Get to know nurse and diabetes educator James Fain, associate dean for academic affairs at the Graduate School of Nursing at the University of Massachusetts Medical School in Worcester, Mass. Fain is also editor-in-chief of The Diabetes Educator. On Nursing Notes Live this month we examine how nurses help manage patients with chronic illnesses. In this episode of the Nursing Notes Live podcast, I got the chance to sit down and interview Jim. Here’s that interview.
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Jamie Davis: Jim, welcome to Nursing Notes Live. It’s great to have you here on the show with us and I’ll ask you our traditional first question for our nurse guest. And that is, why did you want to become a nurse?
James Fain: Okay. My decision to pursue a career in nursing or, I should say, one of the health professions, really went back when I was in high school just thinking about leaving and going into college. I was very fortunate enough to have many friends of the family who were in the health professions. And I would say, in particular, one of them happened to be a nurse anesthetist. While that’s not a role I would be very much interested in going in, I learned that the opportunities to interact with patients and other healthcare professionals in the profession of nursing on a daily basis was something that was very appealing. Also enjoyed the opportunity to think about the many different types of career opportunities and the ability to advance the career while in the nursing profession was very appealing at the time.
Jamie: Yes, there really are so many different directions. I always point this out when this type of thing comes up is, yes, I didn’t know I was going to develop into a nurse journalist when I first went to nursing school but yet here I am. So there are so many ways to come about being a nurse.
James: Absolutely. Different educational areas, but pretty much once you’d become registered nurse, licensed, really the whole world is open to you for the tremendous number of opportunities or different careers you might choose within that nursing field.
Jamie: So what led you to become a diabetes educator nurse?
James: My career probably as diabetes educator began when I was in the Master’s program down at the University of Alabama in Birmingham, which was the School of Nursing there. I went for my Master’s degree and at the time, back in the 80s - ‘79 was when I actually graduated - but in the late 70s, early 80s, the role of clinical nurse specialist was a very popular role. And I chose to go to the University of Alabama because they had a very strong clinical nurse specialist program in diabetes nursing. What that really meant was that as a registered nurse and then having the ability to become certified in diabetes education, I would have the ability to work either in an inpatient or an outpatient clinic as a diabetes clinical nurse specialist. When I was in teaching before that I was very much interested in the patient with diabetes. So I just found that this was a great opportunity to advance in the field of diabetes education. I knew if I could get some good clinical practice as an educator that eventually I would possibly able to think about my role as a researcher or a nurse scientist so that I could actually conduct research in the area of diabetes, self-management in particular. So again it was pretty much as I was a graduate student in my Master’s program, it was a wonderful program. At the time, choosing a specialty like diabetes or cardiovascular nursing or anyone of those special areas was kind of a way to go.
Jamie: Nurses are primary patient educators in many different roles and dealing with many different diseases, but being a diabetes educator isn’t limited to just nurses. Tell us a little bit about what are some of the roles and responsibilities for somebody who is a diabetes educator.
James: Sure. You are correct. While predominately the majority of diabetes nurse educators are nurses, the whole field of becoming a diabetes educator is open to many other healthcare professionals such as clinical dietitians, clinical pharmacists, physicians, psychologist, exercise physiologist, podiatrist. I would say any one individual healthcare provider, that is, who works with a population of individuals who have diabetes and going forward even now prediabetes, they are an extremely integral partner in that diabetes care team that takes care of the individual with diabetes. The role of the diabetes educator can be about many different things. I’m just going to mention a couple of major responsibilities in areas of self-management that are critical. We help in terms of the notion of nutritional therapy where we look very carefully in making sure someone has a very healthy diet and just eat healthy. The whole notion of exercise planning making sure patients are very active is critical. Probably most individuals would think the educator deals a lot with adjusting medications be that oral or taking insulin. Teaching patients how to monitor their blood glucose levels. And then the whole notion of providing behavioral, psychosocial counseling where we look at someone’s psychosocial care is also very critical. So as you can see many of those responsibilities are just not that of the nurse. It involves many other healthcare professionals to do that.
Jamie: You mentioned prediabetes as being something that diabetes educators are starting to be more involved with education for those patients. I’m curious what you see as the future for diabetes educators as their roles continue to become so important given the millions of people that currently have diabetes or at risk for prediabetes.
James: The role of the diabetes educator is ever so critical as we go forward. As you mentioned, Jamie, we have probably right now, 2015, about 29 to 30 million Americans with diabetes. That’s approximately 9.3% of our population. The more staggering statistic is that there are about another 86 million people who are over the age of 20 who have prediabetes, which means clearly they have been actually diagnosed with this prediabetes condition which puts them at extreme risk for having diabetes later on in life if they do not really engage in a lot of self-management behavior. So the role of the diabetes educator is ever so critical. While probably 10 or 15 years ago, we saw more of the diabetes educators in an inpatient and moving to the outpatient setting, I think we’re going to find that the new role of the educator is being much more of an advocate for healthy eating. Again, being very active is going to move very quickly into this population of individuals who have prediabetes. I think educators are going to have to begin to explore new roles so that we can start working with this particular population.
