It’s one thing not to be acknowledged for the work you do. It’s quite another when your hospital says you don’t do that work at all.
Northumberland Hills Hospital (NHH) is saying that it “does not currently provide any specialized diabetes education for outpatients and inpatients.” For the certified diabetes educators at the hospital, this may come as a surprise.
The “integration team” is presently pushing forward a plan to bring in nurses and/or dietitians from the Port Hope Community Health Centre (CHC) to provide diabetes education not only to patients in the NHH’s dialysis unit, but to give best practices instruction to staff at the hospital. This is even though two seasoned certified diabetes educators are already on the staff of the Cobourg hospital and a third staff member is being supported towards certification.
There’s nothing worse for staff morale than telling somebody they don’t really exist, especially when they do.
Newly appointed NHH CEO Linda Davis may want to have a chat with her own certified diabetes educators before involving outside help. She could be surprised to learn that the expertise the hospital is seeking may be right under her nose.
In last year’s inpatient dietitian posting, NHH specifically states the position is to (among other things):
- Provide consultation to inpatients who are new diabetics or inpatient diabetics who are experiencing challenging managing their condition; provide consultation to outpatients in Emergency, Dialysis, DI, and Chemotherapy on a limited basis when urgent nutritional care is required.
- Act as a resource to members of the interprofessional team in the provision of nutrition and diet information, and provides education to the team as required.
- Counsel and educate patients as required, utilizing clinical information obtained from the patient/family/members/healthcare team and patient chart; develop and modify nutritional/dietary plans as required according to patient needs.
The qualifications required for the job posting include being a “certified diabetes educator.”
The certified diabetes educators at the hospital provide instruction on general diabetes, healthy eating plan, glucose meters, oral agents/insulin’s and insulin pens. They also advise physicians and recommend suitable diabetic oral agents, insulin and insulin dosing.
We’d like to know what it is that the CHC nurses plan to do differently from the existing staff at the hospital? We’d also like to know what “expert knowledge” the hospital feels it is lacking with two and soon to be three certified diabetes educators on the payroll? We’d like to know why it was important to advertise for a certified diabetes educator if the intention was to provide no patient or staff education?
The proposal that came from the Central East LHIN is incredibly vague, so it’s hard to determine why the hospital felt the need to ask the CHC for help, or if the CHC just happened to have more resources than work?
In 2010 the NHH closed its outpatient diabetes clinic as part of cost-cutting measures. If the CHC had the volumes NHH once had, it is hard to imagine the CHC would have additional human resources to spare.
In the reply to us from the NHH/CHC, they note that “dialysis patients tend to have a variety of health conditions and the additional travel to attend a community clinic appointment does create personal hardship for many of these patients.”
Back in 2010 NHH claimed it was doing a great service to these patients by transferring the work to the community (albeit to the next community over). Now we’re told it’s a hardship because many of these patients are in the hospital for other reasons.
Doesn’t this suggest that perhaps the outpatient diabetes clinic should have never been taken out of the hospital in the first place? Is the LHIN really trying to fix its original error, and by doing so, stirring up an even bigger mess?
Here’s our suggestion for the NHH, the CHC and the Central East LHIN: start over. First assess what resources you have and where. Is community need outstripping those resources? Find out why patients are not going to Port Hope, and if it is a hardship, consider re-opening the outpatient clinic the hospital closed in 2010. If additional resources are needed at the hospital, hire them or increase the hours of the existing part-time staff. If the CHC model needs fixing, do it too. Nowhere in the existing plan does it say what this integration is intended to address.
The hospital suggests this is no different from the Community Care Access Center’s role in the hospital. The CCAC is there to help transition patients to community-based providers. The CHC nurses are there to provide a service to patients directly in the hospital — a service that is likely being presently done by experienced hospital staff with proven expertise. That’s a big difference.
We invite Davis to meet with us as soon as possible.