Autistic Nurses: Is Nursing the “Wrong” Job?

I received two private messages in response to my recent blog post, Autism, Murder and the Death Penalty: Two Japanese Cases. One was negative—How dare you write about it?!—while the other was positive: Thank you. It is very important to talk about real cases, even when they are…

Interestingly, both messages eventually asked the same question: Is the nursing profession suitable for autistic people?

Here is what I can say about it.

Autistic nurses: is this the “wrong” job?

Apparently, yes. At least, that was the answer given by one psychiatrist when asked whether autism might partly explain the high levels of common mental disorders among women working in healthcare: “Because that job requires empathy and social skills, and autistic people do not have that.” Nurses, he suggested, could not be autistic.

And yet autistic nurses do exist. (Hedlund 2023.)

According to the World Health Organization (2022), ASD involves differences in social interaction and communication, a preference for routines, focused interests and unusual responses to sensory input. At the same time, functioning varies enormously. Some autistic people require lifelong, substantial support; others live independently, complete university degrees and work in demanding professional environments.

Increasing numbers of students with autism and ADHD are entering nursing education. Ripley (2025) notes that these students may encounter particular challenges during clinical placements and often require reasonable adjustments. Without appropriate support, their learning opportunities—and ultimately their outcomes—may suffer. Clinical staff may also be uncertain about how best to support them.

But what happens after graduation? What about qualified autistic nurses?

Autistic nurses: a gap in the evidence

Hedlund (2023) argues that research on autistic nurses is remarkably limited. Most of the published literature concerns caring for autistic patients, rather than nurses who are themselves autistic. This is particularly striking because health and social care appear among the most common employment sectors for autistic adults (Bury et al. 2020).

So we are left with a significant gap in knowledge—and a number of uncomfortable questions:

Is nursing compatible with autism?

Consider the environment: Hospitals are noisy. Monitors beep. Alarms sound. Lighting can be harsh. Patients may be in pain, confused, frightened, distressed or angry. Work is unpredictable. Priorities can change within seconds. Teamwork is unavoidable, and communication is constant.

For someone who struggles with sudden changes, sensory overload, telephone communication without visual cues, or unexpected physical contact, nursing may present considerable challenges.

And yet some autistic nurses clearly manage these demands.

The question, therefore, cannot simply be whether an autistic person can become a nurse. It is whether the particular characteristics of the individual, the demands of the role and the working environment are compatible—and whether appropriate support can bridge the gaps.

Research and professional accounts describe possible adjustments including:

• predictable routines where possible;

• clear, step-by-step digital instructions;

• reducing unnecessary social demands;

• access to quiet spaces for regulation;

• colleagues who understand communication differences;

• explicit explanations of workplace expectations and culture;

• and making constructive use of an individual's particular interests and strengths.

But this immediately raises another question:

Where does reasonable accommodation end and the essential requirements of the job begin?

If a nurse requires considerable predictability, reduced sensory stimulation and extensive communication support, how does that interact with a profession in which unpredictability, sensory stimulation and rapid interpersonal communication are sometimes unavoidable? Then who supports the patients?

And, perhaps most importantly: Who cares for the carers?

Strengths—and challenges

There are obvious strengths that may be valuable in nursing.

Autistic nurses have described excellent memory (e.g., for dates of birth and phone numbers), attention to detail, honesty and strong concentration (Hedlund, 2023). Some describe intense compassion and a strong sense of justice. Others highlight “laser focus” during critical tasks.

But strengths do not exist in isolation.

Autistic nurses have also reported difficulties with seeing the bigger picture, dealing with change, interpreting colleagues' reactions and coping with chaotic shifts (Wallis 2012; CDC 2019), getting touched by other people, making phone calls (Briefing 2020).

Hedlund and Jordal (2024) found that physical and organisational working conditions, together with inadequate managerial support, could create significant challenges and prevent autistic nurses from making optimal use of their strengths.

This is an important distinction.

A difficulty caused by an unnecessarily chaotic workplace is not necessarily the same thing as an inability to perform the essential functions of nursing. But neither should every difficulty automatically be attributed to a failure of the workplace. Sometimes the demands of the job really are the demands of the job.

A question of support—and safety

Workplace literature commonly recommends adjustments such as reducing distractions, clarifying expectations and building on an individual's strengths and interests. In principle, many of these strategies could benefit almost any employee.

Healthcare, however, has a particular problem: the patient cannot always wait for the environment to become predictable.

If a nurse needs highly structured instructions to avoid misunderstandings, what happens when something unexpected occurs? If communication differences are misinterpreted as a “bad attitude”, what happens to teamwork? If sensory overload affects concentration, what happens during a chaotic shift? And if a nurse becomes overwhelmed, who notices—and what happens next?

These are not arguments against autistic nurses. They are questions about the interaction between individual characteristics, professional demands, workplace support and patient safety.

They also become particularly sensitive when considered alongside rare and tragic cases such as those discussed in my previous post. Kashiwagi and Hirabayashi (2026) examined two Japanese healthcare workers with ASD or autistic traits who committed multiple homicides. The cases are extreme and emphatically not representative of autistic nurses or autistic people generally. There is no evidence that autistic people are more prone to violent crime than the general population.

Nevertheless, the cases raise difficult questions about how autistic characteristics, psychological distress, professional responsibilities and criminal responsibility can intersect.

And they remind us that neither a diagnosis nor the absence of one tells us everything we need to know about an individual's behaviour.

So—is nursing the “right” job?

Perhaps the question is badly framed. Rather than asking whether autistic people should be nurses, we should ask:

• What specific challenges do autistic nurses encounter in real clinical settings?

• Which reasonable adjustments genuinely improve performance and patient safety?

• At what point do adjustments become incompatible with the essential demands of a particular role?

• Do autistic nurses remain in the profession—or leave due to unmet needs?

• And perhaps most importantly: how do we distinguish between supporting a nurse and transferring responsibility for coping with the consequences of their difficulties to colleagues or patients?

These are not hostile questions. They are necessary ones.

If we genuinely care about autistic people's right to participate in professional life, we should not need to pretend that every profession is equally suitable for every autistic person.

And if we genuinely care about patient safety, we should not assume that a diagnosis automatically makes someone unsuitable for a profession.

Both extremes are equally unhelpful. The answer cannot be found in slogans about inclusion, nor in assumptions about what autistic people can or cannot do.

We need evidence

We need research to understand which characteristics create difficulties, which become strengths under the right conditions, which adjustments work, and where the unavoidable demands of clinical practice create genuine limitations. Because ultimately, this is not a question of whether autistic people are “good enough” to be nurses. It is a question of fit, competence, support—and safety.