My Scope of Practice: Six Degrees of Separation

    A clinician, educator, author, presenter, researcher, and once-again student, Janice Beitz, PhD, RN, CS, CNOR, CWOCN, has distinguished herself, not only in achieving her five degrees and/or certifications, but in her overall approach to wound, ostomy, and continence care.

She jumps in with both feet whether she is compassionately caring for the socio-economically and (often subsequently) healthcare deprived in the poorest sections of Philadelphia, animatedly presenting case studies at conference sessions that she lovingly entitles “Train Wreck Central,” or enthusiastically pursuing and proliferating information to improve patient care. Currently seeking a post-master’s certificate in order to become an Adult Nurse Practitioner, Janice will add a sixth set of letters to her name, hoping this will enable her to extend her formal practice capabilities, particularly in the incontinence arena.

    Janice began her nursing studies in 1972, attending the Diploma Nursing School of Germantown Hospital, Philadelphia, Pa. As a new nurse in the OR, she quickly saw the benefits of having a college degree in nursing. She was accepted into La Salle University’s new RN-BSN completion program, earning her BSN in 1983 as part of the school’s second graduating class. “It was a fertile time of my life,” Janice says. “Not only was I expanding my knowledge, but I also had two babies — one going into the program and one as I graduated.”

    Her La Salle instructors, including Dr. Zane Robinson Wolf, urged her to pursue a PhD so she could eventually teach nursing, something she hadn’t yet considered. “Because I had received such a good education, earning my doctorate seemed possible. Many La Salle students sought doctorates because we were really encouraged and empowered. In fact, La Salle is now seventh in the nation among 253 colleges of its type whose graduates go on to achieve doctorates.”

    Janice stayed home with her second son through his infancy but also took a critical care course at Frankford Hospital, Philadelphia. She returned to work, accepting a position at Philadelphia’s Methodist Hospital in the cardiac care unit. She worked there 1 year, applying in the meantime to Villanova University’s Masters in Nursing program. She got lucky — she was offered a federal grant that would subsidize her studies and provide an additional stipend. “In the words of my wonderful colleague, Joanne Catanzaro, luck is the intersection of opportunity and preparedness,” Janice says. “I was in the right place at the right time when I applied to Villanova (my opportunity) and I had received a great education at La Salle (my preparedness). I accepted the grant and with my parents and husband helping with our children, took 12 credits per semester and earned my Masters in 2 years. In the second year of my Masters program, I became a research graduate assistant, which helped me hone my research skills in a world with few search engines.”

    Her degree in hand, Janice could now teach. She secured a position at Temple University where she taught in the baccalaureate program for 8 years. During that time, she worked in the OR at the Medical College of Pennsylvania and in surgery or step-down units at Temple and Graduate Hospitals where she also oversaw student “clinicals.”

    “While I was teaching at Temple, I took the students to Graduate Hospital and became friendly with WOC Nurse Grace Williams,” Janice says. “She encouraged me to take ET (WOC) courses. With my OR and surgical care background, I was already interested in wounds, ostomies, and incontinence. In 1993, I took a part-time distance-learning version of the WOC program offered by the Albany Medical Center. I also was engaged in my doctoral program at Temple. I was teaching, nursing, and studying.”

    Once the theoretical portion of her program was complete, Janice needed to find a preceptor. Enter Linda Lankenau. “Linda’s compassionate patient care and collegial relationships make her a stellar role model,” Janice says. This Past President of the Delaware Valley ET Nurses Association provided Janice with “great experiences and continued mentoring.” Janice also was fortunate to make the acquaintance of Joanne Catanzaro, who also was pursuing WOC education. Joanne had been asked to consult at the Continuing Care Hospital, a long-term, acute care facility in an economically depressed section of Philadelphia. Joanne’s schedule got so busy, she needed help; coincidentally, Janice needed a practice setting. They worked together for 5 years (Janice has been there for 10 years), caring for some of the city’s poorest citizens. “We see some really sick people,” Janice says. “It’s where I feel I have accomplished some of my best nursing, providing comfort and helping patients with their wound, ostomy, continence issues.”

    Meanwhile at La Salle, Janice was appointed Director of Nursing Certificate and Distributive Learning Programs. Her diligence and dedication earned her a recent offer of sabbatical. The “time off” is far from responsibility free — Janice had to create and receive approval for a plan of study in a competitive sabbatical process. Her goals are to become an Adult Nurse Practitioner and to practice clinically and conduct research, preferably in urinary and fecal incontinence. Although not currently active clinically, she is studying at La Salle, enrolled in courses that will prepare her to step into the Adult Nurse Practitioner program, taking study time to prepare for her “year off.”

    Janice sees this new pursuit as a way to upgrade her skills. “I like to learn constantly,” she says. “I try to get better every day. I love WOC nursing. It offers opportunities to develop meaningful relationships with patients not available in other areas of nursing. For instance, I can help a person with a new stoma learn and adjust. And, of course, there are the challenges of wound care, helping people with injuries and conditions who wouldn’t still be alive, even 10 years ago. I also can improve my ability to provide palliative care. I may not be able to help heal everybody, but I can make them more comfortable. It’s all very rewarding.”

    This constant desire to pursue further education is grounded in Janice’s love of learning. She is eager to enhance her assessment skills and ability to perform differential diagnosis. “Narrowing down the possibilities and bringing ‘the latest and greatest’ treatment to bear is fun and challenging,” she says. “In addition, as part of my NP focus, I want to emphasize the role of prevention. This new vista of adult primary care is extremely exciting. It will be wonderful to help people with horrible wounds stop the non-healing process upstream. As a NP, I will be in a better position to do this.”

    To indulge her desire to focus on incontinence, Janice will spend her clinical time next year with an NP involved in continence care, expanding the horizon of her clinical practice. “When I worked in surgery, I saw many incontinence procedures performed. My new status will allow me to be more active in this realm of care, helping, for example, aging women who have had many children gain the help and education they need and teaching younger women appropriate preventive care. Sometimes it’s something as simple as eliminating caffeine in a woman’s diet. I want to be able to help make those life-improving changes.”

    Eventually, Janice would like to have a clinical practice that accommodates her love of teaching. “I would never give up teaching, whether in person or online,” Janice says. “My clinical practice also would be a source for the research I want to perform. I’d like to follow in the footsteps of my role model, Mikel Gray, and be a practicing NP, faculty member, writer, and researcher. He is doing all the things I find most fascinating.”

    Janice appreciates the role of continuing education. “As a clinician and teacher, I would like to develop more continuing education. There is a huge need for more WOC nurses, a need that will only increase. We also have to educate ancillary staff. We have to ensure that wound care is being done well.” Beholden to the impact a La Salle education has had in her life, Janice notes that 40% of the school’s graduates are the first generation in their families to come to college. Janice’s dad never finished high school; she earned her doctorate. “Something good is happening here,” she says.

    Janice says if she ruled the world, she would like to open a clinic for the poor to provide care to folks with wound, ostomy, continence nursing problems. “I know I can’t always make them better,” she says. “But I can make them comfortable and promote their dignity. I am proud to be making a difference in my scope of practice.”

    My Scope of Practice is made possible through the support of ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ.