Diabetes Specialist Nursing: A profession at breaking point?

At the end of November last year, Diabetes UK, supported by Novo Nordisk, published the findings of a survey of diabetes specialist nurses (DSNs; Diabetes UK, 2016). The report makes for worrying reading. Diabetes UK state that urgent action needs to be taken to recruit and develop more DSNs to avert a crisis of care for people with diabetes. The charity is warning that the profession is at “breaking point”.

The survey showed that nearly four out of five DSNs (78%) voiced concerns that their workload is having an impact on patient care and/or safety, and 39% considered their current caseload to be “unmanageable”. The survey paints a picture of a highly committed workforce struggling to cope as demand for diabetes services continues to soar without a corresponding increase in the number of DSNs.

Almost 9 out of 10 DSNs reported working above their contracted hours. Several respondents said their contracted hours have remained the same but they are working unpaid overtime to ensure good patient care. DSN workforce numbers have not kept pace with the increasing diabetes prevalence. The number of people diagnosed with diabetes in the UK has increased by 72% in little over a decade; however, almost a third of respondents (29%) said there had been cuts to DSN posts in their team over the past 2 years, suggesting that current financial pressures in the NHS are having a direct impact on diabetes care and safety. This is just storing up further problems and costs for the future.

Furthermore, these workforce shortages are likely to worsen in coming years unless more DSNs enter the profession, as more than half of the respondents (57%) were eligible to retire within the next 10 years. This is a significantly higher figure than the 33% due to retire from the overall nursing workforce. In the same time period, the number of people with diabetes in the UK is expected to increase by at least 700 000.

Bridget Turner, Director of Policy and Care Improvement at Diabetes UK, said:

“Evidence shows that DSNs reduce length of stay in hospital, improve patient satisfaction and are cost effective. But as they are relatively more expensive than non-specialist staff, DSNs are vulnerable to cost-cutting measures in times of austerity. “Unless urgent action is taken to recruit and develop more DSNs, including to senior grades, workforce shortages are likely to worsen in coming years and this will have a potentially devastating impact on patient care and safety[…] DSNs should not be viewed as a luxury, they should be recognised as vital to delivering safe, quality care for people with diabetes, including by supporting people to successfully self-manage their condition.”

The charity is calling for a national workforce strategy, as well as local action, to ensure there are enough appropriately skilled DSNs to meet current and future demand. It is also recommending a national system to accredit the specialist skills of DSNs, benchmark standards across the UK and create clear career pathways from entry-level specialists through to senior roles.

Some of the recommendations within the report relate to work that TREND-UK are currently engaged in with NHS England to explore the possibility of a recognised qualification for the Diabetes Specialist Nurse. This is already in operation in Northern Ireland, where there is a structured educational pathway. Previous reports have noted that we have over 200 alternatives for the title of DSN, with many holders of the title having no recognised qualification. Furthermore, owing to a lack of experienced DSNs throughout the UK, inexperienced nurses without the depth of knowledge to deal with complex situations are being appointed to senior posts. I believe it is our duty to our patients to ensure that, when they see a DSN, they see a suitably qualified, knowledgeable and competent nurse. The Integrated Career and Competency Framework (TREND-UK, 2015) is key to ensuring this.