Jamie: We’re talking about all kinds of chronic diseases this month on our shows. I’m curious what your thoughts are about how diabetes educators are dealing with patients with other chronic illnesses. So often diabetes isn’t just sitting there alone, but it is actually accompanied by hypertension and increased risk for stroke, hyperlipidemia and things like that. How do you adjust and help patients manage those aspects of their health as well as their diabetes?
James: Very good point and clearly the challenges that the diabetes educator faces is not only dealing with the actual diabetes itself but it’s all those co-morbid diseases such as you mentioned – hypertension, in particular, hyperlipidemia and all those – it’s a tremendous challenge. So the whole area of self-management in teaching the patient that they are indeed sort of like at the center of the healthcare team and that they have to take responsibility for their health is a critical aspect of the role of the educator. Whatever the challenge is we must be extremely proactive with all individuals trying to educate them on all aspects of what they’re going through. We know when someone does have a disease like diabetes they are very likely to have other chronic-type illnesses. So as health professionals we have to focus on the education and training of individuals with all those concurrent co-morbid diseases.
Jamie: What kind of skills does a nurse who is interested in becoming a diabetes educator needs to develop? Is this something that a relatively new nurse can move into very quickly or is it something that requires a significant amount of prior knowledge and experience with a variety of types of patients?
James: Great question. This is something that I think the American Association of Diabetes Educators, which is the national organization of educators, has recently dealt with and is beginning to take a much more serious look at it. Over the years, to become a diabetes educator, the way was to kind of be mentored by another educator in practice. If I think back to when I started my nursing career, what traditionally happened was the old staff development patient education departments within hospitals where you learned about diabetes and you’re taught individual with diabetes or you were working with patients who had cardiac disease and mentored cardiac education with them, the only way to get involved was to really be a part of those departments and learn from others who had that position for years. What makes it also a little bit difficult is that there is no – I’m going to say “technical schooling” to become a diabetes educator. First and foremost, you must be a healthcare provider. So you have to go for the nursing school. You have to go through pharmacy school. You have to go through the school of medicine if you want to be a physician. If you had a liberal arts education you became a psychologist or you became a social worker. All those require you sort of like to get into your own germane-type profession. And then once you’re in that profession as a nurse, as a dietitian, as a social worker, as a physician, I think you then tend to gravitate towards individuals who potentially work in those fields, but also have some expertise within the field of diabetes. I mentioned earlier the American Association of Diabetes Educators has taken a much more proactive look at how we mentor individuals. And we’re now beginning to look at some individual programs where nurses, dietitians, pharmacists who are interested can kind of shadow other professionals in the field to begin to get an interest. That’s critical because once you shadow another professional and you get more experience, he then can learn about the different educational programs, about the CEU’s for those interested. And then you can actually gain enough hours to think about beginning to sit for certification. To sit for certification as a diabetes educator, you need so many hours in the field. That’s the tough part right there. How do you break into those type of jobs? And I’m going to say it again: the easiest way is to be mentored by someone who actually had that experience and can bring you along.
Jamie: You mentioned earlier about the millions of Americans who are currently either have diabetes or are at risk for prediabetes. That means to me that every nurse no matter where she finds herself - or he or she finds themselves - in whatever healthcare setting could be, at least in part, a diabetes educator. Would you like to talk a little bit about ways nurses can find other resources to educate themselves about this?
James: Clearly, the best way would be, as you are a registered nurse, to become more involved in the various professional organizations that deal with diabetes education. Again the one major association out there today is the American Association of Diabetes Educators. There’s an annual meeting every year for this association and they will offer the opportunity for those nurses who are just beginning to think about getting into the field to attend certain programs at that session. There were also certain sessions at that program that are going to be targeted for more intermediate or more advanced type of information related to diabetes education. But the overall mission of the American Association of Diabetes Educators is to really empower healthcare professionals - again nurses, dietitians, pharmacists, physicians - with the knowledge and skills that are necessary to deliver exceptional diabetes education management and support. So that’s probably one of the easiest things to do is to get more in tuned with your professional organization.
Jamie: Fantastic. Final question. We get a lot of questions from student nurses over the years and one of the most popular ones is please share with us the piece of nursing advice that you carry with you every single day. Something someone told you when you first got started that has really helped you through your career.
James: One piece of advice. I would say regardless of whether you work in a very acute care setting as a nurse or you work in a primary care setting or you work, let’s say, in a school-based clinic or you work in industry, you work in the government, again, the flexibility of being a nurse and working at whatever type of setting, I think the one thing that will always be up front is that you will have the ability to make a difference in someone’s life. I say that very sincerely. Again thinking about regardless of what type of nursing you go into, what your specialty is, always remember that what you do the values you bring with you will always make a difference in someone’s life.
Make sure you check out the entire June 2015 issue of Nursing Notes where we take a look at how nurses help patients manage chronic illnesses. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with our panel of chronic disease care nurses including Cindy Richards, president of the American Nephrology Nurses’ Association and pediatric renal transplant coordinator at Children’s of Alabama in Birmingham, Ala. and Pam Cacchione, President of the Gerontological Advanced Practice Nurses Association (GAPNA); Endowed Term Chair in gerontological nursing; as well as an associate professor of geropsychiatric nursing at the University of Pennsylvania in Philadelphia, Penn. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes!