August Palma is the first endocrine specialist nurse from Cambridge to complete the Masters-level Module in Endocrine Nursing at Oxford Brooke’s University. He is an endocrine research/specialist nurse under the Endocrine Molecular Imaging Group of Professor Mark Gurnell at the Wolfson Diabetes & Endocrine (WDEC) Clinic at Addenbrooke’s Hospital in Cambridge, UK. His area of interests include endocrine conditions of the pituitary and adrenal glands. Read on to learn about his career journey, his experience of endocrine nurse studies and his wise words for aspiring endocrine nurse specialists.
Could you tell us about your career journey?
Before coming to the UK in 2015, I was an emergency staff nurse at a local hospital in my hometown in the Philippines. I was never particularly drawn to endocrinology back then, nor had I considered specialising in endocrine nursing. The only connection I had with endocrinology was diabetes (both parents of mine have Type 2 diabetes). Nurse specialisation in the Philippines is also very limited to certain areas only such as critical care, surgical, obstetrics and dialysis to name a few. Endocrine specialist nursing in the Philippines is unheard of even up to this day.
Fast forward to when I was searching for opportunities to apply to as a nurse abroad, I attended a national conference about endocrinology in order to comply with my annual Continuing Professional Education (CPE) credits as a requirement to renew my professional license. Representatives from Cambridge University Hospitals NHS Trust had come to the Philippines to recruit nurses – the “endocrine connection” as I call it, which started in that conference I attended a few months back, seemed to have stuck with me – as fate would have it, the interviewer told me I got the job: “Well, since we don’t have any vacancies in A&E at the moment, we would like to offer you a post in the diabetes and endocrinology ward.” Of course, I didn’t say no and the rest was history.
What inspired you to choose endocrinology?
Within two years working as a staff nurse in the diabetes and endocrinology ward, I felt like I needed to do something more and progress professionally. During my very first appraisal, I mentioned to my mentor and supervisor that I wanted to pursue research. I started looking for research posts within the Trust and an opportunity to apply as an endocrine research and specialist support nurse within the same division presented itself. I have greatly enjoyed doing research for as long as I can remember and to combine it with the complexity of the endocrine system made it even more interesting! When I trained as a nurse, endocrinology wasn’t my first love because I found it really complex to understand. However, that all changed when I became an endocrine nurse because I learnt so much about treating complicated endocrine disorders, and I feel like I make a huge difference in the lives of endocrine patients. This, and the fact that I actively participate in research to improve diagnostic and treatment modalities of various endocrine conditions, inspires me to continue my journey as an endocrine research and specialist nurse.
What motivated you to apply for the SfE Masters-level Module scholarship?
Pursuing higher education was always part of my plan after finishing university. I never got the chance to do this because my career path involved a few twists and turns before I became a nurse. Then came the time when I had to start working to earn money, so pursuing post-graduate studies was considered a luxury rather than a priority at that time. I am grateful to the Society for Endocrinology for granting me a scholarship to do the Masters-level Module in Endocrine Nursing. At first, I was a bit hesitant to apply knowing the time and effort involved (especially for someone who works full time). I thought doing this double module with a busy four-day work week would be a difficult and challenging task. After much consideration and, with the encouragement of some of my colleagues and mentors, I took up the challenge. Another motivating factor was the endocrine project expected as part of the requirements in order to complete the module. This is a chance for endocrine nurses like me to create something that would benefit endocrine patients and improve the endocrine service, in general.
What was the journey through the module and how has this influenced your career?
The journey through the module involved long hours of reading and researching be it in the clinical library at Addenbrooke’s Hospital, or virtual trips to the e-library of Oxford Brookes University. I also had to miss out on a few weekend invitations from friends or give up personal time on my days off for a few months to focus on writing my paper. In honesty, it wasn’t a walk in the park, but in the end it was all worth it. I mainly look after a specific group of patients with primary aldosteronism (PA or Conn’s syndrome) and my endocrine project was to design a standard operating procedure (SOP) to support the running of a virtual nurse-led clinic for patients with PA. This SOP will hopefully provide a systematic approach or pathway from case detection, screening, diagnosis, management and follow-up or surveillance. There are not that many centres in the world that are considered centres of excellence in dealing with PA and this is why only less than one percent are diagnosed with this condition globally when, in fact, previous studies show that among those who have hypertension, approximately five to 15 percent of them may have PA. On a global scale, this would translate to millions of undiagnosed patients with PA. PA is a surgically curable form of endocrine hypertension if it is caused by an excessive production of aldosterone from a unilateral adrenal adenoma. Bilateral PA is managed medically.
