US Healthcare Systems Struggle to Cope With Fall Covid Surge

US Healthcare Systems Struggle to Cope With Fall Covid Surge

As Covid-19 cases spike all over the country, many healthcare systems are in desperate straits. States that proudly saw thousands of their nurses fly out this spring to “frontline” hotspots like New York City, Seattle, New Orleans, and Boston are now starved for resources themselves. With the latest stage of the pandemic coursing through 48 states, the frontlines are often in smaller cities and rural states that tend to lack the amenities common at metropolitian hospitals. Local and state health care systems are struggling to treat patients amid dire shortages of staff, beds, and equipment.

Under the strain of the present surge, healthcare systems are assigning non-Covid patients to beds in convention centers, hospitals are canceling elective surgeries, ICU nurses are working 60-hour weeks, and nurses who sped to New York in April are now working overtime to treat Covid patients in their hometowns. Areas that are especially overwhelmed, such as El Paso, store their dead in mobile cooling units staffed by jail inmates, and airlift non-Covid patients to hospitals in cities that for the present have escaped the new surge. In addition to seeking aid from National Guard medics, the American Hospital Association’s vice president of quality and patient safety, Nancy Fosterome, told Stat News that some hospitals are even turning to local dentists, Red Cross volunteers, and people with basic health experience to help with tasks that require less training.

In North Dakota, the weight of the Covid caseload—currently the worst in the country and, per capita, one of the worst in the world—has effectively broken the state’s contact tracing system. Kailee Lingang, a University of North Dakota nursing student now helping with contact tracing in the state, told the Washington Post that “Test and trace went by the wayside. Even if we had enough staff to call up everyone’s workplace and contact, there are so many new infections that it wouldn’t be as effective. At this point, the government has given up on following the virus’s path through the state. All we can do is notify people, as quickly as we can, that they have the virus.”

In Indiana, the state and local healthcare systems are sputtering in the wake of a 60% increase in hospitalizations. One doctor in the state, Timothy Mullinder, told MedPage Today that patients “who need to go to the ICU have been stuck in the ER for 24 hours because there are no beds available. Post-operative patients are stuck in the PACU recovery area well over 24 hours because there are no beds available.”

With the entire state out of staffed hospital beds, Iowa’s healthcare system is also overwhelmed. Whitney Neville, an Iowa nurse, told the Atlantic on November 13, “Last Monday we had 25 patients waiting in the emergency department. They had been admitted but there was no one to take care of them.” The strain on the system, combined with the state’s relaxed social distancing policies, prompted one infectious disease doctor to speak in near-apocalyptic tones: “The wave hasn’t even crashed down on us yet. It keeps rising and rising, and we’re all running on fear. The health-care system in Iowa is going to collapse, no question.” The problem, however, extends well beyond North Dakota, Texas, and Iowa. A November 17 Atlantic article found that 22% of all US hospitals are facing staffing shortages, and added, “More than 35 percent of hospitals in Arkansas, Missouri, North Dakota, New Mexico, Oklahoma, South Carolina, Virginia, and Wisconsin are anticipating a staffing shortage this week.”

At the center of the system, nurses and other healthcare workers are working as many shifts as they can, while doing their best to attend to waves of incoming patients. The latest surge, however, has driven a growing number of nurses to express their frustration with incoherent policies and public intransigence on the matter of masking, social distancing, and incredulity over the very existence of the virus. Michelle Cavanaugh, a nurse at the Nebraska Medicine Medical Center, spoke for many when she told a Utah reporter, “We’re seeing the worst of the worst and these patients are dying, and you go home at the end of the night and you drive by bars and you drive by restaurants and they’re packed full and people aren’t wearing masks. I wish that I could get people to see COVID through my eyes.”

New York City is Fighting COVID Block by Block. Is it Working?

New York City is Fighting COVID Block by Block. Is it Working?

