Wound, Ostomy, and Continence (WOC) Nurse Week runs from April 14-20 and brings attention to this nursing specialty and the expertise WOC nurses bring to patient care.
As a member of the Wound, Ostomy, and Continence Nurses Society™ (WOCN®) for 31 years and now its president, Vicky Pontieri-Lewis, MS, RN, ACNS-BC-CWOCN, says the field is exciting and ever changing. This kind of dynamic professional learning environment brings a career satisfaction that keeps her advocating for nurses in the specialty while also appreciating the continual work they must do to stay current of WOC developments.
Pontieri-Lewis shared some of her thoughts with Minority Nurse about the career path and the excitement of being in the broader field of WOC nursing.
How did your career as a WOC nurse begin and evolve? After graduating from nursing school in 1983, I had the opportunity to work on a surgical unit with patients who underwent cardiac surgery in addition to patients who also had abdominal surgery, with an ostomy. The unit had an Enterostomal Therapy (ET) nurse, now called a Wound, Ostomy, and Continence nurse, who consulted primarily to patients with an ostomy. I noticed when the charge nurse was making daily patient care assignments, none of my colleagues wanted to care for the patients with ostomies. So, I always volunteered to have the ostomy patients within my assignment.
I worked with the ET nurse at the time to ensure in her absence that I would provide the ostomy patients with the right education. Later that year, my grandmother who lived in a very small remote town in the mountains, was diagnosed with colon cancer. She underwent surgery and as a result had a colostomy. I went to visit her and was appalled by the lack of access she had to any type of ostomy pouching system. At one point she was using a plastic bag! I tried my best to get her access to what we used in the United States so she could have some quality of life.
When I returned, the ET nurse at the hospital announced that she would be leaving. After the experience with my grandmother, I knew I wanted to pursue the role of an ET nurse. I went to my administrator to inquire if the hospital could assist with the finances to attend ET school. After I wrote a proposal for financial funding, the hospital agreed to send me to ET school for 6 weeks, and in return I signed a contract that I would stay at the hospital for one year after becoming certified.
Thirty-eight years later I was still at the same facility, and it became a major academic university trauma medical center. I developed the full scope of the WOC nurse role at the facility and then the advanced practice role. I had no idea at the time how the roles would expand to consulting so many patients with ostomies, wounds of all types, and continence needs. Going to ET school was the best path I took in my nursing career. I have dedicated most of my nursing career to being a WOC nurse, and I absolutely love what I do!!
What attracted you to this specialty? As I shared above, I have a “love” for caring for patients with an ostomy. My grandmother was my inspiration and I always have the memory of her on my shoulder when caring for patients with an ostomy. Caring for patients with different types of wounds was ever-evolving as new technologies and products were being developed. It was almost like baby boomers, but “wound care boomers.” Each time I attended a conference there was something new and exciting being presented.
As the role of the WOC Nurse continued to grow and develop in healthcare systems, so did the WOCN®, the largest and most recognized professional nursing community dedicated to advancing the practice and delivery of expert healthcare to individuals with wound, ostomy, and continence care needs. The WOC nurse conferences began to include more evidenced-based lectures and presentations, more research was being done, and notably, products were being developed across the specialty.
What would inspire nursing students to consider this specialty as a career path? Nursing students across the country would be inspired to pursue a career path to be a WOC nurse by simply talking to and spending time with a WOC nurse. Nursing students today are thirsty for knowledge on how to manage wounds and skin integrity, and to educate patients with an ostomy.
Spending a day or two with a WOC nurse can provide a realistic insight into the scope of the role. Nursing students will undoubtedly be dazzled by the wealth of knowledge and expertise that WOC nurses possess, and the extent of how that knowledge and expertise contributes directly to patient care and quality outcomes. The role of the WOC nurse can be in an inpatient or outpatient setting, allowing one to work independently, and be innovative in the care delivered. Overall, the impact of the role is inspiring and rewarding and it can be a lifelong career filled with continuous learning and professional development.
What might surprise people about your role, all you do, and your connections with your patients? The role of the WOC nurse is very rewarding. WOC nurses can work with all members of the healthcare team to improve the outcomes of patients. Since the scope of practice is very specialized, WOC nurses are viewed as the experts and are consistently relied on not only by the healthcare team, but by patients as well.
