In It For You Summer 2019

THE OFFICIAL MAGAZINE OF THE WOCN® SOCIETY

ISSUE 8, SUMMER 2019

NEW Foot and Nail Care Section of the JWOCN Page 4

WOC Nurse and WTA — What’s the Connection?

Page 7

www.wocn.org

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ISSUE 8 • SUMMER 2019

TA B L E O F CONTENTS THE OFFICIAL MAGAZINE OF THE WOCN® SOCIETY

IN SIDE

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JOURNAL OF WOUND, OSTOMY AND CONTINENCE NURSING (JWOCN): NEW FOOT AND NAIL CARE SECTION

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FUND THE FUTURE OF WOC NURSING

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ASK THE WOC NURSE

WOC NURSE AND WTA — WHAT’S THE CONNECTION?

mission

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The WOCN Society is a professional community dedicated to advancing the practice and delivery of expert healthcare to individuals with wound, ostomy, and continence care needs.

We support our members’ practice through advocacy, education, and research.

In It For You is a publication of the Wound, Ostomy and Continence Nurses Society™ (WOCN®) 888-224-9626 (WOCN) www.wocn.org info@wocn.org

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ISSUE 8, SUMMER 2019

WOCN SOCIETY BOARD AND COMMITTEE CHAIRS JWOCN

BOARD President Kelly Jaszarowski, MSN, RN, CNS, ANP, CWOCN President Elect Stephanie Yates, MSN, RN, ANP-BC, CWOCN Secretary Christine Berke, MSN, APRN-NP, CWOCN-AP, AGPCNP-BC Treasurer Vittoria (Vicky) Pontieri-Lewis, MS, RN, ACNS-BC, CWOCN

Director Diane Bryant, MS, RN, CWOCN Director Kevin Emmons, DrNP, RN, APN, AGPCNP-BC, CWCN, CFCN Director Trudy Huey, MSN, RN, CWOCN Director Jody Scardillo, DNP, RN, ANP-BC, CWOCN

Journal of Wound, Ostomy and Continence Nursing (JWOCN ): NEW Foot and Nail Care Section TA RA BU E SC HE R, DNP, RN-BC , GC NS -BC, A NP-BC , C WO C N, C FC N, NE A -BC

COMMITTEE CHAIRS Accreditation Committee Kathleen McLaughlin, DNP, RN, CWOCN Corporate Development Committee Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP Education Committee Zoe Bishop, BSN, RN, CWOCN Finance Committee Vicky Pontieri-Lewis, MS, RN, ACNS-BC, CWOCN Forum Moderator Committee Trudy Huey, MSN, RN, CWOCN Leadership Development Committee Carolyn Watts, MSN, RN, CWON

Membership Committee Jennifer Anderson, MBA, MSN, RN, CWCN, CFCN, CWS, DAPWCA, FACCWS National Conference Planning Committee Sunniva Zaratkiewicz, PhD, RN, CWCN Ostomy Care Associate Advisory Committee Gisele Castonguay, APRN, CWOCN Public Policy & Advocacy Coordinator Kate Lawrence, MSN, RN, CWOCN Scholarship Committee Carole Bauer, MSN, RN, ANP-BC, OCN, CWOCN Wound Treatment Associate Advisory Committee Janet Ramundo, MSN, RN, CWOCN, CFCN

I

t is with great pleasure that I introduce myself as the new Foot and Nail Care Section Editor for the Journal. I am eager to start by sharing my background as a foot care nurse, talk about the purpose of this new JWOCN section and my vision for upcoming features. My background in foot care nursing started in 1991 after identifying a need for nail care among the older adults for whom I was providing care in both acute and home care settings. At that time, I was a Certified Enterostomal Therapy Nurse and a Gerontological Clinical Nurse Specialist (GCNS) working in a rural community for a home care agency and began consulting with home care nurses on complex or slow to heal wounds. I was amazed at the number of patients with lower extremity ulcers I saw who also had severely dystrophic nails. My desire to “do something to help these patients” began to grow. At the time, I knew no one who was providing such a nursing service. After searching for information on courses, conferences, or experts in the field, I found small pockets of nurses around the country providing similar care. I attended a course and developed my skills in assessment, nail and skin care, acquiring supplies, and made it my mission to provide foot care education for other nurses who care for patients no longer able to cut their own toenails and perform proper hygiene. My overall goal was to help improve function and mobility.

