My Scope of Practice: Lieutenant Colonel Opts for Private (Practice)

   Joy E. Schank, RNC, MSN, APN, CWOCN, is an Army brat. Her dad was in the military and signed up all three of his children for their own tours of duty. One brother served as a medic, the other served in the signal corps, and Joy became a nurse.

Her siblings finished their tours and left, but Joy stayed for more than 21 years, working in the US and abroad and achieving the rank of Lieutenant Colonel. Now retired from the military, she is the Clinical Director of Schank Companies, a private practice in a rural area of the Finger Lakes region of upstate New York. She specializes in the care of ostomy and chronic wound care patients in acute, long-term, outpatient, and home care settings.

   An RN since 1974, Joy became interested in wound care in 1990 while working as a surgical nurse at Walter Reed Army Medical Center, Washington, DC. "I didn't just get interested," Joy says. "I fell in love. I used so much Duoderm the sales representative for ConvaTec said I should work for the company, which I eventually did - as an ET nurse consultant providing lectures on chronic wounds and ostomy care."

   "I earned my ET certification in 1994 and retired from the Army Nurse Corps to establish my own practice. As a nurse and a nurse practitioner, I needed a collaborating physician. I sent out about 25 letters and Herbert Gaston, MD, a general surgeon, replied that he could work with me immediately. He was willing to serve as my mentor, splintering off responsibilities for wound care and giving them to me. Now, ironically, most of the people I see are not his patients."

   Affiliated with Soldiers and Sailors Hospital in Penn Yan, NY, as well as two long-term care facilities and an assisted-living facility, Joy receives referrals from approximately 16 physicians/nurse practitioners/physician assistants within a 70-mile radius. "I'm kind of a one-woman show," says Joy. "My practice consists of wound and ostomy patients as they are referred to me. I am solely on my own until there is a question or a problem that is out of my league. Then I consult with my collaborating physician. He either becomes involved in the patient's care, providing more advanced therapies, or I refer the patient to the appropriate specialist - for example, if a patient's wound needs to be seen by a vascular surgeon. Approximately 98% of the practice consists of wound care patients, mostly elderly, the majority of whom have leg ulcers. I assess the wounds and prescribe treatment based on literature-based algorithms. Even though I practice in a rural setting, I am eager to implement the latest technology in my treatments." Joy notes that her formulary aims to require the least amount of products possible to enhance ease-of-use and cost effectiveness.

   In 1997, Joy received her Adult Nurse Practitioner certificate after taking five classes over 2 years. She says it has been her dream to have her own practice. "I consider wound and ostomy care a calling. I enjoy the independence. In a typical day, I do inpatient, outpatient, home, and long-term care. Plus, I have the opportunity to go around the country presenting lectures on wound and ostomy care to nurses and physical therapists and, sometimes, to physicians. I have conducted comprehensive workshops and training sessions on wound care and presented on a variety of wound and ostomy care topics at meetings and symposia." Joy also appreciates the location of her practice. Her home is on a lake. Her grandparents were from the same rural New York area, and it isn't uncommon for her to treat folks well into their 90s and older. "One of my patients was 104 years old. Recently, I had a patient who is 100 years old." she says. "We live long up here."

   A major barrier to providing optimal care is payment. Some of her patients don't have the money to pay for services. If that is the case, those who lack funds but have the willingness to comply with treatment regimens will be seen for free and products will be supplied to them. Her company used to have contracts with home health agencies, but now reimbursement is made through the office via Medicare Part B billing or through various insurance companies.

   Joy anticipates that the demands of her practice will evolve over the next 5 years to include more litigious matters. "I started getting into legal work because I am determined that the 'true story' be shared," she says. "The tendency often seems to be to go after healthcare inappropriately. I want to educate people about wounds. Even when people receive the best of care, wounds can happen."

   Joy also wants to continue to teach, to simplify wound management for clinicians who may not have received much training in the care of wounds. "Even if you don't specialize, you can achieve success with simple wound care practices for many patients or become more comfortable recognizing when a specialist's help should be sought. Simple steps (see Joy's Pearl's) can expedite healing, reduce pain, prolong dressing wear time, and reduce costs."

   Licensed in two states (Virginia, where she earned her BSN, and New York) and the member of at least eight professional societies, Joy is the recipient of military awards that include the Legion of Merit, Meritorious Service Medal, Army Commendation Medal, and the Army Physical Fitness Award. Joy also reviews manuscripts for Ostomy/Wound Management as part of her duties as a member of the Editorial Review Board, a responsibility she considers "an honor." OWM is proud to salute one of its own and we wish her continued success in her scope of practice.