I had the opportunity to form an in-depth connection with patients from providing support and guidance, to sometimes just lending an ear to listen to their concerns and healthcare needs. Overall, the in-depth connection, the breadth of education that is provided, and the ongoing support is the most satisfying—especially when you can see the impact that you have had on someone’s life.
Wound, Ostomy, and Continence Nurses Week is recognized this year from April 16 to 27 and honors nurses in this specialty while also calling attention to WOC nursing careers.
How did your career as a WOC nurse begin and evolve?
When I was a newly graduated RN in 1988, I got information in the mail about a wound school. Because we had a local “Enterostomal Therapist” (ET), which is what those who may/may not have been nurses that helped those with new ostomies were called, I thought what she did was cool. However, at that time, I was a new nurse, a newlywed, and the thought and finances involved in going away for many weeks was not an option. A decade or so later, though, the ET retired, and I was nursing at a long-term acute care hospital. Boy, there sure were wounds there, and some like I could have never imagined.
I noticed that wound care was pretty far down on the priority list, and I felt that part of that likely had to do with the fact that no one was trained to care for these complexities. So, I asked if I could try. The deal was that they would not allow me overtime or extra pay, but anything I could do to help would be welcome. Quickly that turned into a part-time job, which turned into a full-time job. I started checking into going to a Wound Ostomy Continence Nurse Education Program (WOCNEP).
I asked my employer to help with school cost. They told me to write a proposal, so I wrote a proposal with three options. Fortunately for me, they took option number 3, which was full scholarship, and paid me for my time and my clinical time. Once I became certified, the local hospital also wanted my services, and in my community, my practice bloomed. In the last 23 years, I have spent time devoted to this specialty, which I absolutely love!
What attracted you to this specialty?
When I was in nursing school, I remember learning about leeches, and I NEVER wanted to be the “maggot” nurse for sure.
However, I think that what attracted me was that there were unmet needs in really sick patients; wounds were a puzzle; ostomies were interesting and it was satisfying to help someone get their life back after they contemplated that an ostomy would ruin it; and I learned a lot all the time and continue to learn.
As a student, I was the only one who would take care of this lady who was dying with this terrible fungating tumor on her chest. I held her hand, talked to her … the wound smelled horrible, and she knew that. But I didn’t want her to be alone or to feel like she was repulsive. I remember wishing I could do something to help her. I think of her very frequently, and hope she knows that partly I am trying to make other’s better because of her experience.
How are technological advances or industry advances changing WOC nursing?
When I started as a nurse, there were no fancy wound dressings. There was betadine and sugar, and there was antacid that we used, and of course wet to dry dressings, but there was nothing else.
I recall when the first “freeze dried” hydrogel hit the market, second to hydrocolloids. But in my 35 years as a nurse, we have evolved to complex technology with thousands of wound, ostomy, and continence supplies on the market. We know about wounds on a molecular level. Ostomies may be able to be done laparoscopically now, and even require little stay times.
Adhesive technology on ostomy products has also had an influence on the adhesives of medical tape. We understand continence and it’s effect on the skin as an organ, and we understand that the skin, the largest organ of the body, can fail, just as other organ systems do. We have research that has produced a robust foundation for evidence-based decisions, and we continue to expand that research as technology evolves and people get sicker. We know that wound, ostomy, and continence issues can be influenced by social determinants of health, and that we must see the whole patient to facilitate the best outcome.
We have standards for pressure-reducing surfaces, and we have clinical decision support tools for health care professionals and consumers alike that are evidence based. The evolution has been a revolution, and there is limitless potential as we go to continue to learn, research, develop solutions, and evolve.
What would inspire nursing students to consider this specialty as a career path?
On the outside looking in, nursing students may be intimidated or even put off by the wounds or ostomies. I think what many should consider is that a wound patient is very complicated—a mystery that must be unraveled. An ostomy patient is someone who has had a perceived life altering procedure, and while it can be life altering, many times it improves the life.
People who deal is continence issues or experience continence issues may feel isolated. WOC nursing provides complexity and the ability to enhance quality of life for individuals who are dealing with things that make them feel unaccepted or ostracized. There is no better feeling that making ostomy care successful or seeing a wound close. So, I would say, shadow a WOC nurse and just see if you think you might be up for a challenging and rewarding career!