“Micro-clusters” of Covid cases are now the focus in New York City’s battle against the pandemic. After a devastating spring in which COVID-19 took over 20,000 lives across its five boroughs, city public health officials and legislators have taken the fight against the virus to the streets. The health department now monitors micro-clusters as they pop up in city neighborhoods. As zip code areas are too imprecise in a metropolis of nearly 8.4 million people, officials track micro-clusters block by block and shut down hotspots to choke off the virus before it has a chance to set the city on fire again. Using a “focus zone” system, the city enforces aggressive lock-down restrictions on gatherings and businesses in hotspot red zones, and when a red zone is densely populated, more moderate restrictions are imposed in adjacent orange or yellow “buffer zone” areas to isolate the hotspots and prevent the virus from spreading to nearby neighborhoods.

Governor Cuomo’s micro-cluster tracking strategy allows for flexible, rapid responses to sudden outbreaks. As Thomas Tsai, a health policy expert at Harvard’s T.H. Chan School of Public Health, explained to Stat News: “Social distancing policy is not an on/off switch — this is a dial that needs to be calibrated to the temperature.” In the same article, Ana Bento, a disease ecologist at Indiana University elaborated, “The idea is to… from what we know, create more efficient and evidence-based types of lockdowns. In different cities and in different states, these lockdowns may look very different from each other.”

In a city of nearly 8.4 million people—fertile ground for any epidemic—wresting control away from the virus entails a mammoth, intensive, and a constantly vigilant Test & Trace Corps comprised of doctors, public health professionals and community advocates. New York City currently has over 200 free COVID testing centers at hospitals, health centers, and pop-up locations located across all five boroughs. The state testing program has achieved considerable penetration, administering over 700 daily tests per every 100,000 residents. During August and September, 45-50,000 residents were tested every day, and since cases started to surge in late October, as many as 58,000 people have been tested in a single day (NYC testing figures).

New York City is using a neigborhood-based "micro-cluster" strategy to keep down its Covid curve.
NYC Mayor Bill DeBlasio explains the city’s Track and Trace system.

Positive cases and micro-clusters are monitored and aided by a team of over 4,000 contact tracers. Every day, the Test and Trace Corps sends about 500 COVID-positive New Yorkers a “Take Care” package with PPE and other equipment for a 10-14 day quarantine: a medical-grade mask, sanitizing wipes, hand sanitizer, thermometer, two at-home testing kits for contacts, and a pulse oximeter to monitor their oxygen levels. If they are unable to isolate themselves at home, those testing positive are provided with temporary quarters in a local hotel. At present, the Corps has a 98% compliance rate (i.e., in 98 out of every 100 positive cases the patients are complying with quarantine guidelines and staying indoors alone).

How has the city been faring in its block-by-block micro-cluster battle? With April’s images of refrigerated morgue trucks still fresh in their minds, many New York residents continue to accept the restrictions of social distancing, but exceptions are inevitable in a city containing a multitude of diverse neighborhoods and cultures. Like their counterparts all over the US, NYC officials are contending with “COVID Fatigue,” complacency, and expressions of heated resentment by residents and businesses in locked down neighborhoods. Overall, the zone-based lockdown program seems to be working, but the system may be sorely tested by the current surge and the approach of winter. “We’re all heartened at the fact that this is working,” Jackie Bray, deputy executive director of NYC Test & Trace Corps, told the Washington Post, but “We’re clear-eyed [about] how hard this is going to be to sustain through the fall and the winter.”​​

But is the system working? New York City cases more than doubled between November 2 and November 22. Governor Cuomo and Mayor de Blasio once again closed public schools on November 18, indoor dining is no longer permitted in the city (many argued that dining inside restaurants should have ceased earlier), and an emergency hospital has been reopened on Staten Island to reduce the pressure on other area hospitals.

Updated November 24, 2020.

