My Scope of Practice: Utilizing Technological and Human Resources

As someone dedicated to providing the best possible care for patients with ostomies, wounds, and continence issues, Mary Mahoney, MSN, RN, CWON knows that extraordinary times call for extraordinary changes in the way patients are managed.

Mary’s journey as a nurse began upon completion of her Associate Degree in Nursing at Des Moines Area Community College in 1984; she subsequently earned a Bachelor of Science in Nursing in 1991 and Masters degree in May 2013 from Drake University (Des Moines, IA).   Mary worked in acute care hospitals for 21 years — including a children’s hospital, a general medical surgical hospital, and a trauma hospital — before switching to home care 5 years ago. This diversity offered a vast amount of experience among a broad range of patients with wound and ostomy concerns. Early in her career, caring for these patients was not easy. “On several occasions, I had patients with complex ostomies that leaked and had odor,” she says. “I felt helpless as a staff nurse to assist them because I didn’t have the proper training. I thought more stomahesive paste would help the ostomy pouch to adhere.”

While Mary was working as a medical surgical nurse, Debbie Lauer, RN, CWOCN, consulted on one of Mary’s wound care patients. Debbie shared a great deal of information, acting as both a teacher and role model. Mary then decided to attend a short wound and ostomy program at the Mayo Clinic in Rochester, MN and was hooked. “I wanted to be a WOC nurse and help patients who undergo ostomy surgery and patients with wound and continence issues,” she says. In 1993, she attended the Abbott Northwestern Enterostomal Therapy Nursing Education Program (Minneapolis, MN). As a newly certified WOC nurse, Mary began work at the Wound and Ostomy Nursing Department with Iowa Health Des Moines, first as a staff member and then as a supervisor. She’s been a certified WOC nurse for 20 years.

Mary currently works for a home care agency, UnityPoint at Home (Urbandale, IA) that covers her state and parts of bordering states. Because hiring enough WOC nurses to provide in-person visits for all people in need of WOC care isn’t possible, the agency employs a telehealth style of WOC consultation. Nurses who work for the agency do home visits and fill out an assessment form with attached digital photo documentation that is sent to a WOC nurse. “Nurses take the photo, download into the documentation, send it to us within minutes, then call to collaborate,” Mary says.

In Mary’s experience, healthcare providers do not always embrace the notion of practicing wound and ostomy care via technology. But using this platform, in Mary’s opinion, has helped WOC nurses collaborate with other nurses to identify patients who need assistance at a wound healing center or another referral. “We have identified patients who need hematomas drained, patients with cancerous lesions, patients who need further work-up for lower extremity disease, and patients with necrotizing fasciitis,” she says. “We are able to assist nurses to troubleshoot problems with leaking ostomy appliances and patients with sore skin around the ostomy. The technology utilizes our specialty to the highest level and has allowed WOC nurses to review a large volume of patients with wounds, ostomies, and continence issues.”

Although in Mary’s experience home care does not take the place of a wound healing center or hospitalization, it can provide ongoing assessment through multidisciplinary care. The WOC nurse collaborates with a healthcare team comprised of the primary doctor, wound healing center doctor, medical specialists, home care nurse, social worker, physical therapist, occupational therapist, and patient care navigators to make recommendations for treatment protocols. “We are working on building relationships among these different facets of care,” Mary says. “It’s no surprise home care agencies need to provide optimal healthcare with fewer resources and fewer dollars. An open flow of communication and support among members of the home health care team has helped them navigate a difficult healthcare system that often isn’t responsive to the needs of ostomy patients in particular, especially because products are not always covered by insurance policies.”

Mary also recognizes the importance of organizations such as the Wound Ostomy Continence (WOC) Nurses Society, which offers a unified voice on behalf of patients and their care providers to the Center for Medicare and Medicaid Services, legislators, healthcare administrators, and the community. Mary held several positions with the WOCN Iowa Affiliate before becoming an Ostomy Committee Member and Co-Chair on the national level in 2009 and Ostomy Committee Chair in 2011, a position she still holds.

Mary hopes that her continued work — professionally, personally, and through the WOCN Society — will help healthcare providers embrace new technological advances that already have reshaped an entire scope of practice.

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