At the time I started providing and teaching foot care to RNs in home care, I was living in Northern Wisconsin where the population consisted of a high percentage of older adults. The local health care system purchased a group of communitybased residential facilities, small group homes for older adults, and assisted living facilities in our area. I observed a great need for nail care among the older adults living in these community settings. I addressed this need for nail care delivery in the community (partnering with the local community college) by writing a grant to develop community-based clinical sites for nursing students. The sites were located in local senior centers where I oversaw the foot care students provided and worked with them on their projects. Community-residing older adults would sign up for 4 IN IT FOR YOU

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ISSUE 8, SUMMER 2019

JWOCN

NE W FO O T A ND NA IL C A RE SE C TIO N (CONT 'D. )

appointments, and the students would provide foot assessment and nail care. This system of care delivery also enabled students to enhance skills such as history taking and communication.

While I entered foot care nursing practice working with

I taught my students that, over time, toenails can become thicker and difficult to cut (referred to as debriding in Foot and Nail Care specialty practice). As people age, their flexibility, dexterity, vision, and strength may decline, making it difficult to care for their feet.

Nails affected by chronic conditions such as diabetes and fungal infections are outside the scope of beauty professionals; yet, many older people see this as their only option to get foot care. Salon care is suboptimal to manage the complex nail problems of these individuals, thus the need for nurses to be adequately prepared to provide this care.

fairly healthy older adults in community senior centers and more frail elders in nursing homes, many other nurses work with individuals with complex vascular and other

As my skills developed, I developed a Foot and Nail Course for Nurses offered through the continuing education division of a local university in Wisconsin. Initially, this course was offered annually, increasing in frequency as demand for education grew. Foot and wound care and education became a full-time endeavor as I transitioned from the home care agency to our health system's advanced practice nurse (APN) group. I began consulting in nursing homes as a GCNS with prescriptive authority, providing both foot and wound care services. I saw patients in 10 nursing homes and 10 senior centers each month and worked 1 day per week in the ambulatory clinic providing foot, wound, and ostomy-based services. During this time, I worked with a talented and passionate billing specialist who was instrumental in supporting my quest to bill third party insurers for foot-related services. We worked with Medicare for 3 years and finally I secured privileges to independently bill foot care codes as an APN/clinical nurse specialist (not under another professional's name/number). This process occurred during a time when prescriptive authority, state practice act changes for APNs, and changes in federal programs rapidly evolved, allowing for third party billing.

conditions in specialized vascular, wound, or orthopedic centers who require more advanced education.”

Around this time, the Wound Ostomy Continence Nursing Certification Board (WOCNCB®) commissioned a group of nursing foot care experts to determine the feasibility of a foot care certification exam. This visionary work lead to the Foot Care Certification examination, first offered in 2005. Since the inception of the Foot Care Certification examination, the need for education has expanded; yet, continuing education can be difficult to find. While I entered foot care nursing practice working with fairly healthy older adults in community senior centers and more frail elders in nursing homes, many other nurses work with individuals with complex vascular and other conditions in specialized vascular, wound, or orthopedic centers who require more advanced education.

I continued to advance my education (earning my DNP) and career in a nurse practitioner role working with an

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JWOCN

NE W FO O T A ND NA IL C A RE SE C TIO N (CONT 'D. )

interprofessional pain management group in a large multispecialty clinic and then developing a world-class wound care program at a university-based long-term acute care hospital.

