The diabetes nurse: What’s in a name?

While wandering around the exhibition at the Diabetes UK Annual Professional Conference this year, I was amazed at the variety of nursing job titles on display. At the recent Abracadabra Diabetes Nursing Conference, the speakers were predominantly nurse consultants – and even they shared four different variations of their title! How did this come to be?

Historically, it was Janet Kinson who first recognised the need for nurses with specialist skills in diabetes care. She set up the first course in the early 1980s in Birmingham, which was later to become the ENB (English National Board) 928 diabetes qualification. I’m sure most of us have been through a similar course – I myself completed the ENB 928 course in 1990, early in my diabetes nursing career. However, when the ENB qualifications ceased to exist in the late 1990s, the curriculum from the ENB 928 diabetes course morphed into a wide variety of programmes across the UK, each with its own local flavour – we have such a course in Enfield. Some courses are accredited with local universities, but others are not.

Official qualifications
The current and ongoing problem is that nurses, and other healthcare professionals, in the UK have never had an official qualification for diabetes care, unlike our counterparts in the USA. In the USA, all healthcare professionals wishing to gain a qualification in diabetes education and care have to complete the “Certified Diabetes Educator” course, at their own cost. Holders of this qualification must renew their credential every 5 years to ensure that they have maintained a level of contemporary knowledge in diabetes education. (More information is available at www.ncbde.org.) 

In the UK, the Nursing and Midwifery Council does not stipulate that any specialist qualification is required to carry out the role of a specialist practitioner in any field, not just diabetes. Most of us learn specialist skills on the job or by attending study days, but none of this education, or the need for it, is regulated. Are we short-changing people with diabetes? How can anyone with diabetes be sure of the specialist skills that the nurse they have just seen at the clinic or surgery possesses? 

Competency framework
In 2005 the UK Association of Diabetes Specialist Nurses published a document entitled An Integrated Career and Competency Framework for Diabetes Nursing. This document, which is still used today, looked at the kinds of skills required by nurses caring for people with diabetes at various levels, from novice to expert. It also gave a framework for the skills required to promote career progression. The document is about to be revised and updated.

Conclusion
I believe that we owe it to all people with diabetes to ensure that anyone using the title of diabetes specialist nurse, or whatever other title they choose, has the appropriate skills and knowledge to underpin that title. Let me know your thoughts about this subject, and any possible solutions you may have considered. 

On a related note, the Link section of this issue (page 157) contains an update on progress of the Study of European Nurses in Diabetes (SEND; Llahana et al, 2009). This study is aiming to examine the factors influencing the quality of diabetes nursing care, the workload of DSNs, the job description of DSNs, and the nature of work of DSNs across Europe. You can assist with the study by requesting a questionnaire if you have yet to receive one, and returning it to the SEND study group.