Cheryl Winter, MS RD, MS APRN, CDE, BC-ADM, FNP-BC has created a website with the idea of helping deliver diabetes self-management resources outside of her practice, and giving people with diabetes another medium for obtaining helpful medical information.

By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net
 
Possibly one of the toughest things for anyone to do is to step outside of his or her comfort zone. Taking on a challenge in an already busy professional life can be especially daunting, but one nurse practitioner shows taking on a new venture can be done, and in addition, proves it is an excellent adjunct to continuing her commitment to help care for people with diabetes.
 
Cheryl Winter (pictured, left) has taken a circuitous route to get to where she is today as a nurse practitioner specializing in diabetes care and education. And, she might be the first medical professional to say it is a good thing to change things up to further your career or your ability to serve your patients in an additional capacity. Winter began her career as a dietitian, and after a number of years of seeing limited opportunity and experiencing some professional prejudices, she decided to pursue a career in nursing.

She spent many years working as an intensive care nurse, and while caring for what she calls, “the sickest of the sick,” she realized that many of her patients could have prevented their sickly states had they taken better care of themselves earlier in their lives. 

At that point, she decided to become a nurse practitioner. This move would allow her to extend her medical expertise and credibility to match her existing nursing and nutrition credentials. Winter also decided to commit herself solely to diabetes care and education.

Fast forward several years, and she can tell you about the challenges associated with the current care paradigm for people with diabetes. Sensing these patients needed more, Winter decided to begin her own website to help them get more support and informational resources outside of their medical visits.

Winter, not having any web expertise, started from scratch and has committed to developing her website while maintaining a fulltime medical practice at Texas-based Diabetes America health centers. Having the strains and responsibilities associated with a full patient load and the corresponding daily paperwork, Winter has been adding various elements and features to the website by piecemeal over a number of months.

Winter’s website, DiabetesStepsRX.com, looks to accomplish a few different things. Winter sees her website as an opportunity to fill a void in primary care. She wants to vet medical terminology and information in such a way that it is understandable and comes from a trusted source.

She also says patients are often not counseled by their healthcare providers to lose weight or bring down their A1Cs or attempt to regulate many of the health metrics that come to define people with diabetes. Winter wants these things to be addressed in an open dialogue via her website’s forums and other forms of communication.

Winter is planning on delivering information primarily through her website, including a blog, but she will also have a newsletter, and utilize social media avenues like Facebook and Twitter. She is also planning to provide nutrition and diabetes health advice in the form of e-books, which will be available on her site. 

DiabetesCare.net talked with Winter about addressing some of the challenges in the current care paradigm, discussing how her website is progressing, and her future aspirations surrounding the site.
 
DiabetesCare.net: Can you explain why you wanted to go from being a dietitian to pursuing a nursing degree?

Winter: There were several factors both professional and personal that led to the decision. Professionally, I felt underappreciated in my role as a dietitian. Back in the 80s and 90s the subject of nutrition just didn’t get the respect it deserved from the medical community. It was hard to convince physicians of the importance of nutrition, and if you couldn’t convince them, well then you couldn’t convince the public. Most medical professionals don’t realize the educational preparation of a dietitian. We basically have a four year premed degree, plus a one year internship program. I earned a master`s degree, and it was hard for me to have worked so hard to become a registered dietitian and not be able to make the difference in peoples’ lives that I wanted.

On the personal side, I had small children, and I was looking to spend more time with them. Nurses were making a better living then, and only working three days a week. It is not like registered dietitians today who have much more opportunity. 

DiabetesCare.net: Can you talk about why you decided to develop your website?

Winter: The main reason I developed the website was to allow people with diabetes to get a little more professional assistance than they get in a daily office visit. Persons with diabetes have to go home every day and they have to figure how to manage their conditions. With social media becoming very popular, this is a perfect way to stay involved with patients’ daily lives to show that you really want them to succeed.

