Grace Vanterpool, consultant nurse in diabetes at Central London Community Healthcare, explains what it takes to specialise in diabetes nursing and how demand for the specialty is set to increase
An ageing population and a national obesity crisis are just two of the many factors contributing to the rise of diabetes in the UK. According to Diabetes UK, 11.9 million people in the UK have an increased risk of developing type 2 diabetes, and around 345,000 people live with type 1 diabetes.
Yet despite a growing need for healthcare professionals to specialise in treating the condition, research from Diabetes UK in 2016 revealed that there is a ‘profound mismatch’ between the demand for diabetes services and the supply of diabetes specialist nurses.
So what is it like to be a diabetes specialist nurse? Grace Vanterpool has 30 years of experience in the field. She describes how diabetes nursing has evolved over the years and some of the biggest challenges she faces in her role.
Why did you specialise in diabetes?
I fell into it 30 years ago when my daughter was little and I needed to work regular hours. I worked in outpatient clinics at the time and then I did a diabetic clinic. I then became a diabetes nurse.
How has diabetes nursing evolved?
I did research alongside my caseload. We also ran the retinopathy unit. Then we added renal and cardiovascular clinics at different times of the month. Essentially, this was a forerunner for what’s happening with diabetes nursing today in a more structured way.
I think change has been slow and investment in diabetes has been slow. But in the last five to eight years, we’ve had a plethora of new drugs for the condition, and lots of research confirming the importance of good glycaemic control and reducing risk factors like blood pressure, cholesterol and weight. In those days they’d teach us mostly that type 1 diabetes is very serious because of having to take insulin. But now, more emphasis is placed on type 2 diabetes and type 1 diabetes is almost a poor relation.
Because of the changes in the Government’s plans, treating diabetes is being looked at more holistically and is incorporating mental health, physical health, social services, self-management and empowerment.
All those elements are now brought together, whereas before, they were separate and sometimes commissioned very separately. That’s helping to make things better.
What does your job look like, day to day?
As a nurse consultant, my role has five key domains: strategic, research, education, expert practice and services design. All those domains are set out in a Department of Health document on how nurse consultants should function. Also, I came up the ranks of specialist care and we have some competencies that we have to complete to go from novice to expert.
So my work is very varied. I also manage a team across hospital and community. I’m engaged a lot with the commissioners, patients, the public, family, friends.
No two days are the same and no two mornings and afternoons are the same. The role is patient facing but an hour later, I could be sitting in a commissioning group.
Today, for example, I met with eight clinical commissioning groups (CCGs) and we were looking at how we set up primary care and how intermediate care and secondary care could integrate so there is one care record for the patient and everything is joined up.
How do the roles complement each other?
As a jobbing clinician, I can inform the commissioners, because often these are people who don’t have any involvement in patients. They rely on people like me to give them the local intelligence to provide services that are fit for purpose.
How was it when you first started working with commissioners?
I’ve always had a good working relationship with commissioners. But some of my colleagues have a complete split – commissioners do their thing, providers do theirs. Whereas where I am, we’ve got good relationships with our commissioners and we meet regularly, share best practice and develop our service level agreements together.
What challenges do you encounter?
The biggest challenge for me currently is language. I think there are 120 languages spoken just in Ealing, Punjabi, I believe, being the first and Polish the second. We have quite a diverse community in Ealing, with Southall being predominantly South Asian.
How do you overcome the language barrier?
We have interpreters. But we don’t know whether their translation back to the patient is 100% accurate, we just have to trust their judgment. Sometimes the word we use in English may not have an equivalent in Punjabi or Polish, so that can be challenging. Other than that, we have a very good team and people are always willing to go beyond the call of duty.
One of the other challenges for me is that patients sometimes don’t realise the seriousness of their condition, so they don’t attend their appointments, or don’t take their medication as prescribed or they refuse insulin. It can be quite challenging. But once you get the education on board and they feel empowered and in charge of their diabetes, it’s less of a problem.
Is specialist diabetes nursing something you’d recommend to other nurses?
I would indeed. Diabetes is the fastest-growing long-term condition in the world. There’s going to be an epidemic in the next few years and we need all nurses to know something about it.
What qualities are useful to become a diabetes nurse?
You need a passion for it. You also have to have compassion and to be good at problem-solving because diabetes affects every system in the body. Some nurses specialise in cardiology or respiratory medicine to think about just studying the heart. But when you think about diabetes, if affects the top of your head to the soles of your feet. To specialise in diabetes nursing, you have to know all the systems, how they integrate and overlap, you have to think about medications, how they interact and what works together. It’s quite a challenge. So if you don’t want a challenge, if you just want to do everything the same every day, then diabetes specialist nursing isn’t for you because no two patients with diabetes are the same.