The diabetes nurse prescribing demonstration, established by Health Workforce New Zealand in collaboration with the New Zealand Society for the Study of Diabetes, involves extending the role of diabetes nurse specialists to allow them to prescribe a range of medications for their patients.
For the past 15 years Mary Meendering has been working as a clinical nurse specialist, caring for people with diabetes across every age group and condition, from children, adolescents, women in pregnancy, and adults with type 1 diabetes, to those with complex type 2 diabetes.
As one of the newly designated diabetes nurse prescribers, at MidCentral DHB (one of four demonstration sites) Mary has found her role is already increasing her job satisfaction. ‘Professionally I have the skills and knowledge to safely prescribe and I also have the support from colleagues and clinical supervisors for this project. The benefits to my patients are clear: it will help to reduce barriers for many who would otherwise need to see their GP for a prescription – it will improve the health outcomes for my patients.’
If there is a significant change in a patient’s diabetes status, they will still need to see their GP or specialist. If not, however, nurses like Mary will often be the best person to monitor a patient’s condition, help them manage it and provide routine prescriptions.
A typical day varies, with newly diagnosed children or gestational diabetes patients taking priority. ‘I organise my own nurse-led clinics and attend the routine paediatric, young adult clinics and the high-risk antenatal/diabetes combined clinic. Phone assessments, crisis intervention and clinical management are a large part of the work as well.’
Mary’s interest in diabetes has developed over time, stimulated by psycho-social as well as complex clinical aspects. When the opportunity to become a designated prescriber diabetes nurse came up, Mary applied. ‘It’s a fascinating area of practice and I am inspired by many of my colleagues who are passionate about caring for people with diabetes.’
Having completed her Master of Nursing in 2010, Mary was academically well placed to take part in the project. She believes postgraduate education in subjects such as pharmacology and patho-physiology is essential to underpin knowledge and clinical decision-making confidently and safely. ‘I think it is essential to have a sound understanding of the drugs we use in practice. The support of the clinical sponsors and physician supervisors has strengthened relationships within the team and we work well as colleagues.’
With the extended role Mary can benefit from the recognition of her expertise and knowledge and she enjoys the learning and clinical discussion with case reviews. ‘I find it rewarding professionally to be continually expanding my knowledge. …. Professionally I think that the ability to prescribe will grow the relationships we have with general practitioners and pharmacies. I am hopeful it will also remove some of the frustrations that a delay in treatment changes or delay in getting basic repeats can represent for patients.’