A professional view: Lesley Mills is a Diabetes Consultant Nurse in Warrington and Halton Teaching Hospital NHS Foundation Trust. She delivers diabetes care services and leads clinics in the community, including in the prisons.
A typical day
For me, a typical day as a diabetes consultant nurse involves a variety of commitments. It ranges from leading a specialist team in ward reviews, clinics, and teaching sessions to other healthcare professionals from junior doctors, to care home managers.
I love teaching! The teaching sessions tend to happen over lunchtime, so I have a sandwich at the desk. More recently I’ve encouraged my team to spend at least 20 minutes together having non-work-related discussions. We've also opted to take 15 minutes during the day for a short walk, for a healthier break time. After lunch, it’s back to clinics, ward reviews and other multidisciplinary commitments.
In a virtual world
Since the COVID-19 pandemic, we’ve had to do things differently. It’s been difficult seeing individuals face to face. Although I prefer working within a team, I’ve been working remotely at times - there have been some challenges with this.
Apart from the digital issues we face with some reviews, it has become harder to assess individuals virtually. Whereas in person, you would assess nuances like body language in the waiting room or make assessments based on their walk or mannerisms, virtually, you can only rely on what is presented on the screen.
As healthcare professionals, we must wear personal protective equipment to see every patient on the wards, which we didn’t have to do before. We used to have multidisciplinary team meetings, once a week, in person. We still have these online, but the virtual team meetings are much more structured. There seems to be a loss of spontaneous support from side conversations. That’s a big challenge for me.
On a positive note, a lot more people seem to prefer meeting remotely too. It’s more flexible and comfortable for the patient. You’re not bringing someone out of their working environment or usual space and inviting them to a clinic.
I run a diabetes clinic for young people between the ages of 17 and 25, and they like the virtual clinics. They like the text messages and video calls as it’s what they’re used to, and it makes clinics less medicalised and less disease-focused. This means younger patients are more likely to open up.
Twice a month, I work in a unique setting - two local prisons.
Initially, people in prison with diabetes would have to come into clinics handcuffed to two prison officers. This required special transport and other services to bring them there. It resulted in a lot of missed appointments with clinics and poor diabetes management in the prisons, like higher HbA1c.
After seeing these figures, I decided to move the clinics closer to their home and run clinics within my local prison. My clinical commissioning group, the organisation that organise healthcare services in local areas in England, recognised improvements in HbA1c, reducing admissions and decided to turn this into a regular service for prisoners. I was awarded the Queen’s Nurse Award in 2016 for my work in improving diabetes care in prisons.
It takes me about 40 minutes to get from the outside of the prison to the clinical area. I have to go through several security checks before I get to my clinic room. It’s different in a prison, there are some prisoners that can’t mix within the same waiting room. It’s important to change the way I prescribe medicine in prison because some prescriptions can be misused or traded as a commodity, so I provide something similar.
Delivering diabetes care in prisons, you must develop different management skills. You can't show that you can be manipulated and should be careful not to show too much vulnerability to a detained individual because this could be used against you.
At first, I was a little nervous working with prisoners. Although I don’t always know what the offence is, it can be challenging being alone with them - I was once locked in a clinic room with a prisoner. I’ve learned so much since then and I find the role rewarding. At the same time, it’s important to build a good relationship with both the prison staff and the prisoners, to maximise their diabetes care.
"For prisoners, being listened to by a healthcare professional makes them feel valued, and for most offenders, taking care of their health is the first step in turning their lives around for the better", Lesley said.
For example, I’ve met an offender with an HbA1c of 130mmol/mol and through good diabetes management it went down to 50-60mmol/mol. It’s incredible examples like this that makes my role rewarding.
A healthcare professional needs the support of other professionals no matter the setting, so the advice I’d give to others is to link in with your peers and colleagues where possible and don’t work in isolation. It’s so easy to work in isolation during these trying times. Healthcare professionals needs their multidisciplinary team.
I would say keep up to date with technology when it comes to diabetes care. Technology is changing at such a rapid pace, it’s important to have the most appropriate form of care at hand.
"If I were to summarise work as a diabetes consultant nurse, I would say that it's not a science but an art form", Lesley said.
With diabetes management, you have to think about what the individual needs, so I would also encourage professionals to be flexible in their care. It might require you to use a different route to give the best care and achieve the best outcomes.