The nurse practitioner is a fairly new healthcare role in Australia that was introduced in the 1990s. However, following changes to legislation in the past five years, their numbers have increased. There are now just over 600 nurse practitioners (including 20 with a scope in diabetes) scattered across each state and territory.

The nurse practitioner’s role has been developed to equalise access to specialised healthcare as and when needed by the consumer. It recognises that there are specialist staff already accessible who, with appropriate extra training, can continue to provide specialised care.

What is a nurse practitioner?
A nurse practitioner is a registered nurse educated to a Masters degree level and endorsed to function autonomously and collaboratively in an advanced and extended clinical role. This includes assessment and management of clients using nursing knowledge and skills, including the direct referral to other healthcare professionals, prescribing medications and ordering diagnostic investigations to form a diagnosis.

Many nurse practitioners treat numerous people with diabetes attending general practice but they can appear in other settings, such as aged or palliative care, renal, wound care or emergency.

A nurse practitioner can carry out physical exams, order and interpret laboratory tests, and prescribe medications or change doses without needing to consult with a doctor.

Nurse practitioners can work with people with diabetes and their families to order blood glucose tests or other diabetes-related tests, and to adjust doses of insulin and prescribe other medication designed to manage diabetes.

What is a diabetes nurse practitioner?
Generally, the diabetes nurse practitioner has the additional skills of a Credentialled Diabetes Educator (CDE), so is expert in administering treatments, teaching self-management to people with diabetes, isolating the relationship between other complications and their diabetes control, and maintaining close contact between visits as necessary.

This requires the diabetes nurse practitioner to employ approaches such as motivational interviewing, problem-solving and family negotiation, building relationships and providing families with realistic expectations about the uniquely dynamic nature of diabetes.

What does a nurse practitioner do?
The scope and role of the nurse practitioner is generally shaped by their working environment, usually filling gaps in healthcare.

Other roles include:

• clinical coordination
• in service and upskilling of health professionals in contemporary diabetes management
• initiating and supporting quality improvements in diabetes healthcare, often through to completion
• undertaking clinical research

How do nurse practitioners help diabetes management?

• Increase access to quality specialised diabetes care
• Allow prompt specialised care
• Enable and coordinate case discussion so that care is more streamlined
• Can reduce frequency and cost of health professional visits by maximising the efficiency of the entire team (including allied health professionals)

By considering:

• how the person with diabetes and family have coped with other major stressors in their lives
• their experience with diabetes before diagnosis (e.g. did they have a family member with diabetes complications?)
• their level of confidence in managing their diabetes
• their greatest current challenge with diabetes.

Giuliana Murfet MSc (Diabetes), MNg (NP), is a Nurse Practitioner Diabetes/CDE at Tasmania’s North West Area Health Service Diabetes Centre.

This article was originally published in Conquest magazine published by Health Publishing Australia