The Future Role of the Diabetes Specialist Nurse‐Responsibility without Authority?

Over 30 years ago, Dr Joan Walker’ suggested that all diabetic clinics needed “Field work which might be undertaken by a suitable health visitor“. Her article ought to be compulsory reading for all district general managers, consultant diabetologists and nursing administrators because she clearly foresaw the problems, which still beset us in 1986, inherent in trying to define the exact role of the field worker, now more usually called The Diabetes Specialist Nurse. Reading between the lines of Dr Walker‘s article, the first problem seems to have been that Matron (that powerful lady whose word was law on all nursing matters. Long since defunct, feared, and often disliked in her day, but now greatly missed.) insisted on nurses being generalists and not specialists. It followed that, since all Health Visitors had ‘done’ diabetes as part of their training course, they would be ideally suited to supervise any, or all, newly diagnosed diabetics. After all, what did it involve except teaching injection technique and urine testing? For a time, Dr Walker accepted Matron’s schemeand waited for it to prove unworkable. It eventually did as she emphasised in her paper, “Despite lectures, food demonstrations and visits to the cliniz other duties dilute the Health Visitor‘s interest.. the time they can spend on diabetic problems is limited so that their knowledge is inadequate and it is not fair to make use of them”. The way was now open for Dr Walker to implement her own ideas. And far ranging they were. The detailed job description in The Lancet makes it clear that the Health Visitor who had a specialist knowledge of diabetes was also expected to be mistress of many other trades; nurse, dietitian, chiropodist, social worker, psychologist and detective all rolled into one you will have to read the original to find out what the detective work involved! The article concludes: ‘7he need for field work in the care, and after care, of the diabetic patient becomes more apparent the longer one works in a central clinic. It is doubtful whether the family doctor can find time to undertake all this work. Teaching the diabetic has to be slow, painstaking and above all consistent ... this work can be done by a woman of the right personality who must have considerable tact as well as expert knowledge.“ Joan B Walker. Field work of a diabetic clinic. The Lancet 1953; 2: 445-447.