Nursing studies

Reasonable adjustments: what do I need to know?

How to ensure your nursing practice meets the needs of every individual – plus, the adaptions that help nursing students thrive if they have a disability

How to ensure your nursing practice meets the needs of every individual – plus, the adaptions that help nursing students thrive if they have a disability

A nurse talks through some easy-read material with a patient Picture: Roy Mehta

What are reasonable adjustments? And are they legally required?

Under the Equality Act 2010, public sector organisations in Great Britain must make changes in their approach or provision to ensure services are accessible to people with disabilities.

In addition, by law, all organisations that provide NHS or adult social care must follow the accessible information standard.

‘Public sector organisations shouldn’t simply wait and respond to difficulties as they emerge: the duty on them is anticipatory, meaning they have to think about what’s likely to be needed in advance,’ says guidance from Public Health England.

Who are reasonable adjustments intended to support and how can I help implement them for patients?

Reasonable adjustments are for anyone who has a strand of diversity recognised by the Equality Act 2010, says RCN professional lead for learning disabilities Jonathan Beebee.

‘It’s important they are personal,’ he adds. ‘You can’t say: ‘we’ve produced an easy-read leaflet and that means our service is now accessible to people with learning disabilities.’ It’s not easy for everyone, and not everybody with a learning disability can benefit from it.

‘Treat the individual with dignity and respect – this is something we should be doing for everyone’

Sam Palmer-Nash, second-year learning disability nursing student

Hospital passports have a valuable role in person-centred care Picture: Roy Mehta

‘Instead, you need to think about what the person needs when they are entering a service to ensure they have equality of access.’

The starting point is always to ask the person, or whoever is supporting them, what they need and how the service can help, says Mr Beebee. ‘It sounds simple but it’s something everyone can do. It is also important to remember that not all disabilities are visible.’

Many people with learning disabilities have a hospital passport which lists their individual preferences and needs. ‘It has really key information and it’s always worth asking whether someone has one,’ he says.

Examples of reasonable adjustments in healthcare

They include:

  • Taking the time to find out what the individual needs
  • Giving the person a priority appointment, if they find waiting difficult, or seeing them at the start or end of the day, when it’s quieter
  • Scheduling longer or double appointments, making time to ensure the person understands the information they are given, and providing appointment reminders
  • Avoiding jargon and explaining things simply and slowly
  • Providing a suitable environment that is quiet, with lighting that can be adjusted
  • Remembering that sometimes the smallest change can make a big difference to someone’s health and well-being


What are the benefits of implementing reasonable adjustments?

According to NHS LeDeR – Learning from lives and deaths programme, research has shown that, on average, people with a learning disability and those with autism die earlier than the general population, and do not receive the same quality of care as people without a learning disability or who do not have autism.

‘But if you can get it right for people with learning disabilities, you get it right for everyone,’ says Mr Beebee. He points out that making information more accessible also helps those living with dementia and whose first language is not English.

For accessible, plain-English health resources, he recommends Easy Health – a library of almost 400 videos and leaflets covering 120 health conditions or topics, ranging from annual health checks to x-rays. Membership is free.

RCNi Learning module: Improving care for people with learning disabilities

Learn about 5 ways to improve your practice

Sam Palmer-Nash, a second-year learning disability nursing student at the University of Hull suggests using the acronym TEACH:

  • T is for time Alongside making more time for appointments, it’s important to think about whether they are happening at the right time for the patient. ‘Does the person function better in the morning or later in the day? Someone may take pain medication, which needs time to work. Make sure the timing is optimal,’ says Mr Palmer-Nash, who is a team leader with the online community @westudentnurses, where his focus is on learning disabilities
  • E is for environment Think about the room temperature and make sure it’s free from distractions.’ Also consider whether dressing casually makes patients feel more at ease. ‘A uniform can be seen as a bit of a barrier,’ says Mr Palmer-Nash
  • A is for attitude ‘Treat the individual with dignity and respect – this is something we should be doing for everyone’
  • C is for communication Think about the communication methods someone needs, including visual aids and sign language, so they can make fully informed decisions about their care. ‘It’s about providing accessible information, improving understanding’
  • H is for help ‘Seek help from those who know the patient well. They can tell us so much information about them, helping us to get to know them, so we can provide better support.’ Bear in mind that sometimes people’s loved ones may be quite cautious about what the patient can do. ‘They worry about taking a risk and it may go wrong. But with some support, we can see it’s something that person is able to do’

Essential checks to ensure individuals’ needs are met

Mr Palmer-Nash advises checking that the person is registered with their GP as having a learning disability. ‘Without that marker, they might miss out on their annual health checks, which provide valuable screening,’ he says. ‘Build this into your conversation’.

