My Scope of Practice: A Recipe for WOC Care

  Phyllis started working in the home health sector after graduating from the University of Maryland School of Nursing (Baltimore, MD) in 1974. In the 1990s, she was responsible for a patient with a colostomy and a fistula and had to make several phone calls to the enterostomal therapy (ET) nurse at the local hospital to learn how to provide care. Before that, Phyllis had never heard of an ET nurse. She spoke with Diane Krasner, PhD, RN, CWCN, CWS, MAPCWA, FAAN in the late 1990s at a seminar in Baltimore and learned ET certification included wound and continence care, which piqued her interest even more. She already knew she enjoyed the challenge of promoting wound healing and found it satisfying to help her home health patients keep an ostomy appliance on for several days without leaking; with formal certification, she would be able to do so much more.  

    In 2000, Phyllis attended the Wicks Educational Associates School (Mechanicsburg, PA) and became a certified Wound Ostomy Continence (WOC) nurse that same year. “I went to Wound, Ostomy, Continence school because I was drawn to that specialty,” Phyllis says. “I had no plans as to what to do when I finished. Luckily, my supervisor saw the benefit of my education and helped create a position for me in a consulting and educational role.” Phyllis’ responsibilities with HomeCall, Inc in Maryland, where she has been working since 1986, include meeting the needs of patients, staff, and her employer. She provides patient consults in homes throughout Maryland, teaches staff, conducts annual nurse competencies in WOC-related care, and advises on best practice and liability issues. “I like the flexibility of the role,” she says. “I am often consulted on specific products that our staff may not be familiar with and help decide if they are beneficial to add to our available supplies.”

    Phyllis believes 1 of her primary functions is to ensure her fellow nurses have the information and tools necessary to provide optimum patient care. In her experience, it usually takes only 1 joint consult with the nurse to solve pouching problems and issues, provide a wound treatment change that promotes healing, or provide the patient the guidelines needed to manage incontinence. But she always assures the patient and nurse she is available for additional visits if needed.

    Phyllis says 1 of the most challenging parts of health care is trying to keep “patient” and “care” the primary focus. The many federal regulations and measures to protect from liability require nurses to focus on documentation, which can distract from caring for the patient. “It sometimes becomes a balancing act between meeting the patient’s and the payor’s needs,” she says. Over the last few years this has become more of a concern, but because Phyllis tries to stay focused on patient issues, her role has seen minimal change. “My role as a WOC nurse is my vocation, not my job or my career,” Phyllis says. “It is most gratifying to help patients extend ostomy appliance wear time. Sometimes these patients have been in facilities for a few months since their surgery and face continuous skin and pouching problems. They are depressed; their lives revolve around the unpredictability of their ostomies. Often the source of the problem is identified with 1 visit, and patients who were changing their pouch 3 times a day are able to keep it on 3 to 4 days or even longer. I am grateful to be able to help them, and I appreciate their expressions of gratitude.” 

    Over the last 40 years in home health and 15 as a WOC nurse, Phyllis has perfected her recipe for providing great care: equal parts passion, dedication, knowledge, and experience make up her scope of practice.

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