My Scope of Practice: A Professional Who’s Been There

Life’s challenges are not supposed to paralyze you, they’re supposed to help you discover who you are. — Bernice Johnson Reagon, American historian

 Wound, ostomy, and continence care is a vocation and avocation for Paula Erwin-Toth, MSN, RN, CWOCN, CNS. Born with multiple birth defects involving her urinary system and pelvic and hipbones, Paula spent a good part of her childhood in care facilities. “My passion for WOC nursing stemmed from personal experiences,” Paula says. “My first memories are of hospitals, casts, nurses, and doctors. My experiences left me with good and bad memories. Rather than generating fear, my healthcare professionals were generally helpful and supportive, inspiring me to pursue a career in healthcare.”   When Paula was 10 years old, she underwent a urinary diversion. She had the great fortune to have Norma Gill, the first Enterostomal Therapy (ET) nurse in the world, as her ET. Like Paula, Norma also has an ostomy and was able to combine empathy and clinical knowledge to change the lives of her patients. Paula aspired to one day have that type of impact on others. Although many 10-year-olds aren’t sure what they want to be when they grow up, Paula was certain her future was in WOC nursing.

  Paula began her career in 1976 when she entered a nursing program; she graduated as valedictorian at Akron City Hospital’s Firestone School of Nursing. In 1982, she completed the ET education program at the R. B. Turnbull Jr. School of WOC Nursing Program at the Cleveland Clinic (Cleveland, OH) and went on to obtain her BSN and MSN from the University of Akron in 1986 and 1990, respectively. In 1990, Paula became the Director of WOC nursing education at the Cleveland Clinic, a position she held for 21 years until 2012 when stepped down to head her own consulting firm. “I was not ready to retire; I wanted the flexibility to choose projects I care about,” Paula says. “My passions are education and advocacy for patients and providers dealing with wounds, ostomies, fistulae, and incontinence.” She is also a prolific speaker and author.

  Throughout her career, Paula has seen many changes, from advances in technology and products to problems related to patient’s health insurance. “The pressures to reduce the length of stay, cut costs, and increase our responsibilities have effected change in all healthcare settings today,” she says. “Although not ideal, this change seems to have focused the attention of management on what WOC nurses have been saying for years: Prevention is key and much less costly than treating an ulcer once it occurs.”

  What has stayed the same throughout Paula’s long career is the need to put the patient first. “We cannot lose the key component of what we do — that is, caring,” she says. “Electronic medical records, product advances, and improved patient/family education materials are all critical if we are to provide quality care, but it is essential to show we care and express empathy for our patients, their families, and our colleagues.”

  Paula has experienced most of her patients’ special challenges. She recalls how, on her honeymoon, her pouch leaked while she was sleeping. Although mortified at the time, she has been happily married for 33 years and has a story to tell her patients — ie, that accidents happen and life goes on.

  There is very little that Paula isn’t willing to share or do to help her patients get back to their normal lives, but sometimes patients want a little too much. “Once I had a young male patient with a new ileostomy ask me to — how shall I put this — engage in an activity not included in my job description,” Paula says. “He figured that as a WOC nurse, I could help him (as he put it) ‘Get back on the horse again.’ I respectfully declined and offered referrals and advice to help him adjust to his changed body image, altered pattern of elimination, and concerns about sexual activity.”

   In such scenarios, Paula has found countless benefits in listening to patient concerns first and coming up with a treatment plan second. “It may sound naïve, but some of my most difficult situations in patient care, such as the noncompliant or ‘impossible’ patient, were solved just by sitting down and listening to the person, discovering what is most distressing, and developing a plan of care that will work for everyone,” Paula says.

  Paula has helped countless patients over the years, but one patient’s words have always stayed with her. A physician who underwent a permanent colostomy at the age of 48 said to her, “The surgeon may have saved my life, but you made it a life worth living.” Paula continues to help reshape the lives of her patients with the care and empathy that have become synonymous with her scope of practice.

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