Registered nurse (Diabetes education)

Essential duties, functions and responsibilities

Diabetes educators are specialized healthcare providers who have the education, experience, and credentialing needed to work effectively with people across the spectrum of diabetes to enable them to engage in impactful self-care.

Completes an assessment or coordinates patient assessments with the interdisciplinary team of the patient’s condition and situation, mental/emotional/behavioral status, environment, finances and support system. Synthesizes information and determines the needed services.

Screens potential patients identified through the discharge planning or other process that require case management. Receives information from FDIHB staff and from other services units concerning contract facility and referral patients to determine the need for diabetes related service.

The educator/clinician’s focus is on both knowledge and skills to create individualized self-management plans, coordinate care, interpret personal data, conduct focused and/or complete educational assessments and promote successful self-management through adaptation.

Develops with the patient/family and interdisciplinary care team members the service delivery plan based on needs identified and available provider and financial resources. Obtains needed services for patient through arrangement with service providers. Serves as a resource person on issues concerning case management.

Reviews charts, care plans, contacts patient/family members, and service providers as necessary to determine if services delivered as planned and meeting needs of the patient.

Develops and recommends practice standards that pertains to the Diabetes Program; evaluates care outcome and suggests strategies to improve program delivery.

Follows structured evidence-based diabetes curriculum to educate patients in a clinical, inpatient, and/or classroom setting and document in the electronic health record.

Recommends National Practice Standards, which pertain to the Diabetes Program; evaluates care outcomes and suggests strategies to improve program delivery.

Participates in the collaboration with the medical and nursing administrators to plan, implement and evaluate programs to assure competent and effective clinical practice that advance programmatic goals, and that strengthen the systems that support the quality of patient care.

Provides community diabetes education through health fairs and community health events when assigned.

Participates as an active member and attends meetings held by diabetes support groups, committees, and task forces.

Participates in patient and staff rounding to assess strengths/weaknesses and to identify areas of needed change or improvement to optimize patient satisfaction and generate plans of care accordingly.

Collaborates with providers to create individualized plans of care regarding insulin use and setting of standards.

Provides quarterly staff training and updates on Diabetes Standards of Care and trends.

Involves excellent communication as well as complex critical thinking and clinical decision-making skills directly with diabetes medication management.

Reassess the patient family at appropriate intervals to determine if their condition or situation has changed and revise goals and the plan of service accordingly.

Confers with providers regarding the need for implementation of patient and/or professional diabetes education services; assists in the development of and implementation of diabetes related educational program, which includes Telehealth/Telemedicine.

Maintains current records and submit reports at designated intervals on the status of the patient, including assessment, service plan implementation and evaluation of care.

Submits data reports as designated intervals using a standard format for program monitoring and evaluation.

Prepares patients and family for termination from case management when services are no longer required.

Other duties as assigned.