The SOP has greatly influenced the way how I follow up patients on a regular basis from starting the initial investigations, booking dynamic and confirmatory testing, keeping track of their blood pressure readings and monitoring their response to medications, and acting as liaison between them and the endocrine doctors for any specialist concerns.
What are you most proud of in your career so far?
Apart from being the first and only nurse in our Trust to complete the module so far, I am most proud of being able to help patients with PA. I feel very happy and proud when patients tell me that their lives have changed dramatically after surgery, or that they feel so much better when a diagnosis is finally made and that the appropriate medication helps provide better BP control. Unfortunately, PA is not widely known to clinicians, especially at the primary care level, and this contributes to the low diagnostic rate. Some people with PA have severe phenotypes that are characterised by resistant, refractory or uncontrolled hypertension involving multiple antihypertensive agents and they may also experience mild to severe hypokalaemia. These patients are also at a much higher risk of cardiovascular morbidity and mortality than age-and-gender matched patients with essential hypertension. Thus, it is quite important that investigations to detect and diagnose PA are not delayed and are done in a relatively timely manner. All these issues can be worsened by the patients’ poor general quality of life with fatigue being one of the most common symptoms they report. Being part of the patients’ journey from diagnosis to treatment and somehow making a difference in their lives is something I consider a proud moment for me.
Would you recommend the module to your colleagues?
Absolutely! In fact, one of my colleagues has been accepted and is due to commence soon. I am also encouraging other members of our team to do the same.
Do you have any advice for aspiring endocrine nurses interested in career development but don’t know where to start?
Endocrine nursing, as a whole, is a broad field with so many opportunities to specialise in for further career development, so it’s really important for an endocrine nurse to think about which area of expertise to focus on under the guidance of the Society for Endocrinology’s Competency Framework for Adult Endocrine Nursing. I believe this is the first step that each endocrine nurse should contemplate and work on. The framework is quite useful in assessing one’s progress in their career journey and level of expertise, which will guide each endocrine nurse every step of the way.
Discussing professional development goals and objectives with your line manager during annual appraisals is another way of planning ahead and looking into progressing one’s career. This is a great chance to find out if funding and resources are available within the Trust or elsewhere, i.e. NIHR, society grants or scholarships and other external sources of funding, and if full support to undertake a course can be expected from the management.
It is also important to network with other endocrine specialist nurses, engage or participate in relevant professional meetings and events to keep up-to-date with opportunities available outside the work environment.
Have you had mentors and how has this helped you so far?
I had the opportunity to be mentored by Louise Breen, the Nurse Committee chair of the Society for Endocrinology, when I did the module. As my work-based facilitator, she provided me expert insights and ideas especially during the drafting of my learning contract for the module.
I am quite lucky to work with colleagues who are very supportive and ready to lend a hand or simply share ideas with. During my appraisals, I was never turned down nor rejected when I proposed to pursue something that will help me in my career progression. My managers – Katy Davenport and Andrea Lake – encouraged me to apply for study grants, consider starting a specialist nurse-led clinic for PA, and get more involved in the set-up phase of a new clinical trial, among other things. I am grateful to all my colleagues in the Endocrine Investigation Unit at the Wolfson Diabetes and Endocrine Clinic (WDEC) for their continued support and encouragement, and also to Dr. Russell Senanayake, Dr. Waiel Bashari, Dr. James MacFarlane and Professor Mark Gurnell for always sharing their valuable time and expertise in the field. I wouldn’t be where I am today, nor would I know anything about endocrinology and research if not for the support and guidance from all of them.
You can find out more about the Masters-level module in Endocrine Nursing, and find out how to apply on our website.