Beyond the diabetes ward
Lead nurse Amanda Epps’ specialism of diabetes and endocrinology isn’t confined to her workplace of East Kent Hospitals. Amanda has type 1 diabetes. She regularly monitors her glucose levels, matches her insulin to the carbohydrates she eats and plans her work activities in order to adjust insulin to avoid issues with blood glucose levels. Without these, Amanda risks going into a hypoglycaemic episode at work, which would need rapid treatment with dextrose tablets.
Amanda doesn't let this stop her from giving the best care possible – in fact, it has helped her be more knowledgeable in her role.
Amanda has some advice for nursing staff with diabetes: “You can speak to your manager about making reasonable adjustments. This might be asking for set days or shifts to you manage your diabetes more easily, factoring in frequent breaks and time to deal with issues that may arise, like high or low glucose levels”.
Read next: Diabetes: the essentials for non-specialists
Tamsin Fletcher is also a team lead for diabetes and endocrinology, diagnosed with type 1 diabetes herself aged 19 months. She went on to become a specialist diabetes nurse a decade ago, now stationed at Staffordshire’s Royal Stoke University Hospital.
She manages her diabetes via technology, including a hybrid closed-loop pump. This delivers insulin dependent on her glucose readings, from a continuous glucose monitor. These recently became available to people with type 1 diabetes in England as part of a five-year roll-out.
Tamsin, who suffers from complications, notes: “I try to use my experience to help others with diabetes who may be experiencing similar challenges.”
Support for students
Nursing students might be especially apprehensive about starting their careers while juggling individual health challenges.
Tell your team and don’t suffer alone
Natasha Green, a second-year adult nursing student at University of East Anglia, was told she had myalgic encephalomyelitis (ME) at 15. Rarely ill beforehand, she found herself essentially housebound overnight, spending most of her time asleep.
It took until Natasha was 27 to be referred to an ME clinic. She now presents a detailed health ability passport with details on reasonable adjustments to her placement providers before starting.
What is a health ability passport?
Also known as disability, health, or workplace adjustments passports, health ability passports provide a framework to discuss an employee’s health and what workplace changes can be made to support them.
Completed by the individual and their line manager, a passport is signed by both parties, indicating adjustments will be made and upheld. They should be reviewed at agreed intervals to ensure adaptations remain appropriate and allow the employee to fulfil their role, with adjustments made if the employee’s needs or role has changed.
Passports can be used to discuss and document:
- timeline and responsibilities to make adjustments happen – for example, procuring equipment
- procedures to follow if the person becomes unwell, including who to contact, particularly in the case of mental ill health
- behaviours to look out for that may signal health is declining or an episode of illness is beginning
- things that can trigger or exacerbate the disability or condition, and how these can be minimised
- recommendations from occupational health.
Natasha's symptoms fluctuate day-to-day, but she takes 10-minute breaks every 90 minutes during flare-ups. “I work to my abilities and if I'm struggling with pain or muscle spasms, I’ll inform my charge nurse and get allocated fewer patient-heavy bays,” she says.
“I don’t work nights or consecutive days, and start slightly later due to having medicine to help me sleep. I’m also protected from respiratory patients, as COVID-19 caused a serious relapse in my ME and asthma.”
Natasha is having ongoing clinical tests for several associated symptoms. “I've been fortunate that my placement and workplace managers have all supported me through this,” she says.
She advises other students to advocate for themselves: “The best thing before starting placements or jobs is to discuss your reasonable adjustments plan with your manager. Be honest and open – long- term conditions are dynamic and variable, so if you're particularly struggling one day, tell your team and don’t suffer alone.”
Better perception is needed across not just our workforce, but also the public
If your plan isn't being implemented, Natasha urges nursing staff to raise this, as it could count as discrimination. Not all colleagues will know about every condition in depth, she says, so if you’re affected, be willing to educate them on how they can support you through yours.
“We often forget nursing staff can be patients, and living and nursing with a long-term condition provides its own set of challenges in an already demanding setting,” says Callum Metcalfe-O'Shea, RCN Professional Lead for Long-Term Conditions. He agrees that “open, transparent conversations” are essential between nursing staff and employers, including on placements.
“Better perception is needed across not just our workforce, but also the public to ensure nursing staff can feel safe and confident to be recognised as an individual when providing nursing care, no matter their setting,” he says.
How to talk about long-term conditions
Holly Chadd, RCN disability officer, shares tips for discussing a long-term condition with your manager:
- Be open and honest. Whether you’re newly diagnosed or your symptoms are changing as your condition progresses, you’ll need some workplace support. Good line managers respond better with more information on your condition and how you’re feeling.
- Understand your condition. Seek advice from experts including your treatment team, occupational health and charities about what could help you at work.
- Seek outside support. You’re not alone and our peer support network includes RCN members with long-term conditions.
- Find self-care techniques. Find out what works for you and remember to prioritise yourself. If your employer isn’t supportive, get advice from the RCN.
Continuing your career
Tincy Jose is a junior sister working in acute medicine. She was diagnosed with Parkinson’s Disease in 2019, just 5 years after joining the NHS. Although Tincy was 41 at the time, the condition is more common in those over 60.
It was at work that Tincy first noticed a symptom – her right foot “slapping the ground”. Later, a colleague encouraged her to get it checked, by which point Tincy was also dealing with a hand tremor.
After her diagnosis, the first person Tincy turned to was her matron, who helped to reassure her. When her own new neurology specialist nurse reassured Tincy that her career was not over, she felt a sense of determination. Despite trepidation, the first time she tried inserting a cannula after diagnosis, she succeeded, which built her confidence.
Tincy still holds her busy role with support from her colleagues. On top of nursing, she now educates colleagues about the condition. She and her ward’s clinical nurse educator present to colleagues to ensure the right polices are in place.
“Living with diabetes doesn't define me. It's a part of my life, but it doesn't limit my ability to work and achieve my goals,” agrees Tamsin. “With proper management and support, I'm capable of excelling in my career.”
Find out more
- Read the RCN’s guide on managing your career with ill health and disability.
- Watch Clare’s story about nursing through a Parkinson’s diagnosis.
- See the RCN’s guidance on physical disabilities and long term conditions.
- Read the NHS Staff Council Guidance on building disability inclusive workplaces, which the RCN helped develop.