What might surprise people about your role, all you do, and your connections with your patients?
The role of the WOC nurse is one that is very interprofessional. We become trusted and relied upon by others on the care team in the inpatient and outpatient settings. We are valued and sought out. We make long-term relationships with our patients. Sometimes those relationship are life long because the patients are seen episodically.
It is very gratifying to be able to step into people’s lives when they are vulnerable, scared, and embarrassed. Having the privilege of doing so has a lot of the “feel good” moments that nurses love. We sometimes experience the heartache of a patient having to lose a limb or live with a permanent impairment. But the rewards of actively participating in their wins along their healing path is extraordinary.
Wound, Ostomy, and Continence (WOC) Nurse Week runs from April 17 to 23 this year and celebrates this nursing specialty and the nurses who dedicate their talents to this area of care. To find out more about what makes this career path so rewarding, Minority Nurse heard from Vanessa Maxwell MSN, RN, CWON, PLNC and owner of Wound Care Solutions by Vanessa, LLC. Maxwell has been a WOC nurse for nearly 12 of her 19-year-long nursing career and says she wouldn’t change anything. She’s also a nurse entrepreneur who found a patient need that she’s able to help fill with her business.
Please tell me a little about your background and how you decided to become a WOC nurse.
I am a first-generation college student. My parents both completed high school but did not attend college. I started out with my associate’s degree in nursing, returning to obtain my Bachelor of Science in Nursing a year later and then returning to graduate school to complete my Master’s of Science in Nursing in 2014. I have been a nurse for 19 years, and I have spent my entire nursing career working for one healthcare organization in the Memphis, TN area in various nursing departments.
I started as a new graduate nurse working med-surg/ telemetry and oncology and staying in this area of nursing for four years. I went on to work in the emergency department (ED) observation unit/float pool where I worked for three years, floating to various nursing units in the hospital. One day, my assignment was to assist the CWON (Certified Wound Ostomy Nurse) with tasks in the wound ostomy department, so that she could concentrate her time on evaluation of the patients. Prior to floating to the Wound Care department, I was always inquisitive about wounds wanting to know the science of wound healing, why a particular treatment over another type of treatment, how the wound would heal, dressing choices and why a particular dressing was chosen, how to stage the wounds properly, the mechanism of action of the treatment.
It was not until I was hired in the role of Wound Ostomy RN that I learned my true love was ostomy care. Wound ostomy, continence, and foot and nail care all can be performed by the same nurse, and we can seek certification for all or any of the combination. A position came open in the Wound Ostomy department and the rest is history. I have been a CWON ostomy for almost 12 years now and I still love this role.
When did you discover WOC nursing and what about this specialty appeals to you?
I discovered WOC nursing when I started as a nurse extern. I externed on a post-surgical unit and there was a patient with an extended length of stay. This patient had a large pressure ulcer and the nurses caring for her would allow me to perform her wound care. I had no problem with the nurses allowing me to change their patient’s dressing; I enjoyed it. I was able to pack the patient’s wound and apply a nice cover dressing. I was able to see the wound was get smaller; even though I was not able to truly understand what was taking place as I do now. With wound care, either you like it (in my case love it) or you don’t. I have not noticed an in between. In this specialty, I love to teach my patients and their family members about the disease processes that caused their wounds and to teach them treatment and preventative measures.
You’ve expanded your nursing career to begin your own business. How did you decide to make the leap as a nurse entrepreneur?
I saw a huge need in the wound ostomy field of nursing with gaps in several aspects of nursing in the nursing home, skilled-nursing facilities, home healthcare, acute care, and even with nurses (including Advanced Practice Nursing). I can further elaborate… Bedside nurses still have problems with staging pressure injuries and implementing proper preventative measures. Some nurses also lack a solid knowledge of understanding the care they can provide to their patients that is within their scope, without having to rely on the wound ostomy nurse. That is important in that, we do not want a moist wound to become dry and that is considered a worsening wound. With all the co-morbidities against a patient (malnutrition, vascular disease, and diabetes), we certainly do not want a wound to worsen.
What market need does Wound Care Solutions by Vanessa, LLC fill for patients who need WOC care?
