My Scope of Practice: Helping Practice Evolve

Without continual growth and progress, such words as improvement, achievement, and success have no meaning. — Benjamin Franklin

When Charlotte Lisco, RN, BSN, CWOCN, enrolled in a local community college’s adult education program to learn how to be a unit secretary, she had no intention of becoming a nurse; her career goal always had been to be a high school teacher. But like so many others, she fell in love with all nursing had to offer, quickly taking her burgeoning interest from a part-time job to a full-blown career.

After changing her major to nursing and completing her certified nursing assistant certification, Charlotte graduated from Marycrest International University (Davenport, IA) in 1999 and headed home to California to work for the Kaiser Permanente Fontana Medical Center (Fontana, CA) as a medical/oncology nurse. Not long after that, she was attracted to the field of wound, ostomy, and continence (WOC) nursing. As a nurse educator for the Center’s education department, Charlotte taught a pressure ulcer treatment and prevention program to the nursing staff. She worked closely with the center’s CWOCNs — Carol Paulson, RN, BSN, CWOCN, and Phyllis McGinnis, RN, BSN, CWOCN — while preparing the program. Charlotte found their passion for pressure ulcer prevention infectious. As Carol neared retirement, she approached Charlotte about becoming a WOC nurse. “She thought I would make a great WOC RN, pointed me in the right direction, and I’ve never looked back,” Charlotte says. “I sought out programs, proposed a business plan to my medical center to aid me in schooling, and was off to the University of Texas MD Anderson Cancer Center (Houston, TX) Wound Ostomy Continence program in the fall of 2005.”

Charlotte still works at the 300-bed Kaiser Permanente Fontana Medical Center as a WOC nurse consultant. She sees all types of wounds, ostomy/fistula, and continence issues, and her practice covers all age groups from the NICU to the elderly. Charlotte spends a great deal of time working in the ICU assisting in patient management and helping nurses understand the importance of preventing hospital-acquired skin issues. She also provides education and support to the RNs, MDs, and staff. “Wound care can be a little scary for some RNs, and I enjoy helping them understand the importance of prevention and how to tackle their fears related to staging and providing care of these sometimes complicated patients,” she says.

Charlotte is also a clinical consultant for EHOB, Inc (Indianapolis, IN). In this capacity, she provides educational lectures for RNs on many different topics related to pressure ulcers and wound care, both at her medical center and abroad. She has traveled to China on 3 separate occasions to give lectures and educate Chinese RNs on pressure ulcer prevention/management and on how the EHOB line of products can benefit their diverse patient population. “It has been very exciting and interesting to interact with the Chinese nursing world,” Charlotte says. “I have toured hospitals that have 1,700 beds,100-bed ICUs, and full waiting rooms. The world of health care in China is unique; providing adequate health care to close to 1.4 billion people can be a challenge. Pressure ulcer prevention is an evolving concept, and it has been very exciting and rewarding to help nurses in China develop ideas on how to bring new ideas to the bedside.”

Pressure ulcer prevention is an established practice in the US, but here, too, it is still evolving. Best practices continue to advance with WOC field of care. “The world of health care is ever-changing,” Charlotte says. “We are seeing more patients with more complex needs and sometimes lack of resources. Developing a working treatment plan can be a challenge. The shift from how to manage pressure ulcers, in place 10 years ago, to how to prevent pressure ulcers has brought many issues to the bedside. Engaging staff and helping them understand that prevention management is a very important focus of their daily nursing routine is not easy. State and federal reimbursement changes, reporting, and ongoing review have shifted the focus of the hospital-based WOC RN.”

Charlotte is ready to face whatever the future may bring. Although she is not sure how her role will evolve — the constant changes of health care reform keep her from predicting what might come next — she remains thankful for the little every day victories that eventually mature into the overall success of her scope of practice.

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