You should also ascertain whether someone needs support with food and drink. ‘Food can be taken away because it’s assumed the person don’t want it, but actually they might be struggling to eat,’ he says.

What about reasonable adjustments for employees?

Reasonable adjustments must be made to remove or reduce disadvantage related to disability when an employee is doing their job, or when someone is applying for a job, says employment advisory service Acas.

Such measures may involve making changes to the workplace, equipment or services provided, the ways things are done and information, to ensure accessibility.

The Equality and Human Rights Commission advises:

  • Making structural or physical changes, such as widening a doorway, providing a ramp or moving furniture
  • Relocating light switches, door handles, or shelves for someone who has difficulty in reaching
  • Providing contrasts in decor to help the safe mobility of a visually impaired person

Reasonable adjustments in the workplace

Examples include:

  • Providing the right type of phone for someone who uses a hearing aid, an adapted keyboard for someone with arthritis, or a special chair for someone with back problems
  • Giving one-to-one support to help an employee with anxiety
  • A phased return to work for someone who has been on long-term sick leave because of their disability
  • Allowing more frequent breaks for someone with diabetes to get the necessary amount of food or drink
  • Ensuring an interview is held on the ground floor for a job applicant who uses a wheelchair
  • Giving more time for someone with dyslexia to complete any written or reading tests that are part of a recruitment process
  • Altering working arrangements, including shift patterns

Source: Acas

How can nursing students with disabilities be supported?

Whether to disclose your disability or not is a personal choice, but there are several advantages in doing so, especially at an early stage, says nursing lecturer at Queen’s University Belfast Conor Hamilton.

‘If it’s left too late, there may not be sufficient time to implement support,’ he says. At Queen’s, students are advised to disclose any disability at the application stage, so individual support needs can be addressed.

‘Putting support services in place early allows the university experience to be the best it can be,’ says Mr Hamilton. ‘If students don't disclose their disability, we can't give them the support they need and are entitled to.’

Students can disclose a disability or medical condition at any point during their studies, enabling them to gain support they may not have realised was available. He advises students to make themselves familiar with the process in case they choose to disclose at a later stage.

Podcast: Support for nursing students with disability or impairment

My employer is really supportive – I just needed to be given a chance

Becky Fell

Before she became a healthcare assistant in 2008, Becky Fell, who has visual impairment, faced upset in her working life. ‘I had a rough time,’ she says. ‘There were people who didn’t treat me very nicely and were really quite cruel.’

As a result, she lacked confidence. ‘I felt very timid, wouldn’t say boo to a goose and didn’t want to ask for any help because of the experiences I’d had. I just tried to cope on my own.’

Simple workplace modifications allow me to demonstrate my capabilities

Fortunately, it’s been a completely different picture since she joined the NHS. ‘I’ve never had any issues and been treated really kindly. If there has ever been anything I couldn’t do, someone else will always help. It’s been a breath of fresh air,’ she says.

Now promoted to associate healthcare support worker development educator with Gloucestershire Hospitals NHS Foundation Trust, Ms Fell’s role involves looking after the trust’s healthcare support workers, including supporting newcomers with induction and training, alongside providing pastoral support.

Having ocular albinism makes it necessary to avoid bright light, so her desk is set up in a dark corner, screened from light coming in through the windows, with her computer protected against glare.

She can wear a visor at work, and when she teaches using PowerPoint, her computer background is changed to green because white is too bright for her.

‘My employer is really supportive and helpful,’ says Ms Fell. ‘I was able to say what I needed and they couldn’t have helped more. I’m very self-sufficient, independent and proactive about my sight, but there are some things I simply can’t do. I’m perfectly capable – I just needed to be given the chance.’

How health ability passports can help

Nursing staff who require reasonable adjustments to be made at work can complete a healthy ability passport – a document completed by the employee and their line manager, the passport provides a framework for discussion about the employee’s health and what changes can be made at work to help them. It is signed by both parties, indicating that adjustments will be made and upheld.

Not all employers recognise health ability passports, so at this year’s RCN Congress, which takes place in Glasgow between 5-9 June, there will be a resolution calling on the college to lobby ministers to make the passports compulsory for the nursing workforce.

The value of disability disclose

At Queen’s University, students who disclose a disability are referred to the university’s disability services. There is also a nominated member of staff who liaises between the student and the service, making referrals when needed.

A disability officer considers what individual support students need, including any reasonable adjustments, with information held in confidence and according to data protection regulations.

For students who feel confident, Mr Hamilton advises them to share their disability with others. ‘Blog it, write about it or highlight it on social media,’ he says. ‘It can help others to seek advice or give confidence to others with a disability to register for courses like nursing.

‘Nursing students who have a disability can empathise with patients, bringing lived experience to the job. Patients appreciate that.’

Further information

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