There is good evidence that diabetes specialist nurses (DSN) are vital for good diabetes healthcare, but what exactly do they do and how does their work benefit people with diabetes?
We asked Sonya Smith, a Diabetes Specialist Nurse in Wolverhampton, about her role and why she thinks DSNs are crucial in diabetes care.
Why were you interested in becoming a DSN?
As a student nurse, I shadowed a DSN and enjoyed how versatile the role was and the challenging nature of diabetes. I felt that to get the skills I needed for the role, I should gain general nursing experience, so I first worked as a district nursing sister and community matron. I have now been a DSN for 6 years.
What does a DSN do?
In Wolverhampton, DSNs like me work as part of an integrated diabetes team and we assess patients with diabetes who have complex needs. We plan care with the person with diabetes and their families or carers, developing personal diabetes management plans to identify goals and promote self management.
We work across the wide spectrum of diabetes care, both in primary care and in hospitals. We provide support and guidance to colleagues in the wider healthcare teams.
In Wolverhampton we are working very closely with our local GP practices under a new initiative called ‘WICKED’. By establishing DSNs and consultants which are linked to certain practices, we encourage face to face visits with patients. We are hoping that the project will make our services more accessible and this will lead to fewer repeat hospital admissions and better diabetes management. The project is in its early stages but it has already improved communication between primary care and hospitals.
What’s a typical day for a DSN?
We work to a rota system in Wolverhampton, so every day is different. We are assigned to general clinics, Type 1 clinics and antenatal clinics within the centre. We also offer community clinics within health centres in the city and there is an emergency nurse role too.
On average I treat 50 patients face to face and 50 on the phone each week.
A typical day runs from 9am to 5pm but the role is extremely varied so our days can be very different.In clinic, whether in primary care or the diabetes centre, I see patients every 30 minutes. A typical appointment includes reviewing medication, starting new medication such as insulin and advising on insulin doses according to the food/carbohydrate eaten. As an emergency nurse, I will manage the telephones, complete telephone clinics, assess walk-in patients, assess emergency referrals, help doctors and be the first point of contact for any query. It is a busy role and we are always in demand. We often need to juggle lots of things at once!
Home visits include going out to patients in their own homes to assess them and put a diabetes management plan in place together with their GP, relatives and carers. Liaison with the wider integrated team is crucial with housebound patients and of course end of life care planning can also be an aspect of our role.
What’s the difference between a practice nurse and a DSN?
The role of a DSN is very specialised compared to the generality of a practice nurse. Practice nurses can provide services to patients, such as offering diabetes education, completing yearly reviews and advising on medication. Appointments are often 10 minutes.
DSNs have the luxury of 30 minute appointments to focus purely on diabetes management. We have the skills and expertise to manage complex cases and we take on referrals of those people who may be having difficulty managing their condition.
A large part of our role is education and support – not only to our patients but also to other members of the multidisciplinary team and patients and their carers.
What is the most enjoyable part of your job?
Being able to spend time with individual patients to discuss and agree their management plans is the most enjoyable part. I love being able to help people gain confidence in managing their own condition so that diabetes becomes part of their life and not the focus of it.
How do people with diabetes benefit from seeing a DSN?
People are assessed by a person with expertise and skills in diabetes and together they plan their diabetes management. Individualised appointments provide an opportunity to be listened to in an environment where they don’t feel rushed and they are given one-to-one education and can discuss their concerns at length.
Easy access to a DSN – including being able to contact them for assistance by phone - means a continuity of services.
What do you see as the future of DSNs?
Diabetes is on the increase in the UKbut specialist nurse roles are not on the up. Unless we act fast, the role could eventually be privatised or dissolved totally. So we need to fight for our roles, for example by more DSNs completing academic research to add to provide evidence to support the value of our positions.
I would like to see DSN role titles uniformed and dependent on assessed competence. I would also like to see stronger support for specialist nurses from the unions and diabetologists.