Andrea Lake, diabetes specialist nurse (DSN) and our lead diabetes research nurse, shares her CUH story on Hypo Awareness Week. Andrea is currently a National Institute for Health and Care Research (NIHR) clinical doctoral research fellow.
My usual role at CUH is as a diabetes specialist nurse (DSN) and the lead diabetes research nurse; a dual role which I’ve developed over a period of time. However, at the moment I am a National Institute for Health and Care Research (NIHR) clinical doctoral research fellow. I was the first nurse in the East of England to be granted an NIHR fellowship to undertake my PhD, which is a real honour.
I have spent my nursing career to date at CUH. I trained at Addenbrooke’s, first stepping foot here as an eager student in 2005. The training was excellent and as a student I spent time with the diabetes specialist nurse team, including Karen Callaby. I was totally inspired. When I qualified my first role was in the intermediate dependency area (IDA) and I loved my job there, and would have stayed if it wasn’t for my love and interest in diabetes.
I really wanted to be a diabetes specialist nurse (DSN) and when an opportunity arose and I applied to join the DSN team as a junior DSN, working four days a week as a DSN on our wards covering inpatients, outpatients and pregnancy, along with one day a week of research delivery. I had limited experience or understanding of research and at my interview I explained that I am willing to learn, I work hard and that I learn fast, and I was delighted to get the job! So in 2010 I started a fixed term post.
Fast forward several years and I was awarded the lead diabetes research nurse role, working half the week in research and half the week as a DSN.
My passion for research has grown and is now equal to my passion for diabetes!
I believe that in order to have forward-thinking, great clinical practice, we need to have a good understanding of the research arena. This can take many forms, such as being aware of latest guidelines or taking part in audits, through to developing a hypothesis and testing it using methodologically robust methods.
I got to a point in my career where I was confident in the DSN role and I knew how to undertake a research project from end to end, but in order to progress my career I would have to choose a pathway. I really didn’t want to give up either role and felt a bit disheartened.
At that time I was attending a Florence Nightingale Foundation conference and I attended a lecture on clinical academics. It was a revelation, as I didn’t know that nurses or allied healthcare professionals (AHPs) could be clinical academics.
A clinical academic is a clinical professional working across healthcare providers and academic institutions. They have a dual role combining their clinical career with a research career, working in health and social care while researching ways to improve patient outcomes. That was where my career really took off!
I went away and found out about the NIHR fellowship programme. The fellowships are designed to support individuals to become leading researchers and are open to nurses, AHPs, midwives and doctors. Though I will say it is tough to get, and you can’t underestimate the time it took to get the offer, it is possible.
I finished my NIHR funded pre-doctoral fellowship with the University of East Anglia (UEA) in 2018. Following that I was fortunate to be awarded a bridging fellowship in conjunction with UEA, and in 2020 I was awarded the NIHR funded clinical doctoral research fellowship. The rest is history!
I did take a short break during 2021 to come and support the CUH family during the second wave of Covid. I am really pleased I played my part during this time, supporting my CUH colleagues, our patients and getting back to my clinical roots.
At this point in my career I feel I am able to take my diabetes expertise and my now developed research expertise and bring them together. I’m undertaking a randomised feasibility study on process evaluation currently looking at how patients with diabetes are supported in hospital. The project is due to complete in early December.
For me, all these opportunities have kept me in nursing and have kept me at CUH.
I’ve been asked why I haven’t worked in different hospitals, but when there’s as much diversity and opportunity as there is here at CUH, why would you step away from that?
There is a wealth of knowledge to access here at CUH, all of which has contributed to my academic development. For example, Professor Christi Deaton leads the Clinical Nursing Research Group (CNRG) at the University of Cambridge which I joined and which offered me support in exploring the academic training opportunities. From a clinical perspective, Katy Davenport had the vision that created that first job I had with one day a week of research delivery. From that, our ability to deliver research within our clinical setting and the willingness of the whole team we work with and our leads, such as Katy, to be innovative and open minded has allowed all of this to progress. The culture of research has completely changed in the department. I do feel really privileged, but equally I have also had the drive to go out and seek these opportunities; none of them just landed on my lap.
What I most enjoy is the ability to make a difference. I know that sounds cheesy, but I have the ability to make a difference in so many different ways. Whether it’s a clinical shift with a patient, right through to being able to look at how a service is being delivered, how we could be doing it better and importantly how do we test the effect of any changes made in a robust way.
The ability through the skills I’ve been supported to develop throughout my career at CUH has vastly widened my ability to make a difference.
I believe having research led by nurses, midwives, AHPs, as well as doctors, is so important. We are the biggest commodity in a hospital and these teams have that frontline experience, know where the gaps are and can see where improvements can be made; these people are vital.
As part of my masters I undertook a systematic review of the impact of hypoglycaemia for people with diabetes in hospital. My research found that even a single episode of hypoglycaemia for someone with diabetes is associated with a longer hospital stay and increased risk of in hospital mortality.
It is one of my proudest moments that this research has since been cited and published. It is a huge moment of both professional and personal pride that I had contributed to evidence that is now used by researchers and I did that as a nurse!
03 to 09 October 2022 is Hypo Awareness Week, which relates to that paper. Time and time again patients report how hypos are not a pleasant experience. On top of that, to be in a position when you are almost unempowered to manage your diabetes is quite scary. I think that’s why it’s really important to think about what we can do to help patients manage their own diabetes. Here a patient shares their experience of hypoglycaemia which highlights the importance of talking with our patients about their diabetes management and ensuring, where appropriate, we continue to empower them to be able to manage their diabetes and recognising and respecting their experience in doing so.
“Hypos are deeply unpleasant…the combination of slowness to comprehend, including slowness of speech and anxiety make me appear drunk…. What I hear and see in this state is like it has to go through a large fish take of water. The irony is, despite appearances I still feel best qualified to treat myself, I don’t always need the remedies people are proffering me, instead I may need help to access my treatment, like getting my back pack or opening my juice bottle.”
“It’s imperative for me to be asked on admission, what’s my hypo treatment of choice and ensuring it’s available. I wouldn’t mind providing it, but not it being locked away or having to ring for it…it’s really important my equipment is not taken from me or out of my sight. It’s frightening when I don’t know where they are…. At the point of admission it’s a matter of the staff and me understanding what the rules of engagement can be.”
A key theme of this year’s Hypo Awareness Week is recognition. Not just of hypos, but also recognition of the role you play, making sure patients have what they need. This isn’t just at the point of treatment, but also in the hours or days afterwards when they may still be feeling the ill effects.
I would encourage any nurses, midwives and AHPs (NMAHP) to consider research opportunities and careers alongside their clinical roles.
Nurses are natural innovators and problem solvers.
Once I’ve finished my PhD I will have achieved another level of personal and professional growth and will have a unique set of skills. I hope to find a way of combining these into a clinical academic role within the Trust, so I can continue to build my career to help that development of evidence based practice within the Trust, in particular nurses, midwives and allied healthcare professionals.
I strive for innovation and improvement to ultimately benefit our patients, our staff and the staff experience.