Over the past couple of weeks, I had the privilege of attending two major conferences that focused on areas close to the forums heart: the Diabetes UK (DUK) Professional Conference and the Obesity & Weight Management Alliance Conference. Both events were packed with thought-provoking discussions and reminders of the vital, yet often underappreciated, role that nurses play in supporting people living with long-term conditions. I was asked to attend on behalf of our chair, and thankful to be able to support the diabetes forum further.

At the DUK Professional Conference in Glasgow, I joined a panel discussion tackling the complex and, frankly, frustrating issue of specialist nurse substitution. It’s a conversation that’s long overdue.

Specialist nurses are highly skilled professionals who provide nuanced, compassionate, and technically excellent care for people with diabetes. Yet too often, their role is misunderstood or under-valued seen as something that can be "swapped out" or absorbed by another role without consequence. Let’s be clear: this is not just a workforce issue, it’s a patient care issue. See the RCN substitution position statement for more detail.

One of the strongest messages from the panel was the way current banding structures limit progression. Many specialist nurses find themselves stuck at Band 6 or Band 7, with limited options for development despite years of experience and advanced knowledge. It’s not a reflection of their capability, it’s a symptom of a system that doesn’t yet fully understand or recognise the breadth of what specialist nurses do.

We also explored how advanced practice is thriving in specialist care, even if it’s not always labelled that way. Just because a nurse doesn’t carry the formal title of "Advanced Nurse Practitioner" (ANP) doesn’t mean they aren’t working at an advanced level. Clinical decision-making, autonomous working, prescribing, leading services, managing complexity—these are daily realities for many diabetes specialist nurses. The challenge lies in recognising and validating this work, not just through titles, but in pay, development opportunities, and workforce planning.

As a nursing community, we must continue to advocate for appropriate recognition, investment, and career progression for specialist nurses. The care they deliver is too important, and the risks of losing them to burn-out or underemployment are too high.

Some key questions you may be thinking are:

• What is the RCN Diabetes Forum trying to achieve? – highlighting the key role of diabetes specialist nurses across care settings understanding the value and skills they bring to enhancing patient care.

• How are we going to help nursing staff? – The RCN is writing a joint article with Diabetes UK, DISN UK and TREND on this topic and the RCN diabetes forum committee will be speaking to RCN workforce academy about how we can take forward the need for recognition of the specialist role.

This meets the committees aim of highlighting the role of the diabetes specialist in the workforce and recognition as per RCN Levels of Nursing.

Leading on from this, I then attended the Obesity & Weight Management Alliance Conference in London, where I joined with Amanda Williams, Vice Chair of the Diabetes Forum Committee. We wanted to again highlight how nurses are central to supporting people living with obesity—and not just in specialist settings, but at every point of contact.

One of the key takeaways was the importance of early, supportive conversations. As nurses, we are uniquely placed to build therapeutic relationships that allow for honest dialogue. When we take the time to listen, understand context, and avoid judgement, we help patients feel safe and empowered, not shamed or blamed.
We also highlighted the need to consider obesity as part of the wider picture of long-term conditions. Many of the people we care for are living with multiple comorbidities - diabetes, hypertension, cardiovascular disease - and yet conversations about weight can at times be overlooked.

Crucially, nurses must be supported to think about both pharmacological and non-pharmacological approaches. New medications are changing the landscape of weight management, but behaviour change, nutrition support, physical activity, and psychological care remain critical. It should be highlighted nurses are already leading in this space and therefore need to be supported to continue improvements.

Both conferences served as strong reminders that nursing voices are essential in improving conversations around health and overall care for patients. Whether it’s challenging the substitution of skilled diabetes nurses or pushing for a more compassionate, holistic approach to obesity care, nurses are vital to the contribution of care provided.

We must keep championing the work of specialist nurses. We must create space for early and meaningful conversations with patients, rooted in respect and understanding. We must continue building networks that raise our collective voice, because when nurses lead, care improves.

Let’s keep talking, let’s keep pushing, and most of all, let’s keep showing what nursing can do and promote professional activism.