hewlett spent the early part of her nursing career in clinical care. she then moved into research, where worked on rheumatology care, education and research. she collaborated with the university hospitals bristol nhs foundation trust. hewlett identified that patients suffering from rheumatoid arthritis (ra) consider fatigue as a significant and often overlooked problem. she estimated that up to 98% of people who suffer from ra experience fatigue. she noticed that whilst fatigue makes the symptoms worse for patients with multiple sclerosis, rheumatoid arthritis makes fatigue worse. she described flares of rheumatoid arthritis as "duvet and chocolate days". hewlett evaluated the provisions nurses had for treating fatigue, and found that they had limited ways to measure and manage fatigue. hewlett went on to develop a protocol to evaluate fatigue. she then ensured that it was evaluated in every rheumatoid arthritis trial. in 2007 she was the first person to be named a chair in rheumatology nursing at the university of the west of england.