Your web browser is outdated and may be insecure

The RCN recommends using an updated browser such as Microsoft Edge or Google Chrome

Image of an arrow trending upwards, next to a red passport graphic

Passport to potential

Taking action to achieve reasonable adjustments at work

As part of National Inclusion Week in 2023, we hosted series of one-hour webinars which explored how reasonable adjustments can be agreed and implemented using a health ability passport.

Below you will find two presentations from that week. The first gives an overview of the passport and some key principled and guidance. The second presentation explores the role trade union reps can have in supporting individuals and helping to change the culture around reasonable adjustments. 

Watch: Passport to potential overview

Slides from the presentation are available here.

Watch: Role of the rep

Slides from the presentation are available here.

Frequently asked questions

We are currently building a set of FAQs, check back soon...

Medical diagnosis can take a long time to pursue and could be at considerable cost to the individual it is therefore not always possible for an individual to meet a requirement for a formal diagnosis.

You may wish to see if you have any other medical evidence that could support an understanding from your manager, however, managers must be reminded that the legal definition of disability (Equality Act 2010 and the Disability Discrimination Act 1995 in Northern Ireland) is not about medical diagnosis but any ‘substantial’ and ‘long-term’ negative effect on someone’s ability to do normal daily activities. 

Signposting managers to our Health Ability Passport pages or ordering a hard copy to give to them may help them to become more familiar with their obligations and hopefully help them to gain a better understanding of how to support staff. If an employer continues to insist on seeing a diagnosis, that should be challenged and you should get your union involved.


You can feel incredibly vulnerable disclosing a disability or health condition to someone in a management position. Not only is it deeply personal, but you may be expecting prejudice and presumptions about how you do your job. 

In Fraser’s member story, he talks about needing a sense of confidence in yourself to be able to disclose a disability. Being able to identify and articulate your strengths and your talents while discussing the barriers you face, can help you to feel more confident and to help your manager to realise that making some adjustments can really help you work at your best.

If you can, being open honest can really help get you the adjustments you need. If an employer does not know you have a condition, then the legislation can’t be used to support you. 


Specialist charities are amazing sources for advice and recommendations. There are free helplines and lots of online resources available. The thing to keep in mind is that formal assessments by a charity will usually involve a cost, whereas Access to Work assessments and recommendations are either free or can be fully reimbursed. There is a great example in our member story from Sammi who used the British Deaf Association for her assessment and her employer was happy to pay for it.  

Access to Work, who can experience delays in organising assessments, are also very open to considering any advice and suggestions you have found from charities that you are confident will work. If they feel that the advice is sound, they may agree to support it without an assessment to help speed up the process.


We're very clear in our guidance that people are their own experts. There might be an expectation that a manager knows what to do, particularly if they have medical knowledge, but they will not understand the particular barriers that person is experiencing. Conditions can affect people in very different ways and there are lots of different life and health factors that also come into play. 

Where managers can be incredibly helpful is when the person is struggling themselves to think of what adjustments may be possible. A manager understands how the organisation works and what might be possible, they may also be able to suggest third party involvement from Access to Work, or Occupational Health. The important principle is that the conversation remains open and supportive with the individual ultimately having time to consider the suggestions and control of any decisions. 

In terms of organisational culture, there needs to be consistency in terms of the level of support that they receive. If a manager is solely responsible for suggesting adjustments, then the level of support would vary dramatically depending on the skill and experience of the manager in this area. That’s why the Health Ability Passport can be an incredibly useful tool in supporting managers and well as individuals to navigate their way through discussions.  


Any money spent on reasonable adjustments will be given back so many times over by retaining your skills and experience. It is worth noting that any assessments and adjustments supported by Access to Work will be covered or reimbursed.  

It is also worth noting that adjustments aren’t necessarily expensive, some might involve equipment, but some might be about shift patterns, breaks or dividing up tasks differently. Any equipment purchased can often be of benefit to others too.


Small things can often be easy to implement and make a big difference to those facing barriers at work. Sadly, they can also be completely overlooked or discarded when things change in an organisation. They can also be misunderstood and perhaps resented by colleagues.

In our member story from Lauren she talks about her Autism and sensory sensitivity and how she has it agreed that if the environment becomes challenging, she can request to have five or ten minutes away to prevent her from becoming overwhelmed. It’s a small time out that has huge long-term benefits and having the adjustment documented and reviewed regularly provides a sense of security.

People tell us that this is exactly what the passport is great for and enables people to plan ahead. If you can have a full and open discussion with your manager about how manageable things are at different times, then you can work up a plan of adjustments that can be used, if and when you need them. Good examples might be having parking available closer to your place of work on days where you may be fatigued or in pain, or less patient facing work when you feel you might be headed for burnout.  

In a truly safe discussion, you might also be able to ask your manager for support in noticing when your condition might be worsening, but you are not aware. You could ask that if they notice the symptoms, they alert you and suggest some of the adjustments you have discussed. 

Because stress and mental health are hidden, we don't see them. With physical or environmental barriers, it is perhaps easier to consider how to remove them, but with stress and mental health, you may not know how to begin to tackle them.  

