Deciding how and when to specialise in your nursing career can take considerable thought and planning. If you’re attracted to the idea of specialising in diabetes care, here are the steps you might want to take, the roles available, and the opportunities on offer.
What the role involves
Diabetes is becoming increasingly prevalent – due to an ageing population, obesity and sedentary lifestyles – and is predicted to affect some five million people in the UK by 2025.
Diabetes Specialist Nurses (DSNs) and Diabetes Nurse Consultants (DNCs) work wholly in diabetes care. They may work in primary care; secondary care providing inpatient care; intermediate care working in the community; or in a mixture of these settings.
The DSN is often the first point of contact for patients, referring them to other specialist services that are appropriate to their needs.
DSN’s spend at least half of their time in clinical care, with the rest taken up by patient and staff education. More senior and experienced DSNs and DNCs are expected to take on other elements such as audit and research and guideline development.
Generally, most nurse consultant roles are split equally between service development; clinical practice; teaching and educating others; research, (including quality and audit).
How to specialise
Most nurses will come across patients with diabetes. If you work in an acute setting, acting as a link nurse – linking in with the specialist diabetes nurse in your area to ensure excellent care of patients with diabetes – can be a good place to start. Work shadowing diabetes specialists is also a good way to build networks.
Experience of teaching and making autonomous decisions is also helpful. Cathy Taylor, careers advisor at the Royal College of Nursing, explains: ‘Some nurses specialising in this field have gained experience through the acute sector, possibly branching out from renal, vascular, endocrine or specialist diabetes services.
‘Others develop their career in the community first: practice nurses run diabetic clinics and provide health promotion for patients with diabetes. District and community nurses see patients with diabetes in their own home and advise on diet, medication and treatment of side affects of the condition.’
Because education is such a key component of the management of diabetes, it can be useful to gain experience in running groups, teaching, and developing communication skills.
Grace Vanterpool MBE, chair of the RCN’s Diabetes Nursing Forum, works at Ealing Diabetes Integrated Care (DICE) which is part of the newly formed London North West Hospitals NHS Trust.
With 19 years of experience working as a DSN, Grace has this advice for others wanting to follow in her footsteps.
‘First, focus on building strong working relationships with both providers and commissioners. Link in with the national diabetes nurse consultant group and get a mentor if you can.
‘You need to ensure that you clearly understand the needs of the service and deliver every time – but don’t try to deliver anything that you have not been commissioned to deliver.
‘As well as making sure that you’re competent and confident in your knowledge and skills, aim to be a visionary leader and an innovator.’
Qualifications and training
To become a DNC here in the UK, there is usually an expectation to have completed Masters level education as a minimum – with specialist qualifications and evidence of advanced knowledge of diabetes. Masters level courses will also provide evidence of research skills.
Are you ready to specialise?
Knowing when to specialise can be as tricky as deciding which area to go into. In many cases it’s best to avoid specialising too early. Specialising is often a gradual process and because diabetes affects all bodily systems, the broader your experience, the more you will have to offer.
Cathy says you will know you are ready to specialise: ‘When you feel that everyone is coming to you for advice and you have become known as the expert and feel completely passionate about your subject, with the drive and energy to learn more and carve out a career in the field.’
While diabetes is a definite ‘growth area’ the opportunities to become a DSN or DNC is limited.
In February this year, Diabetes UK condemned the stagnation of DSN numbers as “wholly inappropriate in light of the rapid rise in numbers of people with the condition” and described the current practice of recruiting less qualified/experienced nurses into specialist roles as “short-sighted”.
While the opportunity to specialise is there, the extent to which employers are willing to fund consultant posts is fairly limited, says Cathy. ‘Many nurses work in the same way as consultants, but won’t necessarily hold the same job title, often working as a specialist adviser, or clinical nurse specialist,’ explains Cathy.
‘The pharmaceutical industry employs diabetes advisers and there are many clinical nurse specialist posts in the NHS, which, sadly, do not offer the same rate of pay as consultant posts. Nurses with vast amounts of knowledge and experience work in these roles.’
While most nurse consultants currently work within the NHS there may be increasing opportunities to work for private companies in future.
‘These may well have a greater role in providing NHS and private services in the future, since the health and social care reforms of 2013,’ explains Cathy.