Guest Editorial: Calling All Nursing Students: How Much Wound Care is in Your Future?

From March 30-April 3, more than 2,000 student nurses and nursing faculty will attend the National Student Nurses’ Association 64th Annual Convention in Orlando, FL. Thinking about this event presents the perfect time for student nurses, faculty, clinical instructors, and preceptors — anyone involved in wound prevention and care practice or education — to look ahead and ponder the future of nursing in general and wound care nursing in particular. 

Let’s start with the numbers. Nurses constitute the largest and fastest-growing part of the Unites States’ healthcare workforce. Yet even with 3 million strong and growing, nurse supply is not meeting demand.1 By 2025, the nationwide supply of registered nurses (RNs) and licensed practical/vocational nurses (LPNs/LVNs) is expected to be higher than the demand,2 but that is only part of the story. Not only does the future employment picture differ from state to state, but there also are important concerns about the distribution of the nursing workforce by practice setting and specialty area. Wound prevention and care are needed for populations in all age groups and settings — think neonates, anyone with mobility limitations, and persons attached to a medical device that puts them at risk for device-related skin injury. But first and foremost are concerns about care for older adults, whose numbers are exploding and who generally have many more health problems than their younger counterparts. By 2025, approximately 18% of the U.S.’ population is projected to be >65 years of age; moreover, the number of people in the oldest age group (>85 years) is projected to grow from 5.9 million in 2012 to 8.9 million in 2030.3 People on both ends of the age continuum — the very young and the very old — are at high risk for skin injury. 

Next, consider the number of people living with chronic health conditions such as diabetes mellitus (DM) that increase their risk for developing skin problems and chronic wounds. In 2012, an estimated 9.3% of the population in the U.S. had DM.4 Of those, 21 million had been diagnosed; 8.1 million had not. Although the overall increase in the incidence of DM has decreased, a projected 48.3 million people in the U.S. will live with DM in 2050,5 and an estimated 6% of Medicare enrollees who live with DM will develop a foot ulcer that may lead to amputation.6 In 2010, ~73,000 persons living with DM lost part of a lower limb; 60% of nontraumatic lower-limb amputations among people aged 20 years or older occur in people living with DM.4 All persons with limited mobility are at risk for developing pressure ulcers. An estimated 15% of patients in acute care facilities have a pressure ulcer7; in 2011, the rate of pressure ulcer-related hospitalizations among Medicare enrollees was 1,131.1 for every 100,000 enrollees.8 Other types of chronic wounds such as lower leg ulcers or traumatic wounds that require care may become problematic or slow-to-heal; for example, the rate of wound dehiscence following surgery ranges from 8.6%-39%.9 Millions of people now and in the future need a cadre of health professionals to help prevent and manage skin-related problems. 

Wound prevention and care is an interdisciplinary effort, but responsibility for the day-to-day care of the millions who are at risk for skin breakdown or have existing wounds falls squarely on the shoulders of nurses. All nurses have a solid knowledge of skin care and wound prevention, assessment, and management, but we also need many more nurses who specialize in this area. Consider the data presented and compare them to the number of certified wound, ostomy and/or continence care nurses (CWOCNs) in the U.S. — estimated to be more than 5,000. As of February 2014, more than 15,000 healthcare professionals had obtained a wound, diabetic wound, lymphedema lower extremity, or ostomy management specialist certificate from the National Alliance of Wound Care, but that number also includes physical therapists, physical therapy assistants, occupational therapists, physicians, and physician assistants.10 Even if we assume 10,000 of these certificates are held by RNs and LPNs/LVNs, LLC an HMP Communications Holdings Company,™ and we add the 1,500 RNs, LPNs, and LVNs who obtained a wound care certificate from the American Board of Wound Management,11 we are currently looking at a wound specialty nurse workforce of approximately 16,500 nurses. You get the picture! So do we … and we are concerned. 

