My Scope of Practice: Carpe Diem in Practice

Time is a wheel in constant motion, always rolling us along. Tell me, who wants to look back at their years and wonder where have those years gone? — Lee Ann Womack

 Carole Bauer, MSN, ANP-BC, OCN, CWOCN, intends to visit all of the national parks in the US. She already has hiked Isle Royale National Park in Michigan and to the base of the Grand Canyon with her husband, Mark, and son, Ryan. With 28 parks left to cross off her list, Carole isn’t wasting any time making her dream a reality.

   “Probably the most important lesson that comes from working with cancer patients with wound, ostomy, and continence issues is that you should not put off enjoying life for all it is worth, because you don’t know what life will bring you if you wait,” she says.

  Carole has dedicated much of her time and career helping patients diagnosed with cancer. She began her work at the oncology inpatient program in Detroit’s Harper Hospital before becoming a high tech home care RN for the Michigan Cancer Foundation Home Care Program in 1983. It was during this time that Carole developed a passion for wound, ostomy, and continence nursing. Inspired by Christine Rymal, a WOCN with whom she had worked closely, Carole decided to further her education in this specialty.   Another person might have waited until the program she wanted to attend was accepting applications, but not Carole. Throwing all caution to the wind, she applied to the WOC program at MD Anderson (Texas), even though the deadline had passed. Fate was on her side. She was accepted to the program and quickly headed to Houston to begin her studies.

 After obtaining her WOCN, Carole worked another year as a home care nurse and then took a position with her current employer at the Karmanos Cancer Center (Detroit, MI), working specifically with cancer patients who have wound, ostomy, and continence needs.

   “In my current position, I provide wound, ostomy, and continence consultation services throughout the cancer center,” she says. “As a consultant to the medical team, I make recommendations for the management of complex wounds. I also serve as a role model and educator to the bedside staff on issues pertaining to wound, ostomy, and continence.”

   Carole recently returned to school to achieve another lifelong goal of becoming a Nurse Practitioner. After receiving her ANCC certification Adult Nurse Practitioner ANP-BC in 2009, Carole opened a clinic where she sees ostomy patients with any diagnosis and cancer patients with wound and continence issues at the Karmanos Center.

   “As a Nurse Practitioner specializing in wound and ostomy care, I am able to help patients with complex wound and ostomy issues that affect their quality of life,” she says. “Once these problems are addressed, their quality of life improves. I have several patients who were afraid to leave their homes for fear their pouching systems would leak. We resolved the issue, and the patients were able to return to their normal lives.”

  Though the job has its advantages, the practice doesn’t come without its share of drawbacks. “The challenging aspects are dealing with patients with complex needs in a down economy,” Carole says. Most people are trying to save money where they can, and Carole has noticed that patients who need daily medical supplies to maintain their lifestyle and health are struggling with the cost of products.

   “Patients are provided less coverage from their insurers and being asked to pay more out-of-pocket costs,” she says. “Probably one of the biggest issues for the WOC nurse is lack of available products once the patient is in the outpatient setting.”

  Regardless of whether patients have insurance, Carole believes they should be given the best care possible. “Outside of work, I volunteer at the Joy-Southfield Health Center, where we provide primary care to uninsured patients in Northwest Detroit,” she says. “We develop relationships with the patients, which has resulted in good outcomes despite lack of funding.”

  Carole is also a Director-at-Large with the Wound, Ostomy, and Continence Society (WOCN), and sits on the WOCN Foundation board as well. Her affiliation with the society has enabled her to enhance wound, ostomy, and continence care nationwide. “At the WOCN, we are responsible for ensuring that the activities of the society meet with the mission of the society. Through my role as a director, I monitor the Professional Practice Committee and the Ostomy Committee for any concerns that need to be directed to the national board.”

  Carole hopes to see her own outpatient practice grow over the next couple of years, expanding her reach of care. “I hope my role will evolve into a bigger outpatient practice where ostomy patients can be evaluated before having issues with their stomas that seem insurmountable,” she says.

  Although living with wound, ostomy, and continence issues may make patients feel like their lives will never be the same, Carole believes their routine doesn’t have to change. “The person you are is not defined by how you go to the bathroom,” she says. “Although it is life-altering to have a diversion of any type, it does not have to change who you are as a person.”

  Carole recommends a number of different products to help maintain a semblance of normalcy. “Today, patients living with an ostomy have an expanded number of products to choose from that can support their lifestyles, including undergarments specifically designed for the ostomy patient,” she says. She believes nothing should stand in the way of her patients’ living their lives to the fullest, something she personally takes to heart.

  With an African safari planned for next year and a long list of US National Parks to visit, Carole truly is making every day count. Her dedication to living life to the fullest, and helping her patients do so as well, is just one way she’s advancing her scope of practice.

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