Diabetes Nurses in the Hospital Setting

I recently read a discussion about "Advocating for better diabetes care in hospitals" and again was reminded of the perpetual problem of providing excellence of diabetes care for hospitalized diabetes patients.

The story was based on an interview with a woman with several family members with diabetes, who has become an advocate for better diabetes care in hospitals. She gave several examples of the errors that hospital staff can make, out of ignorance or because of hospital rules: Mistreated hypoglycemia, insulin given at the wrong time, or meals arriving too late. The article also has a link to an excellent article, Guide to Being Hospitalized from the Canadian Diabetes Association, which gives numerous tips that everyone with diabetes should be aware of. Also, I published a set of hospitalization tips several years back, which complements the tips from the CDA.

One key difference, however, between my tips and the discussion I just read, and the Canadian tips, is my suggestion that hospitalized diabetes patients (and/or their families) should talk with the hospital's "Diabetes Nurse." The diabetes nurse can review your capabilities do "self-care" (to take care of yourself, as you do at home), help sort through the inevitable hospital confusion, and probably teach you a few new tricks you didn't know. Sometimes he/she will have authority to write orders in the chart that authorize you to do some of the things that you routinely do at home, and if not, they can intercede with the treating physicians to write the orders for diabetes self-care. (A fuller description of the role of the diabetes nurse in hospitals may be found in the American Association of Diabetes Educators' Position Statement Role of the Diabetes Educator in Inpatient Diabetes Management.)

Most hospitals have designated one or more nurses to be the hospital's "diabetes nurse"; larger hospitals will probably have a comprehensive diabetes education program. The nurses who run these programs frequently do double-duty, assisting with in-patients and inpatient staff education, as well as teaching outpatient courses. And they are usually fully trained and are Certified Diabetes Educators (CDEs).

Some hospitals have also established inpatient diabetes management programs, tailored to the needs of hospitalized patients. Here's the description of one such program:

"The Inpatient Glycemic Management Programs at [our hospital] are a resource for patients, physicians, nurses, and other health care providers. The programs enhance the care and management of the inpatient with hyperglycemia and /or diabetes. Inpatient diabetes educators collaborate with the health care team and provide Diabetes Survival skills for patients and their families. The programs are based on Best Practice guidelines, which are evidence based. The Inpatient Glycemic Management Programs provide continuing education and a review of the latest technology for the nursing staff and other health care providers."

How do you find the diabetes nurse educator? Usually, it's easy, but here are some suggestions:

• If you have time before an elective hospital admission, you can check your hospital's website to learn their diabetes capabilities: look for a section called "Patient Care Services" or simply use the website's search box for the word "diabetes." And then call the diabetes nurse educator phone number and discuss your situation with them.
• You or your family can ask your nurse, or the head nurse (AKA charge nurse) on the hospital unit where you are staying.
• If all else fails, call the switchboard and ask to talk to the "shift supervisor" or the "nursing administrator" at the hospital.

If you need to be hospitalized, and you are worried about your diabetes care while there, be sure to seek the assistance of the hospital's diabetes nurse!