ENA, AANA: Give Nurses a Voice on Covid Task Force

ENA, AANA: Give Nurses a Voice on Covid Task Force

A growing number of letters, editorials, and petitions are urging the incoming Biden administration to include nurses in their Covid-19 task force. When the new team assembles to battle the pandemic in 2021, the Emergency Nurses Association, the American Association of Nurse Anesthetists, and representatives from Rutgers and NYU’s Rory Meyers School of Nursing, among others have declared that nurses must have a place at the table.

In a widely published opinion piece for CNN, Caroline Dorsen, PhD, FNP-BC, associate professor and associate dean of advanced practice and clinical partnerships at Rutgers School of Nursing and Lauren Ghazal, a PhD candidate at NYU Rory Meyers College of Nursing stated that nurses are “public health experts who will add a unique and important perspective to this critical work.” They added, “Nurses are vital to meeting the task force’s goals, including making rapid testing widely available, building a workforce of contact tracers, prioritizing getting vaccines to at-risk populations (including people of color that have been disproportionately affected by Covid-19), developing clear and detailed prevention and treatment guidelines, providing necessary resources for schools and businesses to reopen safely, protecting workers and the public and, of course, caring for the sick and dying with skill, kindness and dignity.”

Emergency Nurses Association (ENA) president Mike Hastings, MSN, RN, CEN, wrote an open letter to Biden, pressing for the inclusion of nurses on the task force: “As the surge in cases and hospitalizations are expected to continue in the months ahead, the nursing perspective will be critical as your team prepares to address the crisis. Once a vaccine is approved, nurses will play a critical role in its administration to the public. Accordingly, we respectfully request that you consider placing nurses with experience and expertise in pandemics, the frontline treatment of patients and infectious diseases on the COVID-19 task force.”

Using the hashtag #NurseOnTaskForce, a Change.org petition calling for the inclusion of nurses on the task force stated that “input from nurses is crucial to insure that the recommendations regarding COVID apply to all health care workers.” The petition had acquired over 5,000 signatures by November 17.

While there is some debate over including nurses as task force members, the Biden team’s actual plan for handling the pandemic (click here to see a summary of the plan) has been met with enthusiastic approval by National Nurses United. NNU president Zenei Cortez said, “Not only does the plan address the current crisis, it would begin to rebuild the infrastructure needed to be able to respond to infectious disease outbreaks, that are likely to happen more often due to the climate crisis, globalization, and rapid urbanization in the future.”

How Can Healthcare Workers Be Protected More Adequately for the Next Public Health Crisis?

How Can Healthcare Workers Be Protected More Adequately for the Next Public Health Crisis?

With the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, or more commonly, COVID-19), healthcare workers were thrown headlong into the fray of managing healthcare protections. In many cases, this occurred without adequate preparation and supplies.

In a survey conducted by National Nurses United, only 30% of healthcare workers reported that their employer had enough PPE on hand to sufficiently protect staff in the event of a COVID-19 outbreak. Another 38% did not know. At the time of the survey, only 19% reported knowing that their employer had a plan to address when an employee contracted the virus.

Such a lack of preparation — when a pandemic of one form or another was inevitable — is unacceptable. Negligence in care facilities and at a federal level put healthcare workers at more undue risk, and the future demands better solutions.

With the right culture shifts and policies in place, we can ensure that the next public health crisis is met with a prepared and protected workforce.

Actionable Items for Healthcare Worker Protection

After the failure that has been the COVID-19 response, healthcare workers are demanding better protection now and in the future. Care facilities and government institutions alike must come together to create an actionable approach in providing the proper equipment and policies to frontline workers. This means equitable, widespread material solutions, and culture shifts that make for a safer America.

Here, we have outlined five of these actionable items to better ensure healthcare worker protections come the next public health crisis.

1. Create a More Equitable System of Care Resources and Delivery

A functioning safety net for health care does not discriminate based on locale or access to wealth. To provide proper protection to our healthcare workers, it is vital that access to resources is not placed behind a barrier of marginalization. This means taking lessons from global health exemplars to improve systems of community care and streamline emergency resource usability.