I offer wound and ostomy care in the patient’s home in collaboration with the patient’s physician. Since COVID the nursing and healthcare industry, like any other industry, has been hit tremendously. The nursing shortage is at crisis level. Skilled-facilities and home-healthcare have had to turn patients away due to lack of staffing. A lot of these patients have nowhere else to turn. I offer wound and ostomy care services at Wound Care Solutions by Vanessa, LLC. I am private pay; however, my prices do match the fact that the patient is being billed and not a third-party payer. I also can contract with facilities to provide evidence-based education to their staff to ensure they are provided the best treatment and prevention for their patients.
How has Wound Care Solutions by Vanessa LLC helped you expand your nursing and business skills?
Being the owner of Wound Care Solutions by Vanessa, LLC, I have had to dive into business courses and work with a business coach to ensure that I am running a successful business that can stand up to my standards, as well as my clients and potential clients. I want to provide a professional service that people want to refer client to my business and to also utilize my services in the future. I am always working on ways to improve my business. I attend workshops and webinars to further develop my nursing and business skills. I have added another certification since starting Wound Care Solutions by Vanessa. I am a Professional Legal Nurse Consultant (PLNC) and provide legal nursing services to attorneys. I utilize my wound and ostomy knowledge with the training I have received as a PLNC to assist the attorney with the facts needed for a case.
What kinds of benefits does your business provide to patients and how does that impact your approach to patient care?
Whether I am training staff to properly provide wound or ostomy care to their patients or providing services to my clients in their home setting, they can find comfort in knowing that I am a very knowledgeable CWON who is constantly educating herself to ensure I am keeping up with the current evidence to provide optimal outcomes to my clients. I provide individualized care tailored to my client for evaluation, treatment, and follow-up. I also communicate with my patient’s physician after my visit and provide recommendations. Collaborating with the patient’s physician allows prompt intervention and we can keep the patient at home and out of the hospital. This became very evident during COVID and even now when ER wait times are high and inpatient beds are scarce.
What has helped you most in your nursing career as a WOC nurse?
I would say mentors, certification, support of loved ones, professional associations have all been beneficial in my nursing career. When I started in nursing as a new graduate, there were many that encouraged me and even celebrated me when I became a CWON. When I started my own consulting business, I had many that celebrated with me. Instead of having mentors, I have become a mentor encouraging others to choose nursing as a career and to also go into wound ostomy nursing, as well as entrepreneurship. I belong to several professional organizations and the network and support is great. But, no matter what I have the support of my mother she rallies behind me and assists me in whatever way she can.
WOC nurses treat patients who have unhealed wounds, ostomies, or urinary or fecal incontinence issues, so nurses who are in this field or who are considering entering this specialty will have many areas of focus to work in. Some patients receive care for these conditions throughout their lives while others might be going through the process of figuring out the best care for new conditions. Nurses interested in growing professionally as a nurse in education and in patient interaction will find this field particularly satisfying.
Nurses in wound, ostomy, and incontinence care work with patients of all ages and with different health conditions. From infants with gastrointestinal system disorders to patients who have newly presented urinary incontinence to patients with open wounds, WOC nurses know the medical conditions and help patients understand what is happening. They are able to navigate the incredibly complex conditions that bring patients to them and the different stages of understanding and self-care their patients are capable of.
WOC nurses are mindful of the medical care their patients need and also promote education to make their patients engaged in their own care if at all possible. As with any nursing specialist, certification through the Wound, Ostomy, and Continence Nursing Certification Board is encouraged. With varied conditions requiring treatment in this field, nurses can also look into certification for foot care, as so many patients deal with wounds on their feet that won’t heal.
In the efforts of continuing to gain knowledge and education, the Wound, Ostomy, and Continence Nurses Society is hosting a webinar this week. Kathleen Lawrence MSN, RN, CWOCN presents the webinar “Guiding Your Professional Future with the Scope and Standards for the WOC Nurse” on Wednesday, April 17 from 1-2 pm Eastern. If you participate, you may be eligible to earn one credit hour. The webinar is free but you must register to participate.
For fun, the society is also encouraging nurses to send in photos from this week in a photo contest. You can also tag the photos with #WOCNurseWeek2019 and share them on social media. Your team might also want to host a small celebration at work. Take a few minutes to enjoy some goodies and recognize how deeply your work is appreciated by the people you help every day. And recognize your team members for the way you all work as a unit to help you patients and their families achieve the very best health they can.
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