Reporting Asperger's Syndrome to Manager/Preceptors

[purplegal]

So, I know of a former classmate that has recently begun her first nursing job. So far, her preceptors say that she is very knowledgeable, and, for the most part, is doing well. However, they also say that she needs to work on her communication, whether that be at the bedside or with her preceptors. Some of her preceptors were concerned that she takes longer than most to perform certain skills; I know for a fact that skills were never one of her strengths to begin with, but that she can and does perform them well after she has performed them repeatedly. She was diagnosed with Asperger's at age 19, which probably explains some of her issues, and also has Generalized Anxiety Disorder. She was wondering if explaining these things to her nurse manager and preceptors would help them understand why she is the way she is and that she is still capable of performing the job, or if sharing this information would make things worse. I could see it going either way...what are your thoughts?

[caliotter3]

She needs to rely on her gut feelings about these people as she decides what to do. Personally, I have found that explaining things is not helpful, but others have found that they were dealing with more reasonable people. Your friend is the only person who can decide if these people make her feel comfortable enough to divulge information that can be used against her (or for her) in the future.

[Anna Flaxis, BSN, RN]

My thoughts are that, as mentioned above, this has the potential to go either way. Whether or not her supervisors provide reasonable accommodation, or see her divulging this info as making excuses/avoiding responsibility is anyone's guess.

Maybe she should just acknowledge her weak areas and commit to working hard to improve, without the appearance of making excuses to complicate things.

Supervisors like it when people take responsibility for their own weak points and display a positive, can-do attitude about improving their performance. If there is something specific the supervisor can to do support the person in that effort, identifying this is helpful- but the motivation and effort needs to come from the person. So, I'm not sure what divulging her personal health history would change in the grand scheme of things.

[toomuchbaloney]

I am not a fan of reporting specific health information to employers, in general.

Most health organizations today are NOT in the business of giving two craps about the nurses they employ and most will use any information such as this against the nurse at some time.

so, no

[KatieMI, BSN, MSN, RN]

No, she or anybody else must not volunteer such information.

There is powerful bias against mental health issues in health care industry. Giving out this sort of knowledge can, with good probability, make situation worse, not better. In fact, she will do a prudent thing requesting every single health care provider she sees and every pharmacy as well not to release any sort of medical information at all to anyone but herself and limited list of people who must have this access. It may look like paranoid but it is better to be safe than sorry. And it is definitely better to be thought as "good and smart gal but just a little slow to learn" than "smart but crazy freak with some sort of mental disease".

[Lev, MSN, RN, NP]

It is a personal decision which requires a lot of forethought. In most cases, it is a bad idea because there is a stigma. The solution to her problem is to practice those skills till she masters them and not use her diagnoses as an excuse.

[VivaLasViejas, ASN, RN]

I've been burned badly by disclosing mental illness to my employer. I don't recommend it unless one absolutely, positively must have accommodations in order to perform her/his job.

[Mavrick, BSN, RN]

Rather than a weakness, frame it as a strength:

"I am a quiet person and listen carefully before I talk".

"I learn much faster when I do something a couple of times instead of reading about it or being told".

"I understand much better when I focus on one task at first."

Do not put a diagnosis or disease to your preferred learning style. As PPs have said, it can be used oh so easily against you when in the wrong hands.

[jadelpn, LPN, EMT-B]

Being diagnosed on the autism spectrum at age 19 is an overwhelmingly difficult thing. Certain coping skills that have been learned over time without support then need to translate to working life. Which is not always an easy transition.

Which then accounts for generalized anxiety.

I am not sure I would be forward about any health issues. Each and every person who has Aspergers processes in unique ways. Interestingly, there are some people with Aspergers that are amazing in highly charged and stressful situations, as they are unable to read a room to get worked up. On the other hand, clinical tasks that require intense scrutiny can be "ok" until such time as someone tells the person they are doing it wrong. And there is no processing/coping mechanism to be able to adjust.

Bottom line? Your friend needs to get some support. The MD that diagnosed your friend should have a healthy amount of resources as far as life skills and other disciplines unique to each individual that your friend should take advantage of.

I find that as a parent of a child with high functioning autism (which is different than Aspergers as my child never had language for a few years) there is such "Autism is the new black" way of thinking that people roll their eyes and "I don't think so" "what does a 'diagnosis' do for you" way of brushing this stuff off. But as nurses, we work and think in diagnosis fashion. What a diagnosis does for a person with autism is open them to numerous support systems. Meant to help them to cope with life and work. Highest functional level.

And there's a huge level of frustration with "I know that something is wrong with the way I am thinking" when someone is brushed off to the point of being a teenager with a new diagnosis.

So it is not up to you to disclose. I would caution your friend in disclosure. What I would highly suggest is that your friend seek outside services. Many people who have aspergers are highly intelligent and think at a completely alternate level that you or I. Many creatively think outside of the box, have high protective instincts, and as a defense mechanism can come off as arrogant or "full of themselves"--those are the kind of filters that are not always present, and that were not dealt with when the person was developing as a young child. On the other side of that, many can be filled with angst over doing something "wrong" or being corrected.

I wish nothing but the best for your friend. But to tell a 19 year old that they have undiagnosed Aspergers and then expecting their functional level to be a max potential is heartbreaking to me.

[hppygr8ful, ASN, RN, EMT-I]

No, she or anybody else must not volunteer such information.

There is powerful bias against mental health issues in health care industry. Giving out this sort of knowledge can, with good probability, make situation worse, not better. In fact, she will do a prudent thing requesting every single health care provider she sees and every pharmacy as well not to release any sort of medical information at all to anyone but herself and limited list of people who must have this access. It may look like paranoid but it is better to be safe than sorry. And it is definitely better to be thought as "good and smart gal but just a little slow to learn" than "smart but crazy freak with some sort of mental disease".

Asperger's is not a mental disorder! It is a pervasive developmental disorder that exists on a spectrum of functionality. In fact the DSM 5 no longer uses label Asperger's. The current diagnostic term is High Functioning Autism and the fact is some of our greatest scientific minds were diagnosed or were suspected of having Asperger's. The fact that this nurse was able to complete nursing school and actually work a as nurse in phenomenal and should be celebrated. My own husband has this disorder and is highly respected in his field (if thought a bit odd at times). It is covered under the ADA and if she needs reasonable accommodation she should get it. The question is what is reasonable accommodation and how should it be handled.

hppy