Community care workers in Malawi, for example, are funded at a national level and provide care outside of traditional clinics. Government agencies should come together with communities to create safety nets like these—especially for the most underserved and disenfranchised areas. With a comprehensive approach to healthcare solutions, governments can more equitably distribute resources. As a result, healthcare workers will be better protected against the overwhelming tides of future public health crises when they inevitably arrive.

2. Strengthen and Encourage the Growth of the Healthcare Industry

A fundamental aspect of worker protection facing the next health care crisis is the support of the industry through respect, growth, and education. CNAs, for example, are vital healthcare providers who bridge gaps in care for what is often a one-to-one-thousand ratio in terms of patients to physicians. Information about the nobility and necessity of these roles must be spread through public education systems and through incentives offered in both the public and private sectors.

With a sufficiently staffed facility, hospitals need not fear the breakdown of their ability to care for patients in the event of staff exposure. Of course, all staff should also be provided sufficient PPE to avoid exposure wherever possible.

3. Institute Price Controls on Essential Medical Equipment like PPE

One outcome of the coronavirus pandemic has been the consolidation of medical institutions as losses over $200 billion cripple the industry. When these consolidations occur, costs of medical care and equipment trend upwards. This is why a national movement to institute price thresholds and cost controls for medical equipment and pharmaceuticals will be an essential aspect of ensuring healthcare worker protection.

In the event that costs of healthcare continue to climb as they have been, care providers will be hard-pressed to purchase and maintain an inventory of PPE capable of protecting their employees. A national push to institute price controls will better prepare healthcare workers for the next crisis.

4. Shift the National Culture Towards Hygiene and Safety

Keeping not just frontline healthcare workers but all Americans safe during the next public health crisis will require a shift in culture towards the practice and celebration of better health and safety standards. We have potentially seen the beginnings of this shift in the response to COVID-19, with the embracing of masks and efficient hand washing hygiene. However, long-term protective practices will need to run deeper.

Shifting the national culture towards better hygiene must begin in early education. Children should be taught good personal hygiene habits that protect them and others. This includes staying home when they are sick.

Rather than incentivizing perfect attendance, institutions of education can incentivize the protection and care of health instead, reinforcing safe habits for life. Then, when a new pandemic emerges, the odds are better for less-overwhelmed care facilities and healthcare workers.

5. Develop Waste Reductive, Sustainable Medical Equipment Solutions

Medical waste is a problem in environmental sustainability as well as a contributor to high medical costs and limited supplies. Reportedly, care facilities spend $10 billion per year on waste management. Hazardous and regulated biochemical waste is barely a factor in this expense as well, with 85% being often-recyclable standard trash generated by hospitals.

Finding solutions to reduce hospital waste and recycle equipment can help care facilities save on costs while maintaining readiness for a greater need. In the future, healthcare workers will require a profusion of sustainable and reusable medical equipment such as N95 respirators to ensure they are well equipped in a crisis.

Preparing for the Next Public Health Crisis

COVID-19 caught the medical industry unprepared. This placed millions unnecessarily at risk when better protections could have been created through a culture of care and community support.

With more equitably distributed resources, price controls, and sustainable solutions, healthcare facilities can better be protected against health crises of any kind. These protections should be instituted at every level, through joint efforts of the public and private sector. Only then can we build a culture that celebrates health and hygiene, and in turn ensure that more lives are saved. Support frontline healthcare workers in the inevitable healthcare challenges of the future by striving for these community safety nets wherever you are.

Diabetes Nurses: On the Frontlines of a Long-Term Pandemic (Part Two)

Diabetes Nurses: On the Frontlines of a Long-Term Pandemic (Part Two)

Diabetes Awareness Day is on November 14: are you up to speed on one of our longer-running pandemics? The second part of our two-part interview with diabetes specialists Debra Dudley, RN, CDN, BS and Lori Weiss, BSN, RN, CPN, CDCES focuses on the challenges of caring for diabetics, advances in treatment, and reliable sources of diabetes information for nurses. Click to see Part One of this interview.

