1

Diabetes Nurse PractitionerPrepared by Natalie Smith

Transitional Nurse Practitioner – DiabetesMehi/McIntyre Clusters

Hunter New England Health

November 2009

Background

Narrabri Shire DE for 10+yrs

Post grad. Cert. in DE in 2000

CDE since 2006

Part time DE & CH NUM 5 years

2008 Masters in Nursing (NP)

August 2009 commenced as DNP

Service Developments 2004 Healthy Lifestyle Program walking group

continues today.

Service Developments 2007 staff changes &

model of care reviewed

2008 new model

implemented:

- Multidisciplinary

client centred approach

- Outcomes: improved access

reduced waiting time

for high risk foot clients

- Educational opportunities

Service Developments

Engaging & Supportings GP’s & other partners

Dec 2008 Upskilling

GP’s & other HP’s.

Working collaboratively

with GP’s & Barwan Div.

2009 Evaluating Integrated

Care Program

Improving feedback to GP’s.

Engaging Partners“Connect the Dots” Narrabri Dec 2008

Diabetes Australia Kids Camp

Morisset Jan 2009

Resource Accountability & Quality 2008 CHIME

2008 Abbott Medisense Grant

2009 Chronic & Complex Care Best Practice Survey

Health promotions

Workforce Development: Mehi/McIntyre Diabetes NP

What is a Nurse Practitioner

“A nurse practitioner is a registered nurse educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role. The role includes assessment and management of clients using nursing knowledge and skills and may include but is not limited to, the direct referral of patients to other health professionals, prescribing medications and ordering diagnostic investigations.”

NP’s are required to submit Clinical Guidelines that articulate their specific scope of practice.

What does a Nurse Practitioner do?

What does a Nurse Practitioner do? Utilise their clinical guidelines to deliver high quality,

patient centred care.

Provide expert nursing care and high level clinical decision making.

Deliver care in collaboration with other health professionals as part of a multidisciplinary team.

What can’t a Nurse Practitioner do?

Presently no access to PBS (however recent changes will facilitate this in the near future).

Can only practice within the scope of practice outlined in their clinical guidelines. Presentations outside of these guidelines should be referred on appropriately.

Focus of Care Mehi and McIntrye Clusters

Predominantly community health setting & acute hospital sites as required

Resource person for staff

Clients over 16 years with diagnosed or suspected diabetes mellitus, including Type 1, Type 2 and gestational diabetes

Managing diabetes related problems including: acute intervention, ambulatory stabilisation and diabetes education, diabetes complication screening, gestational diabetes and diabetes in pregnancy

Working collaboratively & referring as necessary

Elements of Care Defined by clinical guidelines approved by HNEH and the

NMBNSW.

The DNP will also practice in accordance with The Australian Diabetes Educators Association Standards of Practice, the Code of Professional Conduct for Nurses National Competency Standards for Registered and Enrolled Nurses and the Code of Ethics for Nurses in Australia.

Elements of the DNP role will include:– Comprehensive assessment– Diagnosis– Planning of interventions– Delivery of care and evaluation– Health promotion

Formulary

Diabetes related medications will be included in the clinical guidelines. It would be limited though to oral hypoglycaemic agents and insulin therapy.

Collaborative Responsibilities The DNP may make referrals to appropriate services

required for the client. They may include, but are not limited to: – Specialist physicians – Dietitian– Podiatrist– General Practitioner– Psychologist– Social worker– Non-government organisations, such as Diabetes

Australia.

Collaborative Responsibilities

Accountability Provision of advanced nursing care for people with

diabetes.

Link clients to General Practitioners & other health care providers & community groups.

Promote primary prevention and diabetes health awareness.

Demonstrate clinical leadership and a high standard of professional practice including an ongoing commitment to professional development and quality improvements in diabetes care.

Professional Role

Maintain CDE status

Current best standards of practice will be adhered to and promoted by the DNP.

Review The scope of practice and clinical guidelines will be

reviewed and amended as necessary to facilitate changes in practice.

Outcome measures:

– client satisfaction surveys

– survey from referring source to the DNP

– monitoring of occasions of service

– other auditing processes to evaluate the DNP service.

Recipe for Success

?

Teamwork

Future directions Application for local council grant to enable

Aboriginal specific program.

Mehi Chronic Care Team

Pilot for transitional care project ???

Replicate successful programs & health promotional activities in remote sites

Support & work collaboratively with GPs.