The other reason I created the website was business survival. It gets more difficult for healthcare providers to stay afloat with today’s reimbursement system. Therefore, we all have to market our services, and patients are more likely to return if you offer them something of value or if you can give them something they can’t get anywhere else.  I like my job and I want my employer to continue to succeed, just as I want my patients to succeed.

DiabetesCare.net: You put a great deal of emphasis on prevention for people who do not yet have diabetes as well as care for people with diabetes in better managing their conditions. Can you explain your philosophy and approach with your patients with prediabetes and your patients with diabetes?

Winter: My approach is the same for both. I want my patients to know what is down the road for them if they cannot reach their ideal weight, or improve their blood pressure or their lipid profiles and blood sugars. I don’t say, ‘if you don’t do this, then this is what is going to happen to you.’ I try to explain to them we are all human and none of us are invincible.

In my many years in healthcare, I’ve noticed many of my patients seem to heed the advice of their doctors or nurse practitioners over the advice of a nurse or a dietitian. I found this to be true even with my own family members. Often the healthcare provider doesn’t address the fact that the patient needs to lose weight, or lower their blood pressure. Patients think they are fine and they continue down the same unhealthy path, despite what a dietitian or CDE tells them.

DiabetesCare.net: On your website, you are offering a membership for people. Who are the people you are looking to target and what benefits do they get for their membership?

Winter: My membership is still a work in progress. However, the basic membership is going to be free to anyone who would like to receive blog alerts and nutrition and diabetes information via the newsletter, as well as being able to read diabetes stories on the forum.

I’m hoping persons with diabetes or their families will share their struggles with diabetes, and their long-term complications they may be experiencing, so we can educate and empower others to work harder at their daily management. Eventually, we could relieve potential suffering of this disease.

The premium membership we are offering is going to have a small fee associated with it, and it is geared for anyone who is looking to create balance in their life. Every single person who does not have a balanced lifestyle has the potential to develop diabetes. We have online checking accounts that help us balance our finances, so it would help to have a set of checks and balances for our health parameters. This will be a way of having knowledge to achieve lifestyle balance.

DiabetesCare.net: Are you currently working or consulting with any medical professionals on the site?

Winter: Not as this time, but I am planning on conducting interviews with specialists to answer questions about patients’ chronic conditions. In addition, there are so many amazing dietitians, health coaches, exercise physiologists, and CDEs, and I hope to create reciprocal relationships with these professionals across the country that I trust, and whom I will link some of their sites and information they provide through my site.

DiabetesCare.net: There will be people coming to you through the website who will not be nearby you geographically speaking, how do you plan to coordinate care with this patient population?

Winter: The website is not intended to provide patient care, even for those geographically close to me. It is about patient education that will allow them to better care for their chronic condition. I won’t be providing medical advice or addressing patients’ individual medical conditions through the website. My goal is to provide easily accessible, reputable patient resources that are available to anyone.

DiabetesCare.net: Where do you envision your website going in the next few years?

Winter: Not everything is quite ready yet, but what you see on the website will be what you get. Some people who develop websites may wait to go live until everything is in working order, but then they may have missed  opportunities to utilize areas of the website that are already working.

I hope to be able to write more and develop publications and I would love for the portal and the forum to take off. I am currently working on a free, downloadable e-book on the basics of diabetes management and survival skills for those who are newly diagnosed. This is going to include various agencies that people can link to for further assistance. I know some of this information is already on the Internet, but sometimes patients have a hard time trusting sites. 

I would also like the site to become a resource for other nurse practitioners who would like to come and learn about specializing in diabetes, especially since there are not enough trained physicians to go around.

DiabetesCare.net: You have been so committed to diabetes care. What drives you?

Winter: What has always driven me is the amazing power of nutrition and exercise on preventing disease and what happens when those two lifestyle elements are neglected. For far too long, our healthcare system has been only treating illness and not trying to prevent it. We have answers for diabetes and we just have to show people the way.