My Scope of Practice: An Enlightened Style of Nursing

Thought is the sculptor who can create the person you want to be – Henry David Thoreau

     Deborah Warner, ARNP, MS, CWCN, received her Bachelor of Science and Masters degrees in Nursing in 1983 and 1991, respectively, from the College of Nursing, University of South Florida. In between, she completed the Wound Ostomy Continence Nurse (WOCN, Enterostomal Therapy) program at Arlington Heights Hospital (Arlington Heights, IL). Since she began working in wound care in 1989, Deborah’s scope of practice has expanded significantly — an independent nursing consultant specializing in wound and ostomy care, her areas of expertise include consulting and clinical, educational, research, and medical litigation.

     Deborah has a fluid work schedule; the flow of her day usually depends on the tasks at hand. She may use her home office to work on project development and educational programs or to review medical records. She travels to present educational offerings. Her WOCN duties take her to level-one trauma centers affiliated with medical and nursing colleges. Her care population includes patients of all ages undergoing ostomy surgery or dealing with enterocutaneous fistulas, pressure ulcers, and acute and complex chronic wounds.

     Over the years, Deborah’s various roles have influenced patient care regimens and nursing issues. Her professional responsibilities have evolved in pace with her work environment, from WOCN to Nurse Practitioner within a hospital-based skilled nursing facility to clinical nurse specialist with a non-profit community hospital as a member of the team that included nursing specialties in the fields of pediatrics, orthopedics, cardiology, oncology, respiratory, and WOC, where her responsibilities focused on clinical practice, staff and guidelines for practice development, and membership in nursing committees and the Institutional Review Board. Deborah next served as Clinical/Management Director at a long-term acute care (LTAC) hospital, participating in and overseeing the wound care team, program development, ostomy care, and wound care research and serving as chairperson of the wound care committee. In this role, she focused on process improvement, product analysis, community education, and staff development.

      “I learned I was more successful in my cause to improve patient care when I spoke the language of the department in which I was interacting,” Deborah explains. “When selling the role of the WOCN to physicians, I focused on improved patient outcomes, patient education, and patients coming to terms with their altered body image. When proposing the creation of a WOCN department to hospital administration, I addressed patient satisfaction, improved outcomes, and decreased length of stay, and initiated a timely discharge process. To convince the Product Review Committee to approve a more expensive dressing, I emphasized something all committee members could embrace: cost savings via fewer dressing changes with a more effective product.”

     Deborah holds her many patient success stories close to her heart. “My first ostomy patient was an elderly gentleman who inadvertently facilitated the creation of the WOCN department,” she says. “His unique story was included in my proposal to senior staff, outlining the need to create the WOCN position and department. As an ostomate myself, I recognized the need for hospital-based WOC nursing services. My patient was concerned about pouch leakage and odor. He feared he might never leave home to go grocery shopping or to church. By listening and acknowledging his concerns, I was able to provide him the instruction he needed to mange his colostomy and increase his confidence in dealing with and accepting his altered body image.”

     With the support of the medical executive committee and hospital administration at the LTAC, Deborah developed a systemwide approach for timely implementation of care that empowers nursing staff to provide medically approved treatment orders for wound management, fecal management, and incontinence care at an organizational level. She believes absence of structure can lead to poor patient outcomes and thwart quality care. “When I find a barrier to providing optimal patient care, I look to the system structure and consider the processes and whether the institution acknowledges obstacles to change,” she explains. “I offer process improvement ideas, recognizing that suggestions may not be embraced within an organization. As a nurse consultant, I review medical cases involving litigation, and through discussion with healthcare providers, I understand wound management programs are often absent or lacking. As a contributing editor of Wounds411 (www.rd411.com), I have offered numerous protocols and educational materials to assist healthcare providers help the patient.”

     Deborah’s medical and business experience led her to create Warner Options, Inc., a wound and ostomy consultancy that focuses on education, research, clinical, and medical-legal issues. As an independent practitioner and entrepreneur, Deborah’s role is always changing and she enthusiastically ushers in new opportunities. Flexibility, creativity, discrimination, accountability, and authority are key to her self-employment —not only does she meet client needs, but she also has the authority to make decisions and determine what work relationships to pursue. She advises all who are considering the wound, ostomy, and continence scope of practice to keep key business components in mind. “Listen carefully to your heart, honor your DNA — distinct nursing attributes and distinct nursing/niche advantage — and define what doing your best job would entail,” she advises. “Develop your vision of business ownership and pinpoint your goals. Tap into your true talents and educate yourself on the small business world.”

     Deborah finds meeting with different healthcare providers and collaborating on educational offerings and program development most gratifying. The most challenging aspect of her work is time management — balancing projects and meeting client needs. On the legal side, being deposed requires discerning focus and careful listening. She believes attorneys for the prosecution and defense have their clients’ best interest at heart; when she serves as an expert witness, Deborah’s testimony speaks to nursing standard of care.

     For the past 33 years, Deborah and her husband Tom have resided in sunny Florida; they also have a mountain home in North Carolina. The high school sweethearts grew up in Illinois; their daughter and son-in-law gave them two much-adored grandchildren. A lover of the arts, Deborah enjoys reading, gardening, cooking, and taking nature walks. The last movie Deborah saw in the theaters was Sherlock Holmes, which undoubtedly resonates with her investigative nature as a legal nurse consultant. The Warners also share their home with four pets.

     Deborah is studying Jin Shin Jyutsu (JSJ), an ancient art of harmonizing the life energy in the body. “I believe we are energetic, mindful, physical, spiritual beings,” she says. “Life offers us many lessons and opportunities to share.” Work has enlightened Deborah both spiritually and intellectually. “I have learned that we are part of a community,” she says. “Don’t think of yourself as isolated in your pursuit to serve patients well. Look to your mentors for guidance and reality checks. Be discerning and steadfast in your convictions. I believe it is essential to be philosophically in sync with one’s work environment and recognize philosophy is deep-rooted.” Deborah credits her family and friends for their motivation, encouragement, and understanding. As they help inspire her, she champions her profession and her passions while wholeheartedly inspiring all of those around her in her scope of practice. As Deborah would say in Sanskrit, Namaste!

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