My Scope of Practice: Appreciating the Process of the Profession

    The WOCN’s New England Region ET Nurse of the Year for 2000, Kathleen “Kate” Lawrence, RN, MSN, CWOCN, was nominated for “My Scope of Practice” by her colleague and mentor, Nancy Faller, RN, PhD, ET Nurse. The ET nursing practice Nancy started and grew with Kate’s help now boasts three certified wound ostomy continence nurses (Nancy since moved to Pennsylvania). The nurses provide full-scope in- and outpatient services for a 120-bed hospital in semi-rural Rutland, Vermont, and offer consultation services in home and long-term care settings throughout the county and state. Kate says the practice is “not just healthcare” — it’s a business within a business that must address all aspects of care provision, including the politics of securing what you need and continually educating yourself along with peers and administrators. OWM spoke with Kate about her professional achievements.

What makes your practice unique?

    Our organization didn’t just decide to establish an ET nursing practice; it grew out of need. Our more rural environment demands flexibility so we don’t specialize — sometimes we do wounds and sometimes, ostomies. We must be savvy on our feet, changing hats from clinician to consultant as needed. The biggest advantage of our practice is that we can provide care across the spectrum. We follow patients from acute care through long-term care, offering a full-service experience as standard practice. We collaborate with primary physicians and general, orthopedic, and plastic surgeons — we work as a team. Our care protocols were established in cooperation with physicians for all levels of facilities.

    Because we practice across the care continuum from institution to outcome, we maintain better oversight of product use and develop protocols accordingly. We work with physicians on initiating technology and then hand off responsibilities as appropriate to staff. Physicians look to us to make care provision successful. This has influenced our approach to negative pressure wound therapy and percutaneous tubes. The tube protocol, for example, developed in cooperation with our endoscopists and surgeons, is patient education oriented toward tube use, crisis management of tubes, and establishing a long-term management plan with tube replacements including how to prevent emergencies such as clogged tubes over holiday weekends, and how to move the patient into low-profile devices for long-term use.
Also, we continue to educate and be educated. This gives us the added advantage of teaching everyone in town who we are and why they need us.

What has been your biggest professional influence?

    You can never undervalue academics. Earning my Master’s degree enabled me to get a better grasp of the healthcare picture as a whole. But my involvement in associations like the WOCN has had the biggest impact on my practice. The peer influence — my colleagues as teachers and being taught the process of the profession — has allowed me to articulate both my skills and my needs. The dialogues that occur when you are part of an organization give value to the way you frame your practice. They force you to stay informed and to address the business of healthcare. Clinicians need to look at the economies of care delivery and consider the patient in the broad perspective, not limit their vision only to the care they provide in their specific work environments.

    Currently, I am Director-at-Large for the WOCN. Organizational involvement also provides opportunities to be involved in the business and public policy conversations that eventually support patient care. Plus, I find that being politically active comes back to serve you well at the bedside.

    Life-long learning is one of my mantras. Attending conferences offers a two-for-one deal: academics and networking. Organizational and personal connections are nurtured at these events. I wouldn’t be who I am without my mentors — the “village” of ET nurses who run wound, ostomy, continence educational programs, serve as leaders of organizations, and introduced me to the network of people who have helped “grow” me.
In terms of learning, patients teach me something new about compassion, human behavior, and technique every single day. That is why I so love what I do.

What is the best part of your job?

    I love clinical care and my role as a nurse. It may not be the easiest part but it is the most focused and the most nurturing. Program development, being in education, establishing clinical pathways, and serving as a case manager feed different parts of my soul but at the heart of everything is care delivery.

    Providing care across the spectrum is “truthful.” That’s where you appreciate outcomes and where developing and nurturing a team approach is so important.

What about your job is the most challenging?

    The pace. Keeping up delivery excellence and clinical care in an evidence-based practice, staying abreast of cutting-edge technology, providing patient and provider education, and building relationships within the professional medical community take energy. You need to keep the lines of communication open among all team members—physicians, rehab, nurses, everyone. You can easily get caught up in the hands-on of care delivery and move on, especially when you factor in the ever-present demands of reimbursement and regulatory issues. The challenge is not to practice in an insular way and instead guide people to examine outcomes – that is, are you keeping the customer — whether the patient, colleague, or hospital — satisfied. We also need to be politically savvy to defend our existence. Plus, every day of practice you are at risk of losing your personal lifestyle. Achieving a balance is a constant check for me.

If you could have a do-over with regard to your professional life, what would it be?

    I wouldn’t do anything different about my past but I will thoroughly examine my future options. Life has a way of teaching you lessons as each decade passes. It becomes an obligation to examine how I can continue to do what I feel passionate about professionally and still keep the rest of my life in balance. I ask, What can I add to my toolbox to make things easier? The answer may mean more education. It may mean taking advantage of the opportunities presented by the nursing shortage — it’s a given that we need nurses but it’s not a given how or where these new nurses will practice, what the healthcare system will look like, and what my role will be in 10 years.

What advice can you offer our multidisciplinary readership?

    If your environment allows, pursue your full scope of practice. Remember you can influence care across the care continuum in small and large ways. Become politically active — professional organizations are a great place to start. Nurture personal connections with your peers. They will serve you well no matter what your scope of practice.