1. 1 Diabetes Nurse Practitioner Prepared by Natalie Smith Transitional Nurse Practitioner – Diabetes Mehi/McIntyre Clusters Hunter New England Health November 2009

2. 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

3. Service Developments  2004 Healthy Lifestyle Program walking group continues today.

4. 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

5. 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.

6. Engaging Partners “Connect the Dots” Narrabri Dec 2008 Diabetes Australia Kids Camp Morisset Jan 2009

7. Resource Accountability & Quality  2008 CHIME  2008 Abbott Medisense Grant  2009 Chronic & Complex Care Best Practice Survey  Health promotions

8. Workforce Development: Mehi/McIntyre Diabetes NP

9. 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.

10. What does a Nurse Practitioner do?

11.  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.

12. 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.

13. 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

14. 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

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

16. 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

17. 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.

18. Professional Role  Maintain CDE status  Current best standards of practice will be adhered to and promoted by the DNP.

19. 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.

20. Recipe for Success ?

21. Teamwork

22. 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.