My Scope of Practice: The Scope of My Scope of Practice

    Five years ago, Ostomy Wound Management embarked on a journey of recognition and celebration. Noteworthy wound, ostomy, and continence clinicians were to be nominated, interviewed, and featured in a monthly column that highlighted their accomplishments and described the career choices that rendered them worthy of acknowledgment. We set forth, under ConvaTec’s sponsorship, with a modest appreciation of the scope, if you will, of this endeavor — not fully anticipating the breadth of experiences we would be charting.

    My Scope of Practice has traveled from the bedrooms of home care patients to the battlefields of Iraq; from acute care hospitals to Ground Zero, September 11, 2001; from entrepreneurial ventures to missionary work. It has increased our familiarity about precepting and protocols, research and risk factors, standardization and support surfaces. The stories of dedicated clinicians’ professional challenges and successes are woven with a common theme: Patients first. This fifth anniversary of My Scope of Practice marks a good time to recap some of the stories that have made this journey, to be continued, so memorable.

    Our first column featured Paul Farley, a quietly engaging CWOCN working in home care. Paul shared his approach to the many variables inherent to the healthcare setting, including traffic. Other featured clinicians working in home care include Marsha Davidson, who enjoyed developing relationships with her patients’ families. Lidia Garner pushed for more home care protocols in wound management. Scott Bolhack, MD, makes house calls wherever the patient calls home — often, in his case, the majority of nursing homes in Tucson, Ariz.

    Among the featured acute care clinicians is Jo Catanzaro, a critical care nurse with a penchant for wounds, ostomies, and teaching, is influential in a large city hospital; and Marietta Glazer, a champion of pre-surgery education for her patients. Marcia Simon is helping bridge the gap between research and practice as she seeks new therapies for burn and wound patients.

    Numerous “featurees” have been instrumental in initiating programs in their scopes of practice. In addition to her work with ostomy and wound patient support groups and product committees, Laura Shafer helped start a wound clinic. Jetta Tressell’s determination facilitated a skin care team. Celeste Dimon helped create a Research Council to encourage nurses to catch the research bug.

    Several clinicians have been influential from the industry side of the field. Victoria Langer found inspiration in her ailing husband’s struggle for comfort and devised support surfaces that she went on to market. Terri Maxwell established a two-part business that provides wound, ostomy, and continence supplies and consultation for patients and practitioners.

    Practitioners serving the armed services arena  raised awareness of the unique challenges they face as they treat military and civilian patients. One of several siblings in the armed services/medical arena, Joy Schank fell in love with wound care while working as a surgical nurse at Walter Reed Army Medical Center. Olga Rodriguez has served several tours of duty — the latest in Iraq. Jody Warren, one of a select few certified ET nurses in the Army Nurse Corps, lives by his mother’s creed: Nurse is a verb and a noun.

    Many clinicians find fulfillment working with the disadvantaged in the US and abroad. Podiatrist Alan Cantor was drawn to the plight of Jamaicans with lower extremity issues (Dr. Cantor later provided insights into the rescue efforts on 9-11).  Shawneen Schmitt, inspired by what she was able to achieve during the Red River floods in 1997, has taken her nursing ideals to Latvia, Mexico, Kazakhstan, and North Sumatra.

    Some clinicians’ interests serve a particular niche. Jan Avakian-Kopatich provides a great deal of hyperbaric oxygen therapy. Betsy Nielsen-Omeis helped establish a lipotripsy center and went on to manage the South Texas Pelvic Floor and Bladder Center. Vickie Driver, DPM, and Robert Snyder, DPM, have a thing for feet, as does David Armstrong, DPM, whose special concern is the absence of pain in patients with diabetes and foot wounds. Kathi Thimsen has become involved in medical forensics, using her expertise to determine facility negligence in medical litigation. Joann Ermer-Seltun, as she says, “has a passion for pee.” And some clinicians, like Brenda Hensley and Nancy Chatham, have their hands in everything. Brenda’s responsibilities encompass policies and procedures, finance, patient care, and staff education; Nancy may be the most-paged clinician at her institution.

    Patient age is sometimes a factor in determining career paths. Hiromi Sanada, echoing the views of a culture that respects the elderly, pursued care management of older patients. Sandi Brunello, whose younger twin sister enticed her into the wound-ostomy family, is a kid person. As are Kristine Rogers, who strives to keep her young patients as pain-free as possible, and Marie Oren-Sosebee, the first WOC Nurse for Children’s Healthcare of Atlanta.

    Wound ostomy continence clinicians know that patient management is a multidisciplinary effort. Bonnie Sparks-DeFriese, initially a physical therapist, pursued wound specialist certification and a nursing degree to bridge the gaps among specialties providing wound care. Darren Hammond, clinician and speaker, emphasizes the importance of multidisciplinary care, saying it doesn’t matter which discipline takes the lead. Patient management also involves finding an efficacious balance between care and cost — Susan Langmaid stumps for evidence-based product utilization in conjunction with current practice standards.

    Patient advocates all, some relish the individuality of patient care. No cookie cutter approach for Christa Heinsler. Or for Luis Lira, MD, who employs reiki and acupuncture as part of his holistic approach to wound care, or Diane Newman, who doesn’t simply lecture — she strives to ensure patients understand her instructions regarding continence care.

    So many who shared their stories present at conferences and inservice, lending the voice of experience to their concerns and causes. Several say it is the best part of their scope of practice. A trio of wound ostomy continence nurses (Ann Semo, Carol Korutz, and Janet Brhel), staunch patient advocates, help provide educational programs and work to ensure clinicians in their facility stay credentialed. Concerned that Canada had no enterostomal therapy training programs, Diane St-Cyr took action and became an instructor, coordinating preceptorships at McGill University. Not only does Janice Beitz teach endlessly, but she also is the perpetual student, currently in pursuit of a sixth set of letters after her name.

    Clinician age and length of experience varies among featurees. Rosalie Bolton, who at the time of publication was looking forward to earning wound care certification, graduated from diploma school in 1946. Robbie Sharp discussed what it is like to be “the new kid on the block.”

    Like the subjects of paintings in the Harry Potter series, My Scope of Practice featured clinicians usually are not relegated to one “frame” of interest. Many niche players have initiated programs, care teams, and support groups. Most have trained staff, railed against reimbursement and cost restrictions, and figured out ways to circumvent being told No. Unlike keepers of secret recipes, they readily share the ingredients for their accomplishments. They sing the praises of their mentors. They are humbled by the strength and determination of their patients. They are hand holders, not hand wringers. And they are modest to a fault, repeatedly expressing their surprise with regard to their My Scope of Practice status.

    Five years and almost 50 columns since we introduced My Scope of Practice, we congratulate ConvaTec for its support of excellence in healthcare and for providing the opportunity to recognize those who provide it. Most of all, we are grateful to the clinicians who allow us to acknowledge their efforts. We know their experiences will inspire others to make inroads and seek new paths in their scopes of practice.