Guest Editorial: Are You Sure You Want to Be Only a Wound Care Nurse?

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I always cringe a bit when a colleague says, “I really want to do what you do and take care of patients with wounds.” Some of my peers might encourage this nurse to follow his or her dream to become a wound care nurse in 1 of 2 ways: 1) attend a wound, ostomy, continence (WOC)-accredited program or 2) follow an alternative pathway: take the certification exam, which requires completion of 1,500 clinical hours for the 1 specialization, 375 of which must be accomplished in the fifth year, immediately before taking the exam; or complete 50 continuing education hours over the 5 years before taking the exam. But I contend, Why do you want to be only wound care nurse?

When I wanted to become (only) an ostomy nurse back in 1977, I wanted to better serve patients who either had or were going to have an ostomy. I knew little about what I was getting into when I submitted my application to Harrisburg (PA) Hospital’s Enterostomal Therapy (ET) Program (you can tell how long ago this was, because the term ET nurse now is extinct). I didn’t realize my education would involve so much more than how to provide care and how to use the many products available for a person with an ostomy. My instructors taught us the pathophysiology, staging, and management of a pressure ulcer. We were encouraged to think about how the tools we learned to use managing peristomal skin irritation could be incorporated in the treatment of denuded tissue caused by gastric drainage, mucous, urine, or stool. I learned how to use a Stomahesive wafer (ConvaTec, Skillman, NJ) to treat pressure ulcers; if a pressure ulcer had depth, I was taught to consider sprinkling Karaya powder (Hollister, Libertyville, IL) on the base of the wound and layering Stomahesive wafers within the wound. (Not to mention: I also learned how I could turn an everyday garbage bag into an ostomy pouch.) The skills we were taught for ET nursing easily translated to caring for wounds and skin irritation, which made us more valuable to the communities we served.

My knowledge and skills as a WOC nurse have enabled me to provide care to patients not only with wounds, incontinence, and ostomies, but also persons with feeding tubes and fistulas, as well general issues. For example, I have worked collaboratively with the RN Coordinator of a spina bifida program to initiate changes in practice to prevent latex allergy and anaphylactic reactions in a large trauma center; through the Latex Committee, we were able to change both product and practice throughout the facility. My broader knowledge dealing with chronic care patients increased the value of my input in a wider set of opportunities.

As a WOC nurse, I have been able to touch more lives — patients, their families, fellow nurses, physicians, or other health care professionals — than I would have it I were only an ostomy nurse or only a wound care nurse or only a continence nurse. The overlap in necessary skills, ingenuity, and extended patient contact incorporate the best of why people pursue a career in nursing. 

If I had been only an ostomy nurse, I might never have taken the leap of faith to establish the distance-based Albany Medical Center Enterostomal Therapy Nursing Education Program, which allowed baccalaureate-prepared and masters-prepared nurses the opportunity to complete an ET education program without the expense of leaving their work, home, and families. I have gained confidence not only in my ability to provide care, but also to ensure others are afforded similar opportunities to be better informed.

So, why would you want to place limits on your practice and experience by wanting to be only wound care nurse? Patients with wounds also may have an ostomy. Patients with sacral wounds may have greater difficulties if they also are incontinent. Becoming equipped to address problems across all 3 clinical areas allows you to make appropriate decisions managing related concerns and issues. As only a wound care nurse, would you know how to cross-use products? Would you consider using liquid antacids to treat skin excoriated from gastric drainage or use pectin powder on weeping denuded skin?

If you were only a wound care nurse, what would you do if you were approached by a surgeon to mark a stoma site? Should/can a clinician who has been “trained” but not certified in ostomy care be permitted to perform this task? If the stoma marking resulted in a poorly cited stoma and a subsequent compromise in quality of life and the patient sued, would you be held legally responsible?

All of my questions point to the reasons why it is important for a nurse considering the decision to specialize as a wound care nurse or an ostomy nurse or a continence nurse to take the plunge and become a WOC nurse. I do not mean to imply you are of any less value if you treat only wounds, only ostomies, or only incontinence. But by becoming a board-certified WOC nurse (CWOCN), you expand your potential for providing more and better care to more (interesting/challenging) patients. Being a CWOCN is an honor, at times a humbling, and always a learning experience. I am proud to be a WOC nurse. n

Read more about Dr. Aronovitch's career journey in this month’s My Scope of Practice.