Ravinder is a Senior Lead DSN managing three acute diabetes nurse teams and serving as the professional lead for a health board in Wales, representing diabetes practice nurses in primary care and community diabetes specialist nurses (DSN). She has completed a Master’s degree in diabetes practice and is also a non-medical prescriber.
Moving into diabetes
During my career as a nurse, I have worked in acute medical care, served as a health visitor and blood transfusion practitioner, and transitioned into diabetes in 2015 as a Think Glucose Project Nurse that utilises a ‘traffic light’ system to guide which patients should be referred to the inpatient diabetes specialist team (IPDST).
During this period, I collaborated with the DSNs to develop an education programme and supported a review of guidelines, while also educating nursing staff in diabetes care. Being accepted as an Honorary diabetes nurse specialist (DSN) by the teams, I realised there was much to learn in this area of nursing, which I found truly enjoyable.
In 2018, I successfully secured a role as a programme manager in London for an NHS England-funded diabetes transformation plan. This entailed managing and developing nurses into DSNs across five hospitals in North Central London Hospitals.
To gain the necessary knowledge to support the specialist nurses’ development, I enrolled in the MSc Diabetes Practice course. Throughout this period, I played a pivotal role in the DSN team, enhancing my skills while aiding in the development of nurses and organising their education and assessment of the TREND-UK competencies.
"During my career I worked in acute medical wards and the diabetes ward, I also had family experience of diabetes as my grandmother had diabetes and was on insulin injections when I was a child."
Steps along the way
Although employed as a project nurse in diabetes I ensured that I updated my nursing skills in diabetes to pursue a career as a diabetes nurse by studying an MSc module in diabetes and then later pursuing a full Practice Based Diabetes MSc at Swansea University and working alongside the DSN team to support them. When the funding for the NHS England transformation programme ended, I took on a lead DSN role in an orthopaedic hospital in London and studied for the NMP qualification. I believe prescribing is an essential skill for a DSN as it improves patient care by ensuring timely access to medicines and treatment for patients who would otherwise need to wait to see a doctor. Nurse prescribing allows holistic care, that is patient-focused and increases patient engagement and nurse satisfaction.
Overcoming hurdles
Funding for the MSc was a challenge, I was very fortunate that I applied and was accepted on the first cohort to study a new course at Swansea University. The tutors were amazing and helped me to find sponsorship for the course. It was a challenge to upskill and develop the clinical skills and study for the MSc which I did in my own time on top of my full-time programme management role.
The challenges
I think the main challenges in the role are staffing and investment into the diabetes teams as most teams have been under-resourced and are struggling to meet the increased demands and complexity of diabetes. A specialist nurse takes many years to acquire advanced skills and even when there is funding it's difficult to recruit staff with the skills and competencies required for the specialist role. This is why it was fantastic to deliver the NHS England diabetes transformation programme in North London as we trained 10 new DSNs over two years.
The rewards
I enjoy making a difference and achieving progress in the service, recruiting new staff and developing them, many of my team are studying at master’s level and aiming to become nurse prescribers. I enjoy my clinical role and delivering self-management courses in Xpert and DAFNE. I feel privileged to have studied at Master’s, and to be a nurse prescriber so I can discuss holistic individualised care for patients and prescribe treatments in consultations to make a difference for people with diabetes. Diabetes is complex to manage, and patients require continuous support and education.
What I’m excited about
During my current role, we have made many improvements in our service and have set up a communications hub for patients and inpatient referrals. This allows our staff, more time clinically, and reduces time spent on administration and dealing with telephone enquiries. This system also allows triaging support and dealing with the highest clinical needs first.
Working closely with our diabetes dieticians we have increased and changed our delivery of self-management courses for people with diabetes i.e. Xpert, Xpert Insulin and DAFNE. We now offer many sessions and a variety of courses, for example, face-to-face, hybrid and remote.
Last year I became a member of the TREND committee after many years of respecting their experience in diabetes care to develop my knowledge. I have been attending their annual conferences since 2015 and find their annual conference and patient information leaflets invaluable for patients and a great resource to use.
Last year they came to deliver and support our new health board conference. Recently, I was delighted to hear that a member of my team has been shortlisted for secondary care diabetes nurse of the year in the new diabetes awards. I'm very proud that I nominated her, and she is a DSN ‘unsung hero’ committed to her role and delivers compassionate care to patients.
Top tips
If you are interested in becoming a diabetes specialist nurse, contact your local team and spend a few days shadowing them to learn more about the role. Sign up for a link nurse role, and complete diabetes learning Cambridge Diabetes Education Programme and degree modules. Gain experience on a diabetes ward and explore diabetes practice nursing and community DSN roles. I attend the TREND diabetes nurses conference annually and became a member to network and learn about diabetes specialist nursing competencies.
"There are many ways to specialise as a diabetes nurse, I have colleagues who completed the full masters and then secured a role with the diabetes teams and some started on a diabetes ward."
In the future, we will need more diabetes nurses and I am constantly looking for funding for more staff in our teams, and eager nurses looking to develop into a DSN.
