Managing Diabetes in the Community
20 November 2018 | Lesley Mills QN
I have been working as a qualified nurse for nearly 32 years and working in the area of diabetes for more than 24 years.
For the past 20 years, I have worked in the north west of England, mainly in secondary care but developing a community service in the local area. I started the service with one part-time staff nurse; we now have a team of 14, covering a diabetes population of nearly 21,000.
Part of my clinical role is assessing and reviewing patients. Often my agenda for a patient may be very different to the patient’s own agenda. One example is a young 17 year old who had recently been diagnosed with type 1 diabetes.
All he wanted to focus on is how often can he have a McDonald’s rather than actually taking insulin four times a day and monitor his glucose levels regularly in order to manage his diabetes.
Then there’s the pregnancy clinic – women with pre-existing diabetes and those who develop it during pregnancy. These women need to monitor their glucose levels 6-8 times a day and take medication to ensure that their glucose levels are tightly controlled for the benefit of the baby. The number of women in this clinic has increased five-fold since I started, but the results don’t seem to improve locally or nationally.
I completed my MPhil in medicine back in 2003, looking at cardiovascular disease and diabetes and how nurse-led clinics can be significantly more effective at reducing complications than routine medical clinics. Following my completion of this, I then worked on national guidelines for acute coronary syndrome and hyperglycaemia with NICE.
This opened my eyes to the fact that guidelines can only be developed if the evidence is published. I then decided that we need to get nurses to publish more of their incredible work. I am currently the longest-serving member of the editorial board for the journal of diabetes and primary care. I have published many papers on diabetes – reducing the risk of diabetic ketoacidosis, diabetes and pregnancy, sexual dysfunction and offender health.
Learning about offender health was what led me to reviewing the service we provide to this group of people. Many have been in prison for a number of years and although have access to health care do not attend or are unable to attend their secondary care appointments. I re-designed a service, which moved the specialist diabetes clinics back into the community, which in turn reduced both acute and chronic complications of diabetes but also saved the local commissioning group money. This service was the drive that set me on my path to becoming a Queen’s Nurse – something I am very proud of.
I think that over the years, I have kept giving away my power, rather than holding on to it. This was about to change.
Since becoming a QN, my work has led me to present at both national and international conferences – something that I am proud of. I feel that sharing great practice is an important part of my role.
Recently I have also been undertaking the Queen’s Nurses’ leadership programme. This has given me the opportunity to meet some amazing QNs and share our experiences and work with each other. The programme has also exposed me to some great leaders in health care. These have been inspirational in their teaching and made me really think about my role and how I can further raise my performance. I am beginning to fear people less – as Crystal says, ‘Be at the table or be on the menu’. My ‘imposter syndrome’ is leaving me more each week and I am walking taller in my career. I hope that I act as a role model for the more junior members of the team and when presenting to other teams or at conferences, that I inspire others to develop their passion and care for the benefit of others. I have always held patient care at heart and I will support my team to do the same.
Part of the leadership programme has encouraged me to question what motivates me and my team. This helps me understand and drive my behaviour in the direction that I and others want to go. This led on nicely to the next part of the leadership programme, around influencing health policy. It was at this point where I sat and listened to speakers who really do influence the decision-makers of Parliament, NHS Improvement and the Department of Health. Talking to one of the speakers over lunch was that ‘light bulb’ moment for me and my involvement in the national agenda of illness prevention, workforce development and new technology.
My leadership journey is now coming out of that cul-de-sac that I feel I have been in for so long and I now feel that I am walking confidently along a new path. Where my agenda will be aligned with the national agenda, it will be persuasive and robust, to show how a change is needed and how it will benefit patients, families, carers and the community.
I am excited to consider where the next chapter in my career will take me and look forward to facing new challenges.
Read the blog Lesley has written for Diabetes Specialist Nurse Forum UK.