DN: What are the greatest challenges nurses face when working with diabetic patients?

“Time.”

Debra Dudley, RN, CDN, BS and Lori Weiss, BSN, RN, CPN, CDCES
Diabetes specialist Debra Dudley
Diabetes specialist Debra Dudley, RN, CDN, BS

Debra Dudley: “One of the greatest challenges I have consistently faced over the course of my 50-year career is the lack of time. Time is more essential than ever because the nursing shortage has left many of us overworked. I would love to have daily visits with each patient – even if it’s just a few minutes – to help guide them on their journey because there isn’t always going to be a teachable moment with them during infrequent interactions. This leads to long-term consequences because so many of our diabetic patients return with the same issues. We aren’t able to dedicate the necessary time to provide them with the appropriate education on adequate self-care.”

Lori Weiss: “Time remains the most significant challenge for nurses because they are busy, they are experiencing an increased patient workload, and those patients often have complications that are compounded by their diabetes. Patient safety is imperative, and nurses must balance safety with efficiency in order to treat as many people in need as possible. In order to overcome these obstacles, processes must be implemented that improve workflows and simplify the ability for nurses to do the right thing.”

DN: What technological advances have had the greatest impact on diabetes treatment?

D. Dudley: “There have been significant developments in technology over the course of my career, especially when you consider that early in my career we would place tablets into tubes of urine to measure blood sugar. From an outpatient perspective, the evolution of the continuous glucose monitor has been the most important. It allows a person to check their blood sugar every five minutes, identify if the blood glucose is trending up or down, and make an adjustment based on that trend. There are also mobile applications that help with carb counting, meal planning and exercise tracking – and many of those are free to download.

As far as the inpatient setting, the eGMS insulin dosing software system has been amazing. Once a nurse inputs a blood glucose reading, its algorithms automatically calculate insulin adjustments in real-time. It takes into account a patient’s current blood glucose, their food intake, and how they have reacted to previous doses. This reduces the amount of time a nurse has to spend adjusting doses because they no longer have to reach out to a patient’s provider to make a dose change. Before using this technology, our staff was making a minimum of 3,000 calls per month to providers just for dose adjustments. The amount of time wasted processing dose adjustments was both staggering and frustrating. The use of the Glucommander eGMS has reduced our amount of monthly calls by 95% – from over 3,000 to 150 – and alleviated a significant amount of nurse burden.”

“It’s not uncommon now for patients to inform their nurse or provider of a new app that is helping them manage their diabetes.”

—Lori Weiss, BSN, RN, CPN, CDCES
Diabetes nurse Lori Weiss
Diabetes specialist Lori Weiss, BSN, RN, CPN, CDCES

L. Weiss: “While many of the foundational concepts and approaches to diabetes education and support have remained the same, the tools and resources at our disposal continue to change. Outpatient technology has experienced the highest volume of technological advancements. The most notable [developments] have been the personal and professional Continuous Glucose Monitors, the variety of insulin pumps designed to meet pediatric and adult patient needs, and the explosion of digital and mobile solutions. This has provided patients with more access to information and a deeper understanding of how their decisions impact their disease. It’s not uncommon now for patients to inform their nurse or provider of a new app that is helping them manage their diabetes.

Although the outpatient setting has been most affected by these advancements, the inpatient setting has been able to leverage technology as well. As a Certified Diabetes Care and Education Specialist (CDCES), it is difficult to stay current with all the changes in diabetes care and nearly impossible for a busy bedside nurse to keep track. The eGMS insulin dosing software system has provided busy bedside nurses with an easy and effective way to care for patients. It increases patient safety by eliminating human dosing calculations, streamlines workflow because the algorithms automatically calculate insulin adjustments in real-time, and reduces adverse outcomes associated with hypoglycemia and hyperglycemia.”

