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Six years I have now been working freelance as a ‘diabetes nurse’. The reason for the inverted commas is that this seems to be the simplest, preferred label that others gave me(and myself included) that was the easiest to explain what I actually do in my job. But my role was always much greater than just ‘diabetes nurse’, and this has been my greatest challenge in the last six years to explain to people.

Traditional Nursing Role

Traditionally everyone has this view of nurses employed in the public service, in permanent pensionable jobs, tolling away between day shifts and night duty. Some might climb the ladder, become managers, specialist nurses, even directors. The ‘mavericks’ might leave and become advisers or sales reps in pharmaceutical companies. They may work or establish nursing homes, nursing/carer agencies. But all the time they are working for someone else, with a weekly wage, a safety net and working within the confines of what seems ‘appropriate’ and ‘acceptable’ for nurses to actually do. Nothing wrong at all with this, but for many nurses, they may want something different.

But what if there was another way? 1% of nurses worldwide are self-employed or ‘entreprenurses’ according to the International Council of Nurses [1]. So it is not a ‘phenomenon’ or pipe dream that Helena thought up on a Saturday night while watching X Factor. In actual fact I know many nurses who have established their own companies, some in health care, some not, in Ireland. Again this maybe generally accepted because these nurses maybe providing a service that may not directly impact patient care as such, or interfering in the ‘golden privileged pathway’ that is between doctor and patient.

Nurse Practitioners

There is a new pathway of care that is growing in momentum in the US and globally, this is the role of the Nurse Practitioner and it is a role that I truly believe in, advocate for and support. Nurse Practitioners manage acute and chronic medical conditions (both physical and mental) through comprehensive history taking, physical exam, and the ordering of diagnostic tests and treatments. NPs (within their scope of practice) are qualified to diagnose medical problems, order treatments, prescribe medications, and make referrals for a wide range of acute and chronic medical conditions [2].

Nurse Practitioners are a type of advanced registered nurse, that have obtained a postgraduate degree, typically a masters. They can perform up to 85% of the role that doctors provide [3]……and there in itself lies the problem. There is a crisis in primary care, not just on a national level, but an international level. Nurse practionners could alleviate some of this crisis and help to make some inroads into chronic disease state management such as diabetes, heart disease and asthma. It makes perfect sense. But if the role of nurses increases, where does that leave the role of doctors, especially GP’s in primary care?

Advanced Nurse Practitioner (ANPs) are in Ireland since the early noughties, but seem to solely exist within the public health service, which makes them few and far between and an almost untouchable, unreachable post for many nurses, especially with the ongoing recruitment embargo. The process to establishing an ANP role in Ireland is a lengthy one and would dictate that it is predominately favored as a public service role. It is this politics and red tape that is so beloved amongst the health sector in Ireland that has seen our best trained, most qualified nurses leave for foreign shores. Nurses are no longer inspired to add to their qualifications, as there are no jobs there in which to inspire, which is a shame. Nurses have alot to offer in regards to leadership and research in Ireland, but like our doctors, we are sending our best abroad.

In America, nurse practionners can register and set up independently in practice, but of course, like anywhere in the world, have been met with hostility by some members of the medical community. There is absolutely no evidence available to support any claims that patient safety would be in danger under the care of a nurse practitioner, but the hostility continues. It is in my opinion that this is a financial driven motive, with reduced income to many medical/GP practices, any revenue stream considered to be going in a different direction would be viewed as a threat. What a narrow minded medical practitioner fails to see is that a highly educated and motivated patient, will be more engaged with their health, their GP service and would be encouraged to attend more regularly, therefore enhancing revenue stream. It would also long term lessen complications and reduce hospital based admissions. But again that would make sense, wouldn’t it?

