My Scope of Practice: Don’t Sweat the Small Stuff

”Were there none who were discontented with what they have, the world would never reach for anything better.” – Florence Nightingale, English pioneer of modern nursing

  As many wound, ostomy, and continence nurses would tell you, they don’t treat just a wound. They treat the whole patient. This holds particularly true for Janette Dietzler, MSN, RN, CWS, COCN, FACCWS. As a manager, clinician, and educator, Janette is treating the wound, the patient, and all related issues with an eye to the big picture.   Janette attended Missouri Baptist Hospital School of Nursing (St. Louis, MO) in the 1980s. During this time, she worked as an EMT on a small rural ambulance district and as a nurse’s aide in a nursing home near her house. Both of these jobs helped reaffirm her career choice and her passion for wound care. After graduating, she worked in several different hospitals to accommodate her husband and growing family. In 1991, she was hired by St. John’s Mercy Home Health Agency. Eight years later, she was offered the opportunity to work for Unity Health Systems in a position where she would support a large physician group as the Wound Care Specialist, helping to manage high-risk patients.

  In 2000, Janette was hired as compliance coordinator to address skin and wound care at St. Anthony’s Medical Center, a 767-bed facility that serves more than 918,000 residents in the St. Louis area. Her role gradually evolved to Clinical Coordinator, where she assembled the Skin and Wound Assessment Team (SWAT) of nurses trained in skin, wound, and ostomy care. “As the inpatient Clinical Coordinator, I was able to grow the SWAT program from conception to completion, re-writing the skin and wound program to ensure pressure ulcer prevention was addressed from the moment a patient entered the facility through discharge,” Janette says.

  With the newly developed skin, wound, and ostomy policies (including educational events) in place, staff understanding and awareness of pressure ulcers increased and the incidence of hospital-acquired pressure ulcers significantly decreased at a time in healthcare where, in many cases, few facilities were aware of their incidence rates.

  By 2006, a clear need had emerged for outpatient services in wound care. In response, Janette and the program director Ellie Sicola developed an outpatient treatment center for St. Anthony’s. Although they started with little more than a receptionist and four treatment rooms, the new program grew so quickly they met their 3-year Performa in the first year. In 2011, the center saw some major changes. An ostomy clinic and new hyperbaric oxygen treatment center were added and a standardized Skin Care Protocol was developed to be followed by all areas of the hospital to improve communication between levels of care and ensure delivery of cost-effective, optimal patient care.

  Patient costs have become a huge problem for many treatment centers, including St. Anthony’s. “Unfortunately, the most challenging aspect of wound and ostomy care is insurance reimbursement,” Janette says. “It affects everything. Many patients today do not have insurance. For those who do, providers have to jump through many hoops to help get them care. Sometimes it can be very difficult to achieve the best possible outcomes.” But that doesn’t stop Janette and the rest of her team from trying. Sometimes they rely on creative alternatives to expensive products, such as using maternity pads in place of army battle dressings to cut costs. Janette also has a couple of handy and inexpensive tricks for persons with an ostomy: she suggests eating a few marshmallows a couple of hours before changing the appliance to slow the effluent or putting a couple drops of mouthwash in the pouch to decrease odor.

  Wound care team members do everything they can to heal patient’s wounds; in turn, they expect patients will do the same. “At St. Anthony’s Wound Treatment Center, we ask each patient to sign a contract,” Janette says. “We will help them achieve their wound healing goals, but they have the responsibility for doing their part to make sure their wound heals and stays healed.” So far, the contracts have been successful in getting patients motivated — the center’s healing outcomes have improved to 93%, which is above the national average for 2011.

  The years of work haven’t hardened Janette to the plight many of her patients face; instead, they have taught her a lesson in persistence. “I think the most valuable lessons my work has taught me are patience and tolerance,” Janette says. “Change and growth take time, and working with wounds has shown me you cannot always rush forward. It takes time and patience to achieve a quality outcome. I tolerate much more than I did as a young nurse. I guess that old saying, ‘Don’t sweat the small stuff,’ is really appropriate in wound and ostomy care. In the scheme of things, the little stuff really does not matter. Concentrate on the big picture and do what needs to be done to get to where you need to be.”

  Janette certainly has the big picture in mind when it comes to both her wound treatment center and scope of practice.

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