My Scope of Practice: Skin-Saving CNAs — Power in Leadership and Education

If everyone is moving forward together, then success takes care of itself. — Henry Ford

  Susan Logan, RN, BSN, ET, CWS, FACCWS, has built a remarkable 30-year career tirelessly advancing best practices in wound care. As a Clinical Consultant since 2008, Susan has championed Kindred Healthcare’s (Louisville, KY) Wound Care division.

On a daily basis, she advises, assists, and supports Kindred Hospital locations nationally in operational implementation of wound care standards and wound programming. Susan spearheads Kindred’s Wound Program and Change Development, chairs the Wound Care Advisory Council, and works closely with the hospital division Medical Director to ensure evidence-based best practices and regulatory compliance in wound and skin care throughout the division.

  Susan was the valedictorian of her graduating class at the Central Pennsylvania School of Nursing. She also made her mark while earning her Bachelor of Science degree in Nursing at Carlow University, graduating summa cum laude. Currently, Susan applies her wealth of knowledge to long-term acute care (LTAC), specifically LTAC hospitals and acute care hospitals specializing in the treatment and rehabilitation of medically complex patients who require an extended stay in a hospital setting. Through her work, Susan affects patients in more than 85 Kindred hospitals across 40 states by promoting educational opportunities to her clinical peers based on best practices. “Knowledge is power,” says Susan. “Sharing your knowledge can affect many lives.”

  In 2009, Susan put her philosophy into practice at Kindred’s inaugural Clinical Impact Symposium, which was themed “Wound Management: Setting Standards for Care.” Susan was invited, along with many nationally respected wound care experts, to offer the latest evidence-based information to Kindred’s wound care specialists. Clinicians in attendance were encouraged to return home and share the knowledge and skills, furthering Kindred as a clinical excellence provider in wound care.

  In 2010, Susan’s efforts led to the introduction of the 2010 Skin Saver Initiative to Kindred’s Certified Nursing Assistants (CNAs). The initiative sought to combat pressure ulcers, which, according to the Institute of Healthcare Improvement (IHI), 1 million people develop each year. The initiative discovered that CNAs are often nearly 33% of the direct productive workforce and spend approximately 60% of their time at the bedside. Susan and her team were determined to maximize this significant amount of patient care time to enhance skin and pressure outcomes. The team’s goal became empowering CNAs to recognize their role in preventing pressure ulcers.

  Susan and the team sought to accomplish their goal through education. Additional objectives of the initiative included providing monthly activities and education to all CNAs; working with CNAs to develop effective methods to enhance communication with licensed staff regarding patients’ skin integrity; working with CNAs to improve and develop tools to enhance their skin and pressure ulcer prevention observation and care; providing a quarterly 30-minute educational webinar with the National Wound Care Clinical Consultant; and developing an annual clinical recognition program for CNAs, entitled “Skin Savers,” which included the selection of National Skin Saver Champions from each region. Like Kindred’s symposium, the educational aspect of the program was introduced through a trickle-down dissemination of knowledge via clinician ranks — first, the Wound Care Advisory Council introduced the program to district peers, the Wound Care Coordinators (WCCs), who then discussed the program with their Director of Education and staff nurses. The Wound Care Council then developed the CNA recognition/awards criteria. Susan provided educational activities and tools to the WCCs and Directors of Education to reinforce the best practice information the CNAs had been taught.

  Susan and her council hopes their initiative will decrease pressure ulcer incidence and/or prevalence, decrease incidence of wound deterioration, develop and enhance CNA leadership skills, ensure best practice, provide CNAs with an opportunity to take action and make a difference in skin care and pressure ulcer prevention, and enhance communication among all staff members regarding issues related to skin integrity. Although Susan’s strides toward excellence in skin and wound care education and provision face challenges, she remains steadfast in her mission and remains passionate about her cause.

   “What I like best about my position is that I can provide quality care for thousands of patients through the support and ongoing education I can provide to bedside care givers,” Susan says. “I am able to assist caregivers, WCCs, staff nurses, CNAs, and ancillary staff achieve quality outcomes by providing evidenced-based, best practice for patients at a high risk for skin and pressure issues.” Standardization of best practice issues across 90 facilities and the high acuity level of Kindred’s patients are constant challenges, but initiatives like the Skin Saver Program help by providing a standard national educational program focusing on the special, sometimes intricate needs of the patient population.

  The recent Skin Saver feat has set a standard. Kindred’s talented nursing professionals continue to work arduously to change the norm in their scope of practice. n

Kindred Healthcare’s Regional Skin Saver Champions

  Iona Lamay, Katherine Rodgers, and Zeny Esparagoza are Kindred Healthcare’s 2010 Skin Saver Champions. “East Region winner Iona Lamay is a conscientious CNA and always does a terrific job with her patients,” say her coworkers. “She is incredibly diligent in reporting any skin changes to the wound team. Iona is a great representative of Kindred Hospital Park View (Central, MA) and is one of the reasons they have an extremely low facility-acquired pressure ulcer rate.”

  Central Region winner Katherine Rodgers has been with Kindred Hospital Chicago North (Chicago, IL) since 2001. In 2006, Katherine became an aide in the wound care department and worked in that role for several years, assisting the licensed wound staff by gathering supplies, setting up equipment, and performing patient clean up and positioning. The staff that works with Katherine attests that she provides exceptional quality care for her patients. She does this by making sure that all of their needs are met and works with the licensed staff in caring for patients with skin breakdown. Katherine is always looking for ways to improve her knowledge in caring for patients with special skin care needs.

  West Region winner Zeny Esparagoza is an optimistic team player and excellent mentor who is committed to 100% excellence. Coworkers say, “Zeny is an active participant on projects relevant to decrease nosocomial pressure ulcers. She recommends devices to offload pressure and participates in product evaluation to improve patient skin care and decrease skin breakdown.” Zeny takes a sincere interest in all of the patients at Kindred Hospital San Diego (San Diego, CA), not just those assigned to her on a daily basis.

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