Elevating and Investing in Clinic Nurses: Having Impact on High-Risk Pregnancy Outcomes through Diabetic Education

Healthcare has seen a paradigm shift from inpatient care to a greater focus on ambulatory care in recent years. This shift impacted the way nursing within the ambulatory care setting is utilized, due in part to the increased number of complex patients requiring a higher level of care. Ambulatory care nurses now play a pivotal role in the ongoing relationship with complex patients to elicit a positive impact on outcomes and minimize gaps in care through engagement of the health care team. As this paradigm shift has occurred, the maternal fetal medicine clinic at an urban academic health center saw an increase in the diabetic population and demands over the last couple of fiscal years without increasing staff. In order to adapt to the changing health care landscape, our operational and department-wide culture was analyzed; we invested in a nurse that had interest in the diabetic population. Elevating a clinic nurse to become a certified diabetic educator ensured that we are providing the highest level of care backed by education. We know that many health implications can arise when a patient does not understand the impact in having tight control over this disease on their body and baby; however, most of our patients in this urban community do not. To list a few, poor blood glucose control, diet control, and medication adherence have been known to cause increase in fetal weight, higher rates of needing a cesarean birth, and preeclampsia, which in and of itself can cause harm to mom and baby.
Our top priority was to develop a robust education class which also included dietary support, education on impacts of carbohydrates, community resource materials, and identification of goals that each patient felt comfortable with. Early results reflected an increase in our patient’s adoption of carbohydrate counting, appreciation of having in-person classes in both English and Spanish, and decrease in the ideal fetal weight. The data has shown 87% of patients in our program had an increase in carbohydrate counting after their first education class, and just prior to delivery majority of our patients had estimated fetal weights less than 95%.
We plan to follow our data over the next few quarters to see what other gaps we have and how to address them. With the success of the program, we are educating our other clinic nurses to be comfortable being an expert in educating this population. This is important in so many ways, but mostly to have continuity of care and ensuring that all nurses are using our evidence-based recommendations.