DN: What are the most useful sources of information for nurses providing care for diabetic patients?

L. Weiss: “There are many reputable sources both online and in print to assist nurses caring for diabetic patients, but I find the best sources of information to be from the American Diabetes Association and the American Association of Diabetes Care and Education Specialists. The ADA issues its annual “Standards of Medical Care in Diabetes” to help guide nurses and physicians on how to best treat patients with diabetes and glycemic management issues. This is available for free online and includes best practice information on topics that range from nutrition therapy to pharmacologic approaches and recommendations for use of technology. The ADCES provides online courses, practice tools and documents, and webinars from industry experts to share a wealth of knowledge in an ever-changing field.”

Click here to see Part One of this interview.

Debra Dudley, RN, CDN, BS: Debra’s nursing career has spanned 50 years and she has spent the past 25 specializing in diabetes education and glycemic management. She is currently the Clinical Diabetes Educator for AdventHealth Waterman in Tavares, Florida, and has extensive experience in Pediatrics, NICU, and Maternal Child Health. Debra is an industry leader in providing support for those with a diagnosis of diabetes or pre-diabetes and improving their self-management through informative discussions, classes, and support groups.

Lori Weiss, BSN, RN, CPN, CDCES: After spending more than 20 years on the frontlines as a nurse at health systems in Wisconsin and Dallas, Lori Weiss is now applying her field expertise at the insulin management software company, Glytec, where she serves as the Clinical Project Lead. Lori understands the complex processes, risks, and challenges providers face titrating insulin.

Diabetes Nurses: On the Frontlines of a Long-Term Pandemic (Part One)

Diabetes Nurses: On the Frontlines of a Long-Term Pandemic (Part One)

Diabetes nurses work on the frontlines in the fight against an ongoing epidemic/pandemic that will continue to afflict over 13% of the US population long after COVID-19 recedes into the background. The diabetes pandemic has been mounting rapidly in the early 21st century. In 2003, 194 million adults worldwide between the ages of 20 and 79 had diabetes. By 2025, it is estimated that some 333 million of the world’s adults will be diabetic.

Nurses have long played a vital role in diabetes care, and studies suggest that patients fare better and have lower glucose levels when nurses are closely involved in the treatment of diabetes. As expert communicators and patient educators, nurses help America’s 27+ million diabetes patients understand how the disease and its complications affect the body, explain the treatment plan, keep them motivated, and advise them on adapting their diet and lifestyle to keep the disease under control.

As November is American Diabetes Month, this is a good time to take a look at how nurses are fighting this disease and assess the latest developments in treatment. DailyNurse asked Debra Dudley, RN, CDE, BS and Lori Weiss, BSN, RN, CPN, CDCES to share their first-hand knowledge about the key issues facing nurses on the frontlines of one of the world’s longest-running pandemics. Debra Dudley has specialized in diabetes care and glycemic management for 25 years and is currently the Clinical Diabetes Educator for AdventHealth Waterman in Tavares, Florida. Lori Weiss, a Clinical Services Coordinator for the insulin management software firm Glytec, spent over 20 years as a nurse and is an expert on the process of titrating insulin. This is Part One of a two-part interview. Click here to see Part Two.

DailyNurse: How did nurses come to take a leading role in diabetes treatment?

Diabetes nurse specialist Debra Dudley, RN, CDE, BS
Diabetes specialist Debra Dudley, RN, CDE, BS

Debra Dudley: “The role of the nurse has really evolved from basic bedside care to a leader in diabetes treatment and education during the mid-1990s. At that time, providers realized they needed to change their methodology of treating people with diabetes from provider disease management to patient self-management. In doing so, nurses were tasked with educating people with diabetes about the disease and how to treat it. This role is critically important because it helps improve long-term health, lower hospital admissions and reduce the chronic complications associated with poor glucose control.”

