., Kirby, P., Carroll, J. & Thompson, P., 2024. Towards a consensus for dyslexia practice: Finding of a Delphi study of assessment and Identification [Online]
Available at: https://osf.io/preprints/edarxiv/g7m8n
4 The British Dyslexia Association, unkown. Neurodiversity and co-occurring differences [Online]
Available at: https://www.bdadyslexia.org.uk/dyslexia/neurodiversity-and-co-occurring-differences
5 National Autistic Society, 2022. Asperger syndrome [Online]
Available at: https://www.autism.org.uk/advice-and-guidance/what-is-autism/asperger-syndrome
6 Gazizova, D., 2022. Symptoms of Autism [Online]
Available at: https://www.clinical-partners.co.uk/for-adults/autism/symptoms-of-autism
7 Ratto et al, 2018. What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills. Journal of autism and developmental disorders, Volume vol. 48,5, pp. 1698-1711.
8 Royal College of Veterinary Surgeons, 2022. Demographics data: Veterinary Nurses [Online]
Available at: https://www.rcvs.org.uk/who-we-are/committees/advancement-of-the-professions-committee/diversity-and-inclusion-working-group-dig/diversity-and-inclusion-strategy/demographics-data-veterinary-nurses/
9 Equalities Act 2010, 2010. c 6 [Online]
Available at: https://www.legislation.gov.uk/ukpga/2010/15/section/6
10 Citizens Advice, 2019. Asking your employer for changes to help if you’re disabled [Online]
Available at: https://www.citizensadvice.org.uk/work/discrimination-at-work/taking-action/asking-your-employer-for-changes-to-help-if-youre-disabled/
11 Department for Work and Pensions, 2022. Access to work [Online]
Available at: https://www.gov.uk/access-to-work
12 Equality and Human Rights Commission, 2022. Avoiding unlawful discrimination when dismissing a worker [Online]
Available at: https://www.equalityhumanrights.com/en/multipage-guide/avoiding-unlawful-discrimination-when-dismissing-worker
13 Stoeber, J. & Rountree, M. L., 2020. Perfectionism, self-stigma, and coping in students with dyslexia: The central role of perfectionistic self-presentation. Dyslexia, Volume 27, pp. 62 – 78.
14 Garratt-Reed, D., Howell, J., Hayes, L. & Boyes, M., 2018. Is perfectionism associated with academic burnout through repetitive negative thinking? PeerJ.
15 Neff, M. A., 2023. Intro to pacing systems. [Online]
Available at: https://neurodivergentinsights.com/mentalhealthresources/intro-to-pacing-systems
16 Miserandino, C., n.d. But you don’t look sick. [Online]
Available at: https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/
17 Kim, C., 2014. Conserving Spoons. [Online]
Available at: https://musingsofanaspie.com/2014/10/15/conserving-spoons/