All the while I continued to instruct nurses in the arena of foot care. Over the past 28 years, I taught thousands of nurses how to assess feet, provide appropriate care within the scope of nursing practice, and refer to others when indicated. Most recently, I returned to where I started, back with older people, helping preserve mobility and prevent/identify early complications through an independent, full-time professional nursing foot care practice delivered in multiple care settings.

foot care. The Foot Focus section will appear in every issue of the JWOCN, offering much needed continuing education related to foot and nail care. I look forward to working with you, as together we continue to shine light on and grow this very important area of specialty practice.

I hope you share in my vision to offer informative, practical, and relevant articles. I enthusiastically invite you to suggest topics and submit foot-focused papers to the Journal. A few of my thoughts for features include the following: Have you implemented a foot care program within your setting? What skills did you acquire as you started your own business? What teaching tools have you found useful with your patients? What are your continuing education needs? Have you conducted a quality improvement project or research study in the area of foot care? Do you have an idea for a best practice, for example, how best to debride a dystrophic toenail? Help us shine light on the intricacies of this service provided to seniors, veterans, developmentally disabled, homeless individuals, those with chronic illnesses, and other unique populations and care settings. I would enjoy hearing your thoughts, experiences, and educational needs and look forward to working with you to submit and publish your work in my new role as Foot and Nail Care Section Editor.

The field of nursing foot care is as old as time and yet so new.

The impact of nurses providing foot care—conducting regular assessments, managing early conditions such as maceration or thickening toenails, and identifying clinical problems for which referral is warranted—in a wide variety of care settings is yet to be fully explored or documented. I know many of you who are providing this care might be doing so full-time in private practices or perhaps devoting a small portion of your time to your patients as needed. Regardless, I am confident that the impact of our care is recognized and appreciated by our patients and clients, but I am concerned that it is less well known in the wider health care community. The WOCNCB first supported this growing specialty with a certification exam. Now the WOCN Society and JWOCN will provide a platform for your excellent work and provide extensive continuing education options with each column. The purpose is to showcase peer-reviewed research, quality improvement projects, and clinical features focusing on 6 IN IT FOR YOU

This article was originally published in the Journal of Wound, Ostomy and Continence Nursing (JWOCN). Beuscher, T. L. (2019).

Commentary. Journal of Wound, Ostomy and Continence Nursing, 46(3), 246-247. doi:10.1097/won.0000000000000526

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ISSUE 8, SUMMER 2019

W TA A D V I S O R Y COMMITTEE

WOC Nurse and WTA — What’s the Connection?

J A N E T R A MU N D O, B S N , MS, C WO C N, A PRN, RN

A

s an instructor with Emory University’s WOC Nursing Education Program (WOCNEP) accredited by the WOCN® Society, I knew that our program received frequent inquiries about providing wound care education to nurses “who didn’t want to be WOC nurses”. Nursing leaders recognized the need for continuing education in wound care to assist with the assessment and treatment of wounds, as well as engaging in risk assessment and prevention of pressure injuries.

Having knowledge of the strong evidence base for WOC nursing practice led visionary members of the WOCN Society to develop the Wound Treatment Associate (WTA) Program.

in the WTA role, WOC specialty nurse, the WOC graduate level prepared nurse and WOC Advanced Practice Nurse. The WTAAC, with assistance from the Society’s national staff members, worked hard to capture the differences in practice and level of autonomy. It is our hope that this document, along with the WTA Outcomes Infographic (view on next page), will show the value of the Program to key users, such as Nursing Leadership and Wound Care Directors.

Another purpose of the role delineation document is to assist the WOC nurse in utilization of the WTA nurse in various practice settings. “We use the WTAs to augment the wound care programs that are directed by the WOC Nurse. Since the number of WOC nurses are fewer per site, the WTAs play a pivotal role in assisting with treatment application, skin inspections on admission and throughout stay, and implement additional prevention interventions,” said Angel Sutton, a member of the WTAAC, who has provided WTA education to hundreds of nurses in longterm care across the country. Angel added: “The WOC nurse is able to commit more time then to assessments, documentation, performance improvement projects and budget management.

