My Scope of Practice: Change for the Faint-hearted

  “I have learned over the years that when one’s mind is made up, this diminishes fear; knowing what must be done does away with fear.” — Rosa Parks

  When she started her career in health care as a physical therapy tech, Hollie Smith Mangrum, PT, DPT, CWS, fainted any time a patient with a wound was seen in the clinic.   “During my last physical therapy clinical, I was assigned to the physical therapist who performed wound care full-time and yes, I passed out the first week,” she says. The goal for the remainder of clinical became simple: see wounds without fainting.

  Over time (once she was able to stay conscious), Hollie noticed how wound care made a visible difference not just in the wound, but also in the patient’s quality of life. Soon Hollie wasn’t fainting every time she treated a patient with a wound; instead, she examined the wound with a keen eye and developed an appropriate care plan. It didn’t take long for Hollie to realize she enjoyed wound care, especially the journey you take with the patient and the friendship built along the way. “I began trying to find any and all opportunities to learn from colleagues,” Hollie says. “These included Hope Voegeli, RN, CWON; Certified Diabetes Educators Kathy Woolfork, RN, BSN, CDE, and Lisa Selbe, RN, BSN, CHPN; and the physicians referring patients to me. I also discovered a passion for teaching — patients, family, coworkers, other health care professionals, and students. Thus began a continuing, independent journey to grow my knowledge so I could effectively teach patients and others. My desire to expand my knowledge base led to a lifelong dedication to learning to achieve my dream of becoming an educator in wound care.”

  Hollie, who graduated from the University of Tennessee (Memphis) in 1995 with a degree in physical therapy, became a Certified Wound Specialist through the American Board of Wound Management in 2000. That same year she opened the physical therapy-based Wound Management Center at Jackson Madison County General Hospital (Jackson, TN).

  She is currently a program director with the Outpatient Wound Management Center at the same hospital and provides education to staff, the community, and potential referring providers. She also handles budgeting, revenue cycle, and staffing operations for the Center. “I have always loved direct patient care,” she says. “However, by leading a qualified team of health care professionals in a wound center environment and promoting consistent referrals from the community, I can help ensure providers are aware of our services so patients get the care they need to heal their wounds and change their lives. I have constant contact with physicians of many backgrounds, nurses and therapists in many types of settings, and students of many disciplines. Having this contact helps me keep providers focused primarily on wound prevention by stressing the importance of early referrals to a wound care center as soon as issues are identified.” Hollie also serves as adjunct faculty for universities and provides continuing education regularly online. She plans to stay on the speaker circuit to help new and seasoned providers continue to grow their knowledge of wound care and hyperbaric oxygen therapy.

  Over the years, Hollie has seen a shift in who provides primary care for patients with wounds; physical therapists remain a large part of the multidisciplinary aspect of such care. Hollie has observed that with managed care, reimbursement for therapists in wound care has decreased significantly over the past several years. For this reason, almost 10 years ago, her hospital outsourced the wound services to a corporate management company, Healogics, Inc (Jacksonville, FL). “I had always viewed these companies as the Big Bad Wolf,” Hollie says. “So when the decision required me to either give up direct patient care with wounds or be the director of the physician- and nursing-based wound center, I chose to stay in wound care and be the director. This meant having a corporate company advise me and my staff how to treat wounds, which turned out to be a great decision. Healogics helps keep its providers current with evidence-based clinical practice guidelines for both wound care and hyperbaric oxygen therapy and assist with providing excellent patient care in our community. I am proud to be a part of it.”

  Although Hollie’s role has changed substantially, she has learned many different aspects of the business of wound care to help provide better care for patients while also helping hospitals provide wound care services in a profitable way. Hollie encourages all practitioners to remember change is inevitable and to constantly reassess for improvement, both personally and in your scope of practice.

  This article was not subject to the Ostomy Wound Management peer-review process.