The Why Wound Care?™ campaign (www.whywoundcare.com) is an initiative to attract nursing students and recent graduates to the wound care nursing specialty. Eight nurse educators, all with wound care experience, met with HMP Communications LLC and volunteered their time and talents to develop this campaign. Our mission is to inform nursing students, recent graduates, and nursing faculty about rewarding careers in wound care. Our goal is to provide access to a variety of wound care resources; this currently includes a complete list of available wound, ostomy, continence nursing schools and certification opportunities (available at “Additional Resources” at www.whywoundcare.com). In addition, faculty members, current nursing students, and recent graduates can register to obtain access to valuable complimentary resources that include evidence-based basic and advanced wound care modules (PowerPoint presentations) developed by members of the Why Wound Care? advisory board, chapters from the textbook Chronic Wound Care: The Essentials (2014), and videos. 

The Why Wound Care? campaign is a long-term commitment to help address nursing workforce issues that may affect optimal care for patients living with or at risk for developing wounds. End-user feedback, including faculty and student nurse responses to available resources, as well as schools, certification programs, and organizations listed on our website, will guide future efforts. Our vision is long-term; our mission and goals are immediate. Evidence-based wound prevention and care information for faculty, nursing students, and recent graduates is needed now. Wound prevention and care are part-and-parcel of nursing regardless of patient population and work setting. Wound prevention and care are part of the future of every nursing student. The statistics tell all: Nurses with more in-depth knowledge of wound prevention and care will be in high demand. 

Nursing students, as you consider your future after graduation, think about this: Wound care specialization is unique. Wound care nurses are needed across the continuum of care and a variety of patient populations. You do not need to focus on one care setting or another. Still not convinced? Check out the bios of the Why Wound Care? advisory board (www. whywoundcare.com/advisory-board). Although our experiences and reasons for embracing wound care are as individual as we are, we share a common thread. Once started on this road, none of us ever looked back! n 

Lia van Rijswijk and Diane L. Krasner both sit on the Why Wound Care advisory board. 

References

1. Grant R. The U.S. is running out of nurses. The Atlantic. Available at: https:// www.theatlantic.com/health/archive/2016/02/nursing-shortage/459741/. Accessed February 16, 2016.

2. U.S. Department of Health and Human Services Health Resources and Services Administration. The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025. Available at: https://bhpr.hrsa.gov/healthworkforce/supplydemand/nursing/workforceprojections/nursingprojections. pdf. Accessed February 26, 2016.

3. Ortman JM, Velkoff VA, Hogan H. An Aging Nation: The Older Population in the United States. Population estimates and projections. Available at: www. census.gov/prod/2014pubs/p25-1140.pdf. Accessed January 15, 2016.

4. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2014. Available at: www.cdc.gov/diabetes/pdfs/data/2014-reportestimates-of-diabetes-and-its-burden-in-the-united-states.pdf. Accessed January 28, 2016.

5. Narayan KMV, Boyle JP, Geiss LS, Saaddine JB, Thompson TJ. Impact of recent increase in incidence on future of diabetes burden U.S., 2005-2050. Diabetes Care. 2006;29(9):2114–2116.

6. Margolis DJ, Malay DS, Hoffstad OJ, Leonard CE, MaCurdy T, de Nava KL, et al. Incidence of diabetic foot ulcer and lower extremity amputation among medicare benefciaries, 2006 to 2008: Data Points #2. 2011. Data Points publication series. Agency for Healthcare Research and Quality (US). Available at: www.ncbi.nlm.nih.gov/books/NBK65149. Accessed February 16, 2016.

7. VanGilder C, MacFarlane GD, Meyer S. Results of nine international pressure ulcer prevalence surveys: 1989 to 2005. Ostomy Wound Manage. 2008;54(2):40–54.

8. National Center for Health Statistics. Health United States 2009: With Special Feature on Medical Technology. Hyattsville, MD: National Center for Health Statistics;2010:2010–1232.

9. Ingargiola MJ, Daniali LN, Lee ES. Does the application of incisional negative pressure therapy to high risk wounds prevent surgical site complications? A systematic review. Eplasty. 2013;13:e49

10. National Alliance of Wound Care and Ostomy. Comparison of Wound Certifcate Programs. Available at: www.nawccb.org/library/images/New%20images%20no%20people/Certifcation%20comparision.pdf. Accessed January 30, 2016.

11. American Board of Wound Management. Certifcation Statistics. Available at: www.abwmcertifed.org/about-us/certifcation-statistics/. Accessed January 25, 2016.