On Thursday 2 February this year, the Co-Chairs of TREND-UK (Training, Research and Education for Nurses in Diabetes-UK) met with the Chief Nursing Officer for England, Jane Cummings. This meeting, at such a high level within the NHS, was made possible by the intervention of Partha Kar, NHS England’s Associate Clinical Director for Diabetes. Partha is very supportive of the work that TREND-UK is doing to promote standardised education and competence within diabetes nursing to ensure that people with diabetes receive high-quality care from educated and competent nurses, regardless of whether they are seen in a primary, intermediate or acute care setting.
We developed a short presentation to aid the discussion that included these specific points:
- What is TREND-UK?
- Why are we having this meeting?
- Diabetes specialist nursing today.
- A model for education within diabetes nursing.
After the obligatory introductions, we were able to explain why TREND-UK was formed. Basically, this was a direct request from the diabetes tsar, Dr Sue Roberts, who stated that she was never sure how to gain information from nurses working in diabetes care when any issues arose. Jill Hill, June James and I took on the challenge with the help of SB Communications Group (now OmniaMed SB) in 2009, to form an umbrella organisation that could channel information to the right places to ensure that nurses working in diabetes care had a strong voice.
As our name suggests, we have been involved in developing educational events such as the TREND-UK conference for nurses working in diabetes care, which has taken place every year since 2010. Owing to increased demand, this conference now has two venues: Manchester and London. We have also been involved in the Diabetes Specialist Nurse Workforce Survey on a number of occasions since our inception. You will also be familiar with the Integrated Career and Competency Framework, now in its fourth edition (TREND-UK, 2015).
We are very proud of our range of Understanding Diabetes leaflets, which provide education on a wide range of topics for people with diabetes and have been made possible thanks to our pharmaceutical colleagues’ support. In addition, our consensus documents and other information for healthcare professionals are all freely available at www.trend-uk.org.
The challenges ahead
In our discussion with Jane Cummings, we were able to stress the challenges faced by DSNs which impact on people with diabetes, such as the following:
- Nurses are entering the specialism from a variety of nursing backgrounds (district and practice nurses may have little experience of type 1 diabetes).
- Primary, community and secondary care work environments differ greatly and lack consistency in access to training and education.
- There are difficulties in recruiting to DSN posts, especially senior roles.
- Banding may reflect the DSN shortage and costs, not qualification and experience.
- There are numerous titles.
- There is no recognised qualification.
- There is an impending DSN shortage, with 57% of the current workforce eligible to retire within the next 10 years (Diabetes UK, 2016).
- DSNs are becoming more autonomous, often with no defined mentorship.
- It is difficult to get time and funding for training.
- The prevalence of diabetes is rising but nursing posts are static around the UK.
- One in six hospital beds are occupied by a person with diabetes (Health and Social Care Information Centre, 2015).
- Medicines management is becoming more complex.
We believe the work of TREND-UK is beginning to meet some of these challenges with the Integrated Career and Competency Framework, which aims to:
- Standardise diabetes nursing practice across different providers.
- Provide a framework for measurement of competence.
- Guide career progression.
- Help identify training needs.
- Measure the effectiveness of training.
- Aid service development by identifying what skills are needed.
- Enhance skill mix (i.e. who can do what?).
Although Jane was aware of the competency framework, she was keen to see examples of where it had improved care for people with diabetes. We were able to give her examples from our own experience, but it would be good if anyone else has examples that they would be willing to share. Please send to info@trend-uk.org and we will forward these on to her.
We all know that the prevalence of diabetes is growing steadily. Sadly, the number of nurses working in the field of diabetes care is not, but we owe it to our patients to ensure that we are a knowledgeable and competent workforce, and that we are ready to enable people with diabetes to be as knowledgeable about their condition as they can be, encouraging self-management. Currently, there is no consistency in the training and development of DSNs and no clear pathway; however, a partnership programme is planned between TREND-UK and Novo Nordisk that can be seen as an example of targeted training and support appropriate for the level at which the DSN is working or aspiring to work, as per Diabetes UK recommendations. The project provides a pathway towards DSN leadership in the future.
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