Improving inpatient care with the help of a diabetes link nurse

Background It is not uncommon, in the author’s experience, for a staff nurse with little knowledge and training or motivation in the field of diabetes to have been appointed diabetes link nurse by his or her ward manager. Often, the naming of a diabetes link nurse appeared to be where the responsibility was felt to end, with even the minimal expectation of attendance at diabetes link nurse meetings for updates of the latest evidence in the field being ignored. Feedback from individuals on negative experiences as inpatients and an overstretched diabetes specialist nurse (DSN) inpatient service made it imperative that the diabetes link nurse system in the large teaching hospital where the author works as a DSN was one that would make a difference to the care of the inpatient with diabetes. This led to the facilitation of a group of ten link nurses with the remit of developing objectives for the role of the diabetes link nurse and examining the perceived barriers to implementation of this role. A t any time, approximately 10 % of hospital inpatients have diabetes (Diabetes UK, 2004), and there is evidence to show that length of stay in hospital for these patients can be prolonged (Department of Health [DoH], 2001; Wallymahmed et al, 2005). Standard 8 of the National Service Framework (NSF) for diabetes (DoH, 2001) demands that ‘effective care’ should be the basic standard for inpatients with diabetes, regardless of age or medical condition. Both the NSF (DoH, 2001) and Diabetes UK (2003) encourage patients, wherever possible, to be involved in decisions concerning the management of their diabetes. Given such basic standards and the substantial number of patients with diabetes in hospital wards, it would be reasonable to expect that the majority of hospital nurses would have sufficient experience and knowledge to care for the inpatients with diabetes. However, research has shown that registered nurses’ knowledge of diabetes is variable, with nurses’ practical skills being particularly deficient (Findlow and McDowell, 2002). Anecdotal evidence from patients on their experiences while in hospital bears this out, with negative reports of inappropriate insulin doses, failure to recognise and treat hypoglycaemia and problems with diet being common. Link nurse roles have been heralded as a potentially very valuable resource (Cullum, 2002) and hospitals tend to have a variety of Improving inpatient care with the help of a diabetes link nurse