My Scope of Practice: A Late Blooming WOCN

It's never too late to be who you might have been. —George Elliot

  Judy Dattilo, RN, BSN, CURN, CWOCN, is a classic example of perseverance and focus. She received her Associates degree in nursing from Pasco Hernando Community College (New Port Richey, FL) at age 46, after which, she worked full time in the area of urology.

Over the next 6 years, she completed her Bachelor’s degree in Nursing from the University of South Florida (Tampa) and became certified in urology. In 1997 she took a 2-year hiatus from urology to pursue her dream of becoming a WOCN. “During a 2-year period, I worked in a physician/WOCN clinic that treated patients with wounds, ostomies, and incontinence,” she says. “I managed the incontinence area, performing urodynamics and biofeedback. This became a 2-year preceptorship with the WOCNs who ran the clinic. I received an exceptional education and hands-on practice dealing with patients with wounds and ostomies.”

  In 2000, Judy became certified as a WOCN and went back to work in urology as a clinical coordinator for pharmaceutical trials. She was hired by Comprehensive Home Care in 2005. Founded in 1997, Comprehensive Home Care is a privately owned company that services Medicare patients. The Community Health Accreditation Program (CHAP)-accredited company currently has 13 offices throughout the east and west coasts of Florida, covering 33 counties. In her current position as Regional Wound Care Director, Judy oversees four offices that encompass eight counties on the west coast of Florida.

  Judy says her organization is unique in that it provides a number of specialty services utilizing nursing and physical and occupational therapy. These services include wound care, infrared light therapy, telemonitoring, ostomy, bladder health, cardiopulmonary, low vision, and behavioral health. “We offer nutritional support, social workers, speech therapists, and aides,” says Judy. “Our outcomes are some of the best in the country. I credit the owner of Comprehensive, Garrett Bragg, and Senior Vice President-Florida West Coast Operations, Debbie Garau, for the support and latitude they provide to achieve our good outcomes.”

  Although her official title is Regional Wound Care Director, Judy also is responsible for ostomy and urologic patients. She is involved in providing staff education and printing the monthly newsletter, the Wound Care Chronicles, a publication that offers pertinent information from recent journal articles of interest on wound, ostomy, and urologic conditions. Judy is also a member of the Corporate Wound Care Committee, which meets twice each month. “Robert Snyder, DPM, CWS, MSc(c), is our corporate medical wound care consultant,” says Judy. “We are responsible for policies and protocols and reviewing and revising the product formulary for cost-effective resource utilization. We discuss issues related to staff and patient care, address staff education relevant to wounds, and educate area physicians about wound care.”

  Judy has developed numerous CE classes for nursing and therapy staff regarding catheter care, urinary tract infections, infection control, OASIS training for wounds, basic and higher level wound and ostomy care, lower extremity ulcers, and nutrition. She also conducts field visits with nurses to see wound and ostomy patients, an excellent method, she says, for her to evaluate patient issues that require special attention and to check staff competencies. “I do patient consults on an as-needed basis if a nurse or physician requests it,” she says. “I monitor photos of the patients’ wounds and receive updates from field staff on patient issues that may need interventions to decrease complications. I work with our Quality Improvement nurses to review charts of wound patients that have had a potentially avoidable event to determine if there were circumstances beyond the control of the agency.”

  Judy also plays a pivotal role on her company’s marketing team and periodically provides presentations to area physicians to instruct them on services related to wound, ostomy, and continence care. “I educate physicians on current standards of wound care and show them our formulary and how the products assist with faster healing and improved outcomes,” says Judy. “Many doctors are unaware of how Medicare reimburses home health agencies. I take the time to explain this to them.” These explanations help physicians understand the need to move away from daily wound care not only for financial reasons but also for better patient care. If a particular medical case requires additional patient services such as vascular testing, support surfaces, lymphedema pumps, debridement, or other treatments, Judy helps contact physicians to discuss the rational for requesting such treatments. Judy believes that because a follow-up letter is provided for all consults, her team has developed a trusting relationship with numerous referring physicians.