You might start by thinking about shift patterns and breaks to overcome any barriers relating to fatigue, overwhelm or the way medication takes effect. Communication may also be something that can be considered as the way information is disseminated, which may contribute to someone’s stress or anxiety levels. A broadcast email may not provide the right opportunities to check back implications, and perhaps finding out about changes that affect you whilst in a casual catch-up may make you feel like the rug has been pulled from under you. In Lauren’s case study, she talks about being excused from big busy team meetings for a short period of time as she adjusted back to work after a period of ill-health.   

Joining the RCNs Peer Support Network, or a network in your organisation can help you to see some examples of adjustments that have worked for others, and inviting a third party like Occupational Health can also help to guide you.  

If managers can create a safe, supportive and un-hurried space then hopefully an individual can think about what their barriers are and what adjustments would work for them.  

Although short and medium-term conditions will not be defined as a disability (which is substantial and long-term), you can take the helpful elements of the passport.  

You might not want to go into as much detail, but the principles can apply: a mutually supportive discussion around the barriers being faced; agreement about adjustments that could help; actions and adjustments documented and a review to capture what worked well and what might need changing.  

The documentation could even be anonymised and made available later to provide examples of good practice around return to work after injury or ill-health.   


Returning to work can be incredibly stressful after a long period away. Getting back to work may be the right next step, but it could feel completely overwhelming. On the other hand, managers may feel worried or uneasy about approaching people when they are off sick and so can leave them feeling a bit adrift and not knowing how to come back. 

Your policy is likely to outline guidelines about keeping in contact and the Health Ability Passport could be a great resource to raise. You do not have to discuss it there and then, but agree to have a read of the guidance and discuss it further at your next catch-up.  

If you are a member of a union, then a union rep can really help with your return to work and any reasonable adjustments that may help. Explain to your manager that they are there to help bring ideas and examples of what has worked well in other areas.  


It is sadly very common to feel guilty and to consider adjustments as preferential. There is a sense that fairness is about treating everyone in exactly the same way, but fairness is actually about giving people the support they need to be at their best and not be harmed or damaged in the process. The law requires employers to treat disabled people in a way that minimizes the impact of that disability. The reasonableness of the adjustment is in relation to the person, it's not in relation to the rest of the team.  


The language preferences around health and disability change from person to person and, yes, they will undoubtably have a strong sense of which terms they prefer, but that should never stop managers from having conversations.

The people that have used the passport tell us that they would much rather somebody asked, or said something and got it wrong, than didn’t try at all. Listen to how the person describes themselves, their health and their barriers.

If you aren’t sure how to say something, ask, and if you get something wrong and the person corrects you, try and resist your human instinct to clam up and think of it as valuable sharing. It is key to note though, that it can become insulting if you have asked, or someone shares a preference, and you continue to ignore that preferred term.  


We know that some people are not able to reach an agreement with their manager about putting adjustments in place and there can be frustrating clashes around what is “reasonable”. It’s important to consider what other factors may be influencing a decision, for example short staffing or pressure from co-workers.  

Third party advice from Occupational Health or a trade union can help to consider the different points of view and find mutual ground. Both will have experience outside of your team and will be able to contribute to discussions from a wider perspective.  

Managers must be mindful that they are legally obligated to support reasonable adjustments for those who are disabled and their refusal can be determined as discriminatory. Speak to your union rep if you feel that this is happening to you.  


Some reasonable adjustments may not be successfully implemented and there may be some trial and error along the way, but this is a healthy step that can be documented and discussed when reviewing the passport.  

Before abandoning the adjustments, it is important to think about why they have failed. Is it the adjustments or other factors (staff shortages) that make them feel unsustainable? Have the rest of the team been supportive or undermining? Could more be done to help implement that adjustment?  

If it is agreed that the adjustment is not sustainable, it’s important to continue to seek out alternative adjustments that may be more doable. That shouldn’t be the end of the conversation. 

It’s really important to document all of these trials and reviews in the Health Ability Passport. Documenting what didn’t work is just as important as documenting what did and it can provide useful evidence in times of change and save having to re-hash old discussions.  

Finally, managers should always be mindful that they are legally obligated to support reasonable adjustments for those who are disabled and their refusal can be determined as discriminatory. 

The RCN Peer Support Network is set up to provide connected support for those with particular conditions or needs. When people join, they complete a statement explaining their areas of interest, so for example, you may want to speak to other students with Dyslexia or other nurses with mobility issues. We will then put you in contact with others that match those areas and the process creates discreet networks, rather than catch-all forums.  

This doesn’t really lend itself to ‘observer’ style membership, so we would encourage managers instead to look at our member stories and to be curious in their own workplace and let people know you are interested in understanding more about successful reasonable adjustments and how they work. 

It’s a really tough decision to leave a role you love and seek a role, or environment, that supports your health better. Whatever that new role is, it is important to remember that you will still be a nurse. In Jody’s member story, she talks about having to take a step back from her clinical nursing role and tells us she is still nursing, but in a spoken way rather than a hands-on way.  

If you are being formally re-deployed, do contact your union rep to support you through the process. They have a wealth of experience in supporting members in these situations and can help you navigate your way through.  

You will get a valuable insight into re-deployment and recruitment listening to Laura’s member story. Laura considers when to disclose disability and health conditions and how to ensure you get the adjustments you need in your new role. Ultimately it is down to an individual to decide when they feel safe to talk about reasonable adjustments, but the Health Ability Passport Guidance can be helpful even at such an early stage.