Wound, ostomy and continence nursing
Wound, ostomy and continence nursing (WOCN), often referred to as wound care nursing, is a nursing specialty encompassing care for patients with ostomies, complex wounds or dressing changes and skin breakdown. According to the Joint Commission, more than 2.5 million patients in acute-care facilities in the U.S. suffer from pressure ulcers each year. Of this number, approximately 60,000 patients die from complications. WOC nurses play a pivotal role in assessing and treating these patients, as well as providing staff education to other nurses.
Education and training
All WOC nurses are registered nurses (RNs). In order to obtain certification from any of the three national certification agencies, a nurse must have a bachelor’s degree or higher. Job experience requirements as an RN vary among the agencies. To be certified by the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB), an RN must have a bachelor’s degree and complete specialty education and clinical preceptorship in a WOCN Society-accredited program. The WOCNCB is the only agency offering advance practice credentialing. They are also the only agency that offers a specialty in foot care (CFCN) for all levels of RNs.
The National Alliance of Wound Care (NAWC) offers the WCC certification to RNs who have been directly involved in wound care management, education or research for at least two years full time or four years part-time within the past five years. Additionally, RNs must fulfill at least one of the following requirements:
- Complete a four-day program of classroom and lab practice sponsored by WCEI
- Hold a current certification through the American Academy of Wound Management (AAWM) as a Certified Wound Specialist (CWS) or any certification from the WOCNCB in any specialty
- Four years of full-time wound care experience plus an additional 60 contact hours in skin and wound care
- If work experience is not available, the RN may do a preceptorship of 120 clinical hours within one year of course completion.
The American Academy of Wound Management (AAWM) requires a bachelor’s degree plus three additional years of clinical experience in providing wound care before awarding the Certified Wound Specialist (CWS) designation. An RN who has three years’ experience in wound care but does not have a bachelor’s degree may be awarded the Certified Wound Care Associate (CWCA) designation; however, this certification is not accredited by any accreditation group.
WOC nursing education programs accredited by the WOCN
As of September 2010, there are only 10 schools on the WOCN certified listed on the WOCN website. Some of these schools are online only, some are on-site only, and some offer a mixed option. The programs offer from as few as 10 graduate credits to as many as 257 continuing education credits. Cost and length of each program varies greatly, with tuition ranging from $1,800 to $7,050. Fees for out-of-state students may be higher.
Job duties and description
Most WOC nurses work in hospitals but are also employed in clinics, doctors’ offices, nursing homes and the home health arena. A large hospital may employ two or more WOC nurses who typically work a Monday through Friday schedule. Some hospitals rotate schedules so one nurse is available to work the weekend, but in many facilities the day-to-day duties of assessing and dressing wounds must be done by regular staff nurses who may have little formal training or experience in wound care.
WOC nurses see any patient in the hospital who has skin breakdown, a stoma or surgical wound requiring complex assessment and treatment. The patient load changes daily, as new consults for the WOC nurse are ordered. Sometimes all the patients who need to be seen cannot be seen in one day, which delays care for the patients. WOC nurses are responsible for initiating therapy with specialized wound vacuums, forming an airtight seal over the wound to drain fluid and facilitate healing. The bedside RN may monitor the vacuum for proper functioning but cannot change the dressing or alter the therapy.
WOC nurses also serve as educators and resource personnel to nurses who have less experience with dressings or assessing wounds. They can teach the nurse about the patient’s wound care needs, as well as educate on skincare products and techniques of using specialty products and dressings. In many facilities, they evaluate and recommend skincare and ostomy products. They also teach new ostomy patients how to care for the stoma and use ostomy supplies.
Job outlook for WOC nurses
As patients become older with more complex disease processes, the need for WOC nurses will continue. A recent article in Ostomy Wound Management states there are only about 4,000 WOC nurses in the U.S. to serve a growing population. Coupled with advances in technology and cost-containment efforts in every level of health care, many patients with ostomies and wounds are discharged from the hospital quicker, either to another facility or to home for self-care. WOC nurses must meet the demands of educating patients in self-care, training staff and simply performing their hands-on duties. Experienced RNs who want to work in a growing specialty may consider WOC nursing as a second career path.
References
Joint Commission Resources. (n.d.). Pressure Ulcers (stage III & IV decubitis ulcers).
Medi-Smart: Nursing Education Resources. (n.d.). Ostomy nursing: An in-depth look.
Turnbull, G. (2008). Who is really providing ostomy care today? Ostomy Wound Management.