The addition of WTAs just adds more players to the wound team.”

Sheila Guither, CWOCN, and Manager of Clinical Practice and Staff Development, stated: “In our world of home care, WTAs allow WOC nurses to extend their reach without increasing travel and time. WOC nurses, which are a scarce resource, utilize WTA expertise to be a trusted, knowledgeable pair of ‘eyes’ in the field.”

After completing the Program, the WTA educated licensed healthcare provider acts as a “WOC Nurse Extender,” with the idea that this person will work under the direction of a WOC specialty nurse following evidence-based international standards of care. The Program has been well received, with close to 6,400 graduates as of 2018. WTA educated professionals work in acute care, home health care, outpatient setting and long-term care.

Despite the acceptance and utilization of the WTA Program, confusion persists. Members of the WTA Advisory Committee (WTAAC) are often contacted with questions about what the WTA can do and how this Program was different from the WOC nursing specialty practice. In response to this, the WTAAC developed the Complete Guide to Role Delineation Among WOCNCB® Certified Wound Care Providers. This one-page document, based on the Society’s WOC Nursing: Scope and Standards of Practice, 2nd Edition, helps to show the differences in the various roles. The document discusses the differences 7 IN IT FOR YOU

Jenna DeLegge, CWOCN, and WTA/OCA Course Coordinator at the same agency, had this to say when asked if some WOC nurses ®

ISSUE 8, SUMMER 2019

W TA A D V I S O RY COMMITTEE

W OC NU RSE A ND WTA — WHAT’ S THE C O NNE C TIO N ? (CON T 'D. )

might feel threatened by the WTA educated RN, “As a team (WOC nurses and WTAs), we are able to reach more patients.

Just as physical therapists (PTs) have physical therapy assistants (PTAs), CWOCNs have wound treatment associates (WTAs) and ostomy care associates (OCAs). Our team’s greatest victory is in our outcomes. I am not threatened by assistance. I am on the forefront of training these teammates (WTA and OCAs) so they can positively impact the health and safety of our patients.

Insurance is changing- it has been evolving for some time now. At a time when insurance reimburses for quality of care, there is no room for me, just we.” Mary Schopp, CWOCN, and WOC Nurse Coordinator, said this about the use of WTAs and the difference from WOC nurses, “I find it imperative to have the WTAs and OCAs on our team. It assists in providing optimal care using best practice for our patients. Our agency CWOCNs and CWONs are spread very thin covering 2-3 regions each. Having WTAs and OCAs on our teams assist in giving us another set of eyes so we can work together to provide timely, appropriate care. The WTA and OCA roles can never replace the knowledge base of the CWOCN. The WTAs and OCAs still need to communicate their thoughts and “recommendations” with the CWOCN to make sure best practice is being served. They require our expertise to guide them on appropriate care. I feel we need to look at this as another “tool” in our tool kit to allow us to provide exceptional care for our patients.”

and interventions of the WTAs. Knowing this Program was based on the strong evidence base associated with our practice and being the only Program to include hands on competency demonstration was very important to the nursing education team at my hospital.

Irene Jankowski is another member of the WTAAC who, with her partner, has successfully brought the Program to hospitals in the New York City area with higher pressure injury rates. “We are definitely using both documents with our clients and they are very well received. Anything we can show that demonstrates the importance of supporting bedside staff with excellent educational programs is great,” said Irene. Irene also noted that nursing leaders are interested in the Program but have many questions about utilization and outcomes associated with the Program.

The WTAAC is committed to guiding the WTA Program and providing the information needed for this Program to be successful for you! Please don’t hesitate to reach out to this hardworking group of accomplished professionals with any questions or comments.

