Nicola Hewer

South Wales Committee Member, Community Diabetes Specialist Nurse Education Practitioner


I qualified in 1989 as an RGN, shortly after qualifying I undertook the BN (Wales), while gaining experience  working in secondary care on renal, then acute medicine and endocrinology wards in the University Hospital of Wales.

It was during this time that I started to develop my passion for diabetes, as I had come to appreciate, not only the  devastating complications that it caused, but also the complexity and diversity of the condition which has continued to both fascinate, and inspire me to learn more ever since.

I had also come to understand the positive impact of sharing this knowledge with others can have,  not only to improve patient outcomes, but also to increase the confidence in staff to know that they were delivering the highest possible standard of research based care possible. It was at this time that my interest in education as well as clinical practice started to evolve, as I gained so much job satisfaction seeing “the light bulb moment”, when a student nurse started to ask more in depth questions, as his/her interest in diabetes had been ignited !

I was then fortunate enough to be provided with the support to undertake the PGCE, which enabled me to explore, amongst many other things, the different ways in which individuals both learn and retain knowledge, something which I am still constantly fascinated by.

Changing direction and becoming a community nurse, I undertook the BSc in Community Health Studies before becoming a deputy team leader within the district nursing service. From a personal perspective, I felt that working in the community allowed me to develop, both as an individual, as well as a professional. It taught me the importance of true holistic care, taking the needs of  family, friends and carers who support the individual, as well as the wishes of the individual into account, in how they would like to be supported by the health care professionals.

During my time as a district nurse I began presenting on the Diabetes Foundation Course. I gained satisfaction from encouraging the students, who were in the main district nurses and practice nurses, to look at ways that diabetes care could be improved within their area of work, and how they could work more collaboratively to improve patient outcomes. I also instigated a project to review how the district nursing service could improve the care and support they provided for this more vulnerable cohort of patients, without impacting negatively on the ever increasing workload of the district nursing teams.

I worked closely with the Community Diabetes Facilitator, gaining more knowledge and experience in the field of diabetes, attending ongoing monthly education and networking sessions, and undertook various  learning modules to expand my knowledge in the management of those with diabetic foot problems for example, and also worked with the community diabetes dieticians to ensure that I was providing accurate, but also realistic, dietary advice.

My passion by now, I had come to realise, was not only for diabetes and education, but also for the importance of care to be provided whenever possible, in the community setting. I was then fortunate to obtain the post of a Community Diabetes Specialist Nurse, as this role incorporated everything that I feel so passionately about.

I have implemented several service improvement initiatives over recent years , which include working with senior nurses for the district nursing service to implement a mandatory education programme, this has resulted in a reduction in clinical incidences and increased job satisfaction. Worked with the community dieticians to implement an education programme for both carers and qualified staff working in nursing homes, following the programme there was an overall decrease in HbA1c levels as well as a decrease in medication prescribed, this initiative was then presented as a poster presentation at Diabetes UK. I have also had an article published earlier this year in the GM Journal, co-authored with Dr David Strain, explaining the impact of hypoglycaemia on the frail/elderly.

My particular interest is improving the education and support to district nursing teams, and those working in nursing and residential homes, the importance of which has been high-lighted over recent months by the current Covid 19 pandemic. Prior to the pandemic, I had been in the process of developing management plans for those with both type 1 and type 2 diabetes in nursing homes. The  aim is to implement these in conjunction with education, specifically tailored to the needs of the staff caring for these more vulnerable, frail/elderly, with diabetes.

I am also aiming to be part of a pilot study, looking at the possibility of using CGM to improve safety outcomes when aiming to de-intensify or discontinue insulin therapy in those vulnerable frail/elderly with type 2 diabetes who are at high risk of hypoglycaemia.

I have recently taken on the post of Community Diabetes Specialist Nurse Education Practitioner for Cardiff and Vale UHB. This is a new role, which will be exciting, but also challenging, especially with the need to adapt current practice in light of the restrictions Covid 19 has placed upon us.