That day as an undergrad at Kennesaw State, Minaz Khetani wasn't thinking of the devastation of diabetes, or train-the-trainer nurse practitioner sessions or even what she wanted to major in. But something made her switch up her route and detour through the school's nursing building.
"I saw nursing and I thought, 'Why didn't I ever think of that?' I believe that everything was meant to be, that I was supposed to take that different route."
Everything fell into place that day, and stayed there. Khetani's nursing career has been on fast-forward ever since. Now a board-certified adult nurse practitioner, Khetani is also a certified diabetes educator for Piedmont Physicians Endocrinology, working alongside a team of endocrinologists helping manage people with Type 1, Type 2 and Gestational Diabetes. She provides one-on-one diabetes care, including lifestyle modification coaching and intense insulin management that relies on data from the latest technology.
One of her proudest achievements was working with her director, Dr. Lisa S. Jasper, director of Ambulatory Advanced Practitioners for Piedmont, on a pioneer program that has resulted in 12 offices across the region where individuals can tap into diabetes education from nurse practitioners and physician's assistants without having to travel to the main hospital in Atlanta.
When the two began, they recognized that across Georgia, particularly in the smaller areas served by Piedmont, there was little access to good quality diabetes education. "Our thoughts were, 'What if we trained providers who were already working in an outpatient primary setting?'" Khetani explains. "I initially went around and trained those potential providers in how to talk to patients about everything involved with diabetes, from prevention to nutrition to long-term complications. We developed a binder and a curriculum, too."
As a nurse practitioner, taking the lead was a stretch, she admits. "Dr. Jasper saw potential in me and pushed me to stand in front of a room full of highly educated providers and share my knowledge," she says.
That experience is a far cry from her first registered nurse job, working on a cardiothoracic ICU step down unit, where after she got comfortable, she found herself with too much time and energy left over. "I worked with a lot of older nurses who had been in the career 25 or 30 years and many of them complained about work every day," she says. "I was bored and didn't think I was being challenged enough. I had four a week of not doing anything, and lots of time on my hands."
She marvels that she ever had too much time while working as a nurse, because her next step was pursuing a master's, beginning at Georgia State. "I signed up for the path that would result in my becoming a Family NP or an adult nurse practitioner," she remembers. That choice was easy: "I love kids and I have two of my own, but I just can't handle sick kids," she admits.
She also switched over to Emory University for an accelerated program, where her wish to no longer be bored was granted. "That program kicked my ass!" she says with a laugh. "I even had to stop working on the weekends. I also got pregnant towards the end and delivered a month after my graduation. I got the cap and gown but I didn't walk; it was too hard, I was like, 'No thank you!' for that outdoor ceremony."
And she says going to work has been "exciting every day," including a stint as a primary care provider at the Kaufman Clinic before joining Piedmont.
The role does demand some finesse with maintaining a work-life balance, however.
"My biggest challenge is making sure I spend quality time with my daughter, Zariya, who is 8, and my son, Zaeem, who is 5," she says. "This means time management while I am working. I try to close all my charts the same day. I review labs and answer emails over lunch break or any downtime, which allows me to go home on time. They're young, they need their mommy. My husband's a wonderful father and he's around, but I din't want to miss this time."
The nurse's role in diabetes education
So many patients who are diabetic or at risk are liable to shut down when a provider brings up the topic. It's understandable, Khetani adds. "As a society there are a lot of pressures, especially on women," she says. "We feel like we have to look a certain way to be happy and have others be happy with us. So when the topic comes up in the clinic, there is a lot of shame that has to be overcome. As a provider, you have to make a safe place where they can express their feelings so you can discuss the health topics. It's all part of having that confidence and that rapport with your patient."
Nurses might be surprised to learn that they may be getting the most information from a patient, Khetani says, and are in a great spot to open a dialogue.
"Nurses play such a critical role in managing diabetes as they are involved in the health care delivery system’s continuum of care. Patients usually share more with them due to the comfort level they present with as they walk into the room. I feel like we should use this opportunity for the benefit of our patient. This could mean anything from teaching the patient about dietary habits to reinforcing compliance with blood sugar monitoring or even foot care, that sort of thing."
Even nurses with no intention of interacting with the patient on their compliance can do a lot of good simply by not judging. "Diabetes is a long-term problem and it's a progressive disease that typically gets worse over time," Khetani emphasizes. "As nurses, no matter what stage that diabetes is in, we need to be empathetic with the patients we deal with on a daily basis and maintain a non-judgmental attitude. That understanding can take the form of saying, ‘I understand your sugars are elevated, let's talk about it.’ And asking gentle questions instead of issuing orders, like, 'What do you think is causing this elevation? What could be done about that?'"
Khetani strives mightily to be supportive and understanding, but she emphasizes that most patients with diabetes have years of negative interactions and guilty emotions informing their health journey. "Even with me, when I see my patients every three to four months, they'll come in and say, 'Don't fuss at me!'"
For providers, there's a balancing act, and it depends on a nurse practitioner not yielding to frustration, Khetani says. "There's a fine line between an attitude of, 'I care about you, and that's why I say this,' and saying, 'Just do this!' As a provider, I also give my patients goals, small attainable goals. Even when what I'm saying is something we literally just talked about and might seem redundant, I go over it again."
She says another key to diabetes management is holding people accountable, both with in-person contact and an online portal where she and her patients can keep up with their progress between visits. "My patients know they're going to come back to the practice again and I'm going to ask how they're doing with those goals every time. They're scared of me -- in a good way," she adds humorously.
And Khetani knows that diabetes can happen even in families with a highly educated nursing professional whose dedicated years of research and work to making sure others have access to the tools and insights that might help them reduce the ravages of diabetes.
Her own husband has lost 30 pounds in the past year, but she notes that his family is overweight and also has a lot of the comorbidity around the weight issue, like high cholesterol and high blood pressure. "My husband is at high risk of diabetes and so are my kids," she notes.
Does that affect her approach to parenting? "Oh God, yes, even my kids could answer that one," she says with a laugh. "We don't drink juice. We don't do sweets on a regular basis. For a long time, my kids thought 'ice cream' was the same as frozen yogurt. But they're good about it and already learning to make healthy choices. At a restaurant, they'll order fruit as dessert."
Her family is just one more reminder that diabetes education and prevention should be non-judgmental, she says. "No one is perfect. Maybe the patient has lost a friend or moved or doesn't have their spouse to cook anymore. Life happens."
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