In conclusion, I would like to thank the members of the WTAAC for their hard work and dedication to the WOC nursing specialty: Sara Coverstone, RN, MA, CHC, CWON David Crumbley, MSN, RN, CWCN Donna Geiger, MSN, RN, CWON Irene Jankowski, APRN, RN, CWOCN, APN-BC Debbie Ritter, BSN, RN, CWOCN, FACCWS Angel Sutton, MSN/Ed, RN, CWOCN, CCCN, CFCN

At the hospital where I work as a CWOCN I have seen firsthand the difference WTA educated nurses can make. Working together, under the guidance of the WOC nursing team, they audit and report for the National Database of Nursing Quality Indicators (NDNQI), provide a second set of eyes for critical skin care assessments and act as a resource for the unit staff. In some of the intensive care units we have seen a reduction of hospital acquired pressure injuries (HAPIs) due to the accuracy of assessment 8 IN IT FOR YOU

For more information on the WTA Program, please visit wocn.org/wtaprogram or email wta@wocn.org. ®

ISSUE 8, SUMMER 2019

S E M O C T U O M A R PROG AS SO CIA TE WO UN D TR EA TM EN T

24 CONTACCONT HOTINURUINS G & 21 COMPETENCY UNITS

for nurses

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developed the WTA The WOCN Society power wound, Program to fur ther em (WOC) nurses in ce en tin ostomy and con en a WOC nurse all health settings. Wh A act s as a WOC is not available the WT vide optimal care for nurse extender to pro chronic wounds. patients with acute and ®

s and for physical therapist istants. ass ist rap physical the

87%

of graduates implemented changes to their practice based on information and skills learned.

71% of graduates reported improved patient outcomes.

INCREASED CONFIDENCE IN WOUND CARE RECOMMENDATIONS FOR PATIENTS

97%

96%

QUICKER HEALING TIMES & MORE COMFORT FOR PATIENTS INCREASE IN KNOWLEDGE AND TREATMENT STRATEGIES

of graduates stated that new knowledge, or updated knowledge, was gained including:

THE ABILITY TO DO ACCURATE WOUND ASSESSMENTS of Course Coordinators believe WTA graduates have increased collaborations with other health care team members to enhance prevention of pressure injuries and management of wound and skin care.

BETTER TECHNIQUES IN WOUND IDENTIFICATION AND MANAGEMENT

UNDERSTANDING OF TREATMENT OPTIONS APPRECIATION OF THE IMPORTANCE OF CRITICAL AND ACCURATE DOCUMENTATION

PATIENT AND COLLEAGUE EDUCATION PROMOTION OF WOUND PREVENTION STRATEGIES

COMMUNICATION WITH THE HEALTH CARE TEAM

AREAS IMPACTED BY WTA KNOWLEDGE & PRACTICE PROFESSIONAL PRACTICE BEHAVIORS LEADERSHIP SKILLS CRITICAL THINKING SKILLS NURSE COMPETENCY HIGH QUALITY CARE BASED ON BEST-AVAILABLE EVIDENCE IMPROVEMENT IN NURSING PRACTICE IMPROVEMENT IN PATIENT OUTCOMES IMPROVEMENT IN NURSING CARE DELIVERY

The Wound, Ostomy and Continence Nurses Society is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

The Wound, Ostomy and Continence Nurses Society is approved by the California Board of Registered Nursing, Provider Number CEP 15115.

47%

59%

67%

76% 74%

71% 73% [REFERENCES] * WOCN Society. (2018). [WTA Program Course Coordinator Survey]. * WOCN Society. (2018).[WTA Program Participant Outcomes Survey]. * WOCN Society. (2014). [WTA Program Outcomes Survey].

83%

Visit

WOCN.ORG/WTAPROGRAM to learn more.

T

he WOCN Society launched the Fund the Future campaign due to the demand for wound, ostomy and continence (WOC) nurses and a strong belief in the continued growth and success of WOC nursing.