  No stranger to multitasking and wearing various professional hats throughout each workday, Judy enjoys educating staff and patients. “I love learning and enjoy sharing information with anyone who is interested,” she says. “Our focus as an agency has been on preventing patient problems and increasing their ability to care for themselves. I have a number of nurses who love wounds and ostomies and have really stepped up to become my wound champions.”

  A significant part of Judy’s responsibility is making sure the wound program — approximately 20% of the total patient census — is fiscally sound. “It is important to monitor staffing and supply utilization,” Judy says. “I have developed reports with the assistance of our IT staff and I have trained personnel in each office to review supply requisitions and shipping procedures to ensure cost-effective supply utilization.” This April, Judy’s agency will begin using an electronic medical records and reporting system, Home Care Home Base. Two of the company’s offices already have gone live with the system and have been reaping the benefits of faster, more complete assess to documentation and reporting.

  Judy’s responsibilities are not without day-to-day challenges and barriers. “The most challenging aspect of my job is wanting to do too much and not having enough time to do it all,” she says. “Because I cover a fairly large territory, I communicate mostly by phone or email when I would much rather be there in person. I travel to each office on a routine basis to meet with the office staff, field staff, and nursing directors to discuss any issues.” Judy admits to often walking the line between dedicated employee and workaholic. She credits her supportive VP of Operations and great staff for keeping her on track.

  The major barrier to providing optimal care is trying to keep up with educating new staff. “We expect a great deal from our field staff,” she says. “It is difficult to provide the amount of education I would like them to have before they go into the field.” Education is an ongoing process. I wish I had a magic wand to give them all the information they need. But our field and office staff know that I am always a phone call away if they have any questions.” Over the years, Judy’s work has taught her that wound care is holistic and that healthcare providers have to treat the underlying cause of the wound and not just the wound itself. “It is important to treat the patients’ emotional needs because chronic wounds can be more psychologically debilitating than physically debilitating,” she says.

  Judy has found ostomy patients to be some of the most memorable. “They come to you scared and emotionally distraught after surgery and by the time they are discharged, they are confident in their ability to manage their ostomy,” she says. “One particular patient — a physician — came to us with a year-old ostomy. He had been to two agencies before us and was having issues with the stoma and appliances. A colleague and I spent time with him the first visit, explaining why he was having difficulty. We encouraged him to express his concerns. It was a simple fix that just needed a specific appliance. The other nurse followed him for several weeks, patiently allowing him to work through the problems and learn about proper stoma management. After he was discharged from service, he wrote a long letter to us. His letter stated we were the only people who had allowed him to just be a patient by taking the time to explain everything to him. Other caregivers assumed that because he was a doctor he should know everything. I cried when I read the letter and I’ve kept a copy to this day.” Judy also has a particular fondness for incontinence and urology patients who often are initially afraid to leave their homes for fear of having an accident, but who eventually learn the skills needed to gain control over their bladder. Judy enjoys the simple pleasures of life, family, pets, and relaxation and loves to spend time with her husband and their two cats, Oscar and Felix. An avid reader, she also is active at her church, making dinner every week for the 24 members of her church’s Bible study group. Judy’s advises up-and-coming nurses to consider this specialty area. She currently mentors several nurses who have shown interest in becoming a WOCN. “There are not enough WOCNs in the world,” she says. “Being a WOCN allows you to work in multiple settings — hospitals, rehabs, or home health— and it is one of the few specialties recognized by the American Nurses Association (ANA). It is internationally acknowledged as evidence-based, as well as rewarding. To see a wound that has been present for months finally heal is wonderful. The impact you can make on an ostomy patient is immeasurable. The aging population will present more chronic wound and bladder issues. Being a WOCN means having the autonomy and ability to work closely with other nursing disciplines and physicians to address these problems. My only regret is that I didn’t become a nurse sooner.” Judy’s hard work, perseverance, and dedication prove it is always better late then never to advance your education and responsibilities in your scope of practice.