Endless curiosity and the ability to communicate with patients and other specialists are just two of the many duties of a good endocrine nurse.
Being an endocrine nurse can be a very challenging experience. It requires very strong observational skills and an ability to sift through mountains of information to find the most important indicators.
“Endocrine nurses are involved in a very holistic type of practice,” says Margaret Eckert-Norton, PhD, FNP-BC, and certified diabetes educator at SUNY Downstate, Brooklyn, N.Y. “You have to be able to integrate technology with the whole person.”
This can be especially important considering the fact the endocrine diseases do not always (or perhaps even often) present with a clear path to the diagnosis.
“In most cases in medicine, we are trained to look for horses when we hear hoof beats,” Eckert-Norton says. “In endocrinology, we are often zebra clinics seeing the rare disorders. We need to be able to see past the usual presentations.”
She also notes that listening skills play a role in endocrine nursing. “We have to get their entire story right to help fi nd a proper diagnosis,” EckertNorton notes. “You have to hear what they have to say in the context of their lives.”
Understanding the Complications
A good understanding of pathophysiology is integral to the specialty.
“The endocrine system is a very complicated system of feedback loops and lots of different factors playing off one another, says Michelle Gurel, RN, BSN, a nurse at Massachusetts General Hospital’s Neuroendocrine Clinical Center in Boston. “It takes a person who is fascinated by intricate processes.”
Lots of data are usually available by the time a person gets to the endocrinologist’s offices. Because of their multi-faceted nature, many tests will have been done, often by many different specialties before the diagnosis is made.
“There is a lot of detective work involved in the specialty,” says Gurel, who is currently president of the Endocrine Nurses Society (ENS). “Because of this, persistence and attention to detail is an important part of an endocrine nurse’s make up.”
In addition, endocrine diseases may present with a group of symptoms that are similar to other disorders. For example, those with pituitary diseases may complain of weight gain, body aches, and fatigue that can be attributable to a number of distinct diseases across many systems.
“It is definitely a matter of doing your due diligence,” Gurel says. “Listening to your patients can lead to that one special detail in their constellation of symptoms that help in establishing a diagnosis.”
Flexible Thinking Required
A certain amount of flexibility in thinking is an important part of being an endocrine nurse. More than many other specialties, this one focuses on chronic care in the home and is more clinic-based. It is also one of the few where patients in the community are tasked with giving their own injectable medications. This means that nurses have to be able to work with patients in multiple places and under differing circumstances.
All of this is a prerequisite for one of the more important functions of endocrine nursing, the ability to take the complex and make it understandable. But an understanding of how the endocrine system works is not enough.
“Many endocrine disorders are seen in patients with multiple comorbidities,” Gurel says. “Because of this, we often have to work with practitioners from more than one additional specialty. We have to be not only able to translate endocrinology to the consumer, but also translate endocrinology to the other specialists.”
She also notes that these same communications skills are important in dealing with patients.
“One of the keys of this specialty is the ability to say to your patient that while this is a very complex system, I’ll break it down for you,” Gurel says. “I want to make it not only understandable, but manageable for my patients. They then become a part of the entire process of their own care.”
Those interested in endocrine nursing have many educational opportunities available to them. One avenue is through membership in the Endocrine Nurses Society (http://endo-nurses.org). ENS provides endocrinerelated learning experiences and sponsors an annual meeting and exposition as well as presenting topics at the Endocrine Society meetings yearly. For those wanting to work with children, Pediatric Endocrine Nursing Society (http://pens.org) has similar services.
“One of the concerns of nursing in general is the increasing average age of nurses and the imminent retirement of many,” Eckert-Norton says. “We need to grow a new crop of nurses in this and most other specialties.”
— Ullman, RN, MHA, is an Indiana-based freelance writer with nearly 30 years of experience. He wrote about medical scribes in the June issue.