HELP GROW THE SPECIALTY OF WOC NURSING AND FURTHER ADVANCE THE QUALITY OF LIFE FOR THEIR PATIENTS BY “FUNDING THE FUTURE".

Through the generosity of inspired individuals, industry partners, endowments and regional/affiliate participation, the WOCN Society seeks to raise and disseminate funding for educational and research activities related to WOC nursing. By “funding the future”, the WOCN Society is able to create and grow a lasting network of certified WOC nurses, generate a heightened awareness of the WOC specialty and further advance the quality of life for the patients that we serve.

Your generous gift will provide funding for future WOC nurses as they seek additional education to grow their knowledge and advance their careers. Each donation makes a huge difference by helping us to serve more people living with wound, ostomy and continence care needs.

Thank you to Coloplast for helping to “Fund the Future” by supporting the preparation of future WOC nurses through an unrestricted educational grant.

The WOCN Foundation is a 501(c)(3) organization and your donation may be tax deductible. Please contact your tax professional for more information. No goods or services were provided in exchange for your donation.

DONATE NOW TO LEARN MORE, PLEASE VISIT

foundation.wocn.org

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ISSUE 8, SUMMER 2019

CEC

CONTINUING EDUCATION CENTER

As the global leader in wound, ostomy and continence education, the WOCN® Society offers online and on-demand access to educational resources through the Continuing Education Center (CEC).

CONFERENCE LIBRARY Access past conference sessions on-demand.

WOUND TREATMENT ASSOCIATE

WOUND TREATMENT ASSOCIATE PROGRAM

CONTINUING EDUCATION

Online wound care continuing education program designed for non-specialty licensed wound care providers and medics/corpsmen.

Choose from more than 30 continuing education courses in WOC care and earn more than 38 Contact Hours.

CERTIFICATION REVIEW OSTOMY CARE ASSOCIATE PROGRAM

Continuing education courses that prepare you for certification/ re-certification exams.

BITE SIZED LEARNING Online continuing education courses that break down important WOC nursing information in 30 minutes or less.

Online ostomy care continuing education program designed for non-specialty licensed ostomy care providers.

WEBCASTS Access past webinars and rebroadcasts of conference sessions.

≥ Visit the CEC today

at wocncec.org

The Wound, Ostomy and Continence Nurses Society is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Wound, Ostomy and Continence Nurses Society is approved by the California Board of Registered Nursing, Provider Number CEP 15115.

ASK THE WOC NURSE

the WOC Nurse

ASK

Have you ever wished for someone to talk to who “gets it?” Someone who understands what it’s like to be a WOC nurse yet who is not involved in the same work culture as you? Someone whom you can ask questions that you wouldn’t feel safe asking your work colleagues? Then this column is for you!

A

s a professional WOC nursing society, we’re great about pursuing the best possible information to meet the needs those in our care. We’re less focused on other issues that are not at the core of patient care, which nevertheless robs us of complete effectiveness. In recognition of this gap in our member services we have brought back this “DearAbby”-type WOC nursing advice column.

The issues and questions we invite you to ask are not necessarily clinical in nature. The range of topics you may choose to ask about are limited only by your experiences, curiosity and desires.

Types of questions asked may relate to worklife balance, power struggles in the workplace, managing multiple competing priorities, moral-

ethical challenges with patients and/or colleagues, inspiring those who are resistant, promoting your value as an employee and team member, motivating others to embrace current evidencebased product and treatment selections, dealing with irritating patient and/or colleague behaviors, maintaining clinical excellence in increasingly cost conscious environments and more.

This column is an opportunity to help you deal with things you might not feel comfortable talking about out loud with others. Here we can be anonymous. In our anonymity we can be free to get at the deepest issues and concerns that are eroding the capacity for complete professional and personal fulfillment as WOC nurses.

Please consider sending us your questions or issues anonymously by filling out a form at wocn.org/askawocnurse.

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ISSUE 8, SUMMER 2019