Understanding the role of a Diabetes Specialist Nurse.

As some of you may already know, I am a Diabetes Inpatient Specialist Nurse (DISN) in training. I work mainly with hospital inpatients alongside senior Diabetes Specialist Nurses.

The role in my Trust is very complex and includes a variety of tasks. The Diabetes Specialist Nurses (DSN) in my team review people with diabetes while they are admitted, support ward staff in managing their patients’ condition, come to the wards to see patients in regular follow ups. They work alongside the Multi-Disciplinary Teams (MDT) in hospital to improve the quality of diabetes management on the wards.

Most of my mentors are seriously knowledgeable; they are mostly independent prescribers with master-degree level training and all of them are senior nurses, with lots of experience in the field.
The DSN role, whether in a hospital or community setting, has a strong focus in educating and supporting patients; the aim is to help people to self-manage their condition. Part of a DSN’s job is to also run outpatients clinics, thus helping people to stay out of hospital. They also provide emergency advice over the phone and specialist services like pre-conception clinics, antenatal clinics and pump clinics.

Diabetes Specialist Nurses, a role that has been around for 60 years, are defined as highly skilled healthcare practitioners in diabetes care whose multi-faceted roles require certain professional qualities.
As part of dedicated diabetes teams, formed of other healthcare providers such as doctors, podiatrist, dieticians and clinical psychologists, these nurses specifically meet the needs of people with diabetes and their families, provide experience and expertise and support other health care professionals in the care they provide.

Being a Diabetes Specialist Nurse is a complex job; but what are the competencies required for the role?

The main working group for Diabetes Specialist Nurses, TREND-UK (Training Research and Education for Nurses in Diabetes), released on 2010 a new set of guidelines: “An Integrated Career and Competency Framework for Diabetes Nursing“. These set up a framework that clearly defined the competences expected at various levels of diabetes care. The framework set up 5 level of skills and competencies expected in various setting from nurses, registered or unregistered that works in Diabetes.

On the base of the Framework, had been created the WAND competencies, a useful instrument to assess in a systematic way the knowledges, skills and competency of nurses at the various levels, and that has been used as a base for career progression, training and revalidation purposes. At a Diabetes UK Conference, delegates have updated the existing framework and definition, linking for the first time the set of skills and knowledges described in the framework to specific minimum academic achievement and NHS bands.

For example, the title ‘Diabetes Specialist Nurse’ should be used for band 6 nurses who can “demonstrate a comprehensive, specialised, factual and theoretical knowledge within the field of diabetes”. This will be tested through a specific instrument based on the TREND-UK Framework, for example the WAND competencies.
Band 6 nurses are also requested to undertake a postgraduate diploma in a diabetes-related field within a year of their appointment.
Nurses at band 7 have the title ‘Senior Diabetes Specialist Nurse’. The role entails “critical application of detailed knowledge in the field of diabetes alongside management and leadership responsibilities, including completion of a post-graduate diploma”. They are also requested to complete an independent prescribing course. Completing a masters’ level qualification is advisable.
This competencies’ framework, which will be valid only for newly appointed Diabetes Specialist Nurses, places equal emphasis on academic and practice-based learning.

Therefore, the minimum qualification for a DSN has been set at postgraduate diploma level and prescribing has been recognized essential to achieve a senior role. This is a big change from the previous framework, that set up level of skills and knowledge and suggested a post-graduated education but didn’t indicate a clear academic path and academic requirements as “minimum” qualification for the role.

It’s very important to notice that the framework new minimum standards should be applied only for new to post DSNs and not those who have been undertaking the role for several years, and that completing the competencies and qualifications for a specific band does not automatically entitle a DSN to move up a band. It is, however, a big change, that set up a clear definition of the competences and qualification a DSNs should have, end the titles confusion and clarify the exact role and responsibilities of a Diabetes Nurse Specialist, or Senior Diabetes Nurse Specialist.

Diabetes Specialist Nurses are largely a success story: this is especially important given the increasing prevalence of diabetes in the general population.

In the UK, 1 in 15 of the general population has diabetes (7 per cent). By 2025, more than five million people will have diabetes in the UK.
National Diabetes Inpatients Audits (NADIA), an annual evaluation of diabetes care in UK hospitals, showed that in 2017 around 1 in 6 hospital beds are occupied by a person with diabetes. Although rarely the primary cause of admission is diabetes itself, its correct management has a profound impact on length of stay, development of complications (hyperglycaemia is commonly associated with slow wound healing and an increased risk of infections) and patient experience.

National Audits (NADIA 2010-2017) over the years indicated that “DSNs are crucial in supporting independence and in helping people self-manage their diabetes more effectively. They play a vital role in preventing expensive complications, in supporting people with complex needs and, critically, in providing primary care teams with specialist expertise that reduces emergency hospital appointments.”

DSNs are essential to ensure safety and improvement of the care of the person with diabetes, in and outside the hospital. They are often the first point of contact for patients, referring them to other specialist services that are appropriate to their needs.
DSNs, especially when they also have a prescriber qualification, have been proven as cost effective, improving clinical outcomes and reducing length of stay in hospital.

However, according to NADIA 2017, there are still not enough DSNs throughout the UK; that’s why a major project has been set up to create a standardised training model, to get more nurses to join the ranks. I am directly part of this project and it is quite exciting: NHS England is running and evaluating it. It is certainly providing a new view of the DSN role and responsibilities that I didn’t even imagine as an acute-ward based staff nurse, and I am deeply grateful to my mentors for the opportunity and experience they are sharing to me, making me more passionate about diabetes every day.

Erika Nelli

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