Challenging Beliefs & Opinions

Six years I have been working freelance as a nurse in primary care settings in Ireland in the area of diabetes self-management education. I have been met and viewed with a broad difference of opinion across the health care settings and health care professionals that I have worked with. Some applaud and support wholeheartedly the service I provide, referring their patients for what they see as a professional, expert, quality service. Some view me with other contempt and disdain, usually these are the people who feel threatened and want to silence me for some reason only known to them. But for all the challenges that have been put in my way, I have survived and am now taking it to the next level.

I have spent the last six years operating as a sole trader, researching ‘entrepreneursing’ and experimenting, for want of a better word, with ideas, programmes and services that will help to benefit the clients who attend me. I have always practiced within my scope of practice, registered with the necessary bodies and don’t view my service as a clinical or medical one, there are plenty of clinicians out there who can do that. What I provide is an educational support and advisory service for people with diabetes, one which is highly specialized and meets with international best practice. I have developed a range of educational packages and services for people with diabetes, that I know are unique and unrivaled anywhere in Ireland and that work, thanks to the countless references and testimonials that I can provide. I also provide a range of other services, such as teaching, facilitating, public speaking, media work, article writing, preventative health screenings and corporate well being programme, not just for diabetes, but in all aspects of general health and well being.

While I have been paddling my own canoe as a sole trader for the last six years, many people thought that I would eventually wear myself out and disappear, probably into some nursing home in the back of beyond. What many will be surprised to realise, is that, in actual fact, I have now established a very successful, recognized practice that has not just benefited clients in Cork, but those that travel from all over Ireland. I have worked with many bodies, communities, agencies and businesses across the country to advocate for better education & patient centered advice, not just in diabetes, but in all aspects of health. And now a new exciting challenge lies ahead.

The Dream is about to become the Reality

It has always been a dream of mine to set up my own company, form a consultancy, in my own premises and now the dream has become a reality. I want to inspire other nurses, that we are good enough, that it can be done, if you do believe, not only in yourself, but the service that you provide, that anything is possible. I have scrimped the bottom of the barrel like so many small businesses over the course of the recession, and I am still here…..and I have no intention of going anywhere. I have relied on no funding, either private or from the state, all moneys earned from the practice has been put right back into the practice to help it grow and benefit the clients. Very important to note this in view of recent media reports on the transparency of certain health services.

On Monday the 6th of January 2014 I open the doors to my new premises. The excitement, the nerves, the sheer joy of being able to make my dream a reality, there are no words that can describe. I am casting off the patronizing put me downs from many health care professionals and laypersons that I have met over the years, who have treated me like a child. I am not just a ‘entreprenurse’, but I feel I have proven myself over the last six years to be a self assured, confident woman with an idea that has formed a good solid practice, and I am now looking to make it even better….may I even dare say….the best that it can be.

I have no intention of going away or disappearing, I am here to stay and so is my business. I believe in what I do, in fact I am passionate to the point of obsessed, about diabetes and how people with the condition should be educated. This is what has driven me, for the last six years as a sole trader and for the last 17 years as a nurse.

I hope that the future will help me to grow the business, to inspire other nurses, to coach them, to train them and help them establish their own businesses. I am more determined than I have ever been before.

This why the time is right to move from my current base in Blackrock Hall Primary Care Centre in Cork to a brand new premises just around the corner. The new service will operate from Convent House, Convent Avenue, Blackrock, Cork. A beautiful little unit, providing both my clients and I with a professional, quality setting, for what will be a professional quality service. I will be joined by a number of practionners in 2014 that will also share a common philosophy in health care.

For all the naysayers (and they have to be there, because little do they realise, they fuel the fire) there has been amazing support from the majority of people, which has helped the service remain on track for the last six years. No words will ever touch how grateful I am to all these people for their help, advice, motivation, encouragement and pure determination to see this service be a success. I hope that they will take pride on what the service is and what it is about to become.

So as I graduate in January 2014 from University of Warwick with an MSc Diabetes and hang my scroll on the wall of my new premises, it will be the end of one chapter in my career/life and the beginning of an another. Like all start ups, it will be filled with nerves, excitement, passion, determination and of course hidden challenges. But most of all it is filled with hope.

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