DN: What are the most important areas of knowledge for nurses who work with diabetic patients?

D. Dudley: “It’s important to understand that diabetes is probably the only chronic disease that puts the patient in charge of their own healthcare. Each time a patient measures their blood glucose, it is their responsibility to make a decision about if and what they need to do about it. Whenever a patient eats or exercises, they need to make an informed decision on how it will impact their blood sugar. Nurses need to understand that poor blood glucose control is the cause of significant adverse reactions, and communicating that to their patients is critical in helping them manage the disease.”

Diabetes is probably the only chronic disease that puts the patient in charge of their own healthcare.”

—Debra Dudley, RN, CDE, BS

Dudley, continued: “A toxic blood glucose level is 180 milligrams per deciliter (mg/dL), and the body cannot make healthy new cells in a toxic environment. As a result, many patients with diabetes develop wounds that won’t heal, experience repeated hospital admissions and have a higher risk of infection. In fact, diabetes causes 80,000 amputations, 60,000 people to lose kidney function, and 5,000 people to go blind every year. The broad impact poor glycemic management can have on an individual is alarming, and it’s important for nurses to process that information and find effective ways to communicate it with their patients.”

Nurses must understand that insulin, while commonly used, is one of the most dangerous and mismanaged drugs.”

—Lori Weiss, BSN, RN, CPN, CDCES
Diabetes nurse specialist Lori Weiss, BSN, RN, CPN, CDCES
Diabetes specialist Lori Weiss, BSN, RN, CPN, CDCES

Lori Weiss: “I’m often amazed at how limited a nurses’ knowledge is about diabetes, diabetes medications and available resources to care for people with diabetes. But, when I stop and consider how much general information bedside nurses need to process on a wide range of topics, it makes sense why they lack this specialized clinical knowledge. Nurses must understand that insulin, while commonly used, is one of the most dangerous and mismanaged drugs. Insulin is associated with 50% of all medication errors, therefore, properly dosing it in the hospital and providing adequate guidance on self-administration is crucial for patient safety. Additionally, the adverse health effects of poor glycemic management include a higher risk of infection, increased length of stay in the hospital and a greater chance for readmission.”

DN: How can nurses assist in preventing diabetes?

D. Dudley: “The only way we can achieve prevention is through education. We must educate our patients, our community and our country as a whole on how their decision making and behavioral patterns impact their health. Over 30 million people in the United States are affected by diabetes, which means one out of every three patients a nurse will see over the course of his or her career will be impacted by the disease. Through education, we can help patients and community members understand the potential outcomes of their choices, empower them to make the decision that lead to desired results, and positively change healthcare as a whole.”

L. Weiss: “Nurses, and especially Certified Diabetes Care Education Specialists, can assist in preventing diabetes by helping patients process and understand information that can directly impact their management of blood glucose. For those living with diabetes, nurses can assist them in navigating the continued advancements and challenges associated with diabetes to help them enjoy a high-quality life and manage their diseases.”

Click here to see Part Two of this interview.

Debra Dudley, RN, CDN, BS: Debra’s nursing career has spanned 50 years and she has spent the past 25 specializing in diabetes education and glycemic management. She is currently the Clinical Diabetes Educator for AdventHealth Waterman in Tavares, Florida, and has extensive experience in Pediatrics, NICU and Maternal Child Health. Debra is an industry leader in providing support for those with a diagnosis of diabetes or pre-diabetes and improving their self-management through informative discussions, classes and support groups.

Lori Weiss, BSN, RN, CPN, CDCES: After spending more than 20 years on the frontlines as a nurse at health systems in Wisconsin and Dallas, Lori Weiss is now applying her field expertise at the insulin management software company, Glytec, where she serves as the Clinical Project Lead. Lori understands the complex processes, risks, and challenges providers face titrating insulin.

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