Demand is growing for wound care nurses in a number of settings, from acute care to home health. Phyllis T. Kupsick, MSN, RN, FNP-BC, CWOCN, serves patients through the Stanley Regional Medical Center in Albemarle, N.C., and serves as the president of the Mount Laurel, N.J.-based Wound Ostomy and Continence Nurses Society, helping nurses around the world access educational, clinical and research opportunities to enhance patient care. We asked her several questions about wound care.
Q. What is driving the increase in demand for WOC nurses?
A. The number of nurses, and others, providing wound care has grown greatly in recent years, but there are still far too few highly educated and competent wound care nurses. With baby boomers now entering their senior years, more age-related wounds and skin care issues are being seen and this is only expected to increase. And, given the state of our world, traumatic wounds of all etiologies continue to grow.
Q. Are there particular settings in which wound care is expanding?
A. Like many others, I foresee a shift toward nonacute settings. At present roughly 60 percent of our WOC nurses work in acute care, but the trend is starting to shift. With shorter hospital stays, patients with wounds will more likely be seen in home health settings, sub-acute or outpatient facilities and long term care facilities. As that occurs, naturally, we would expect to see more wound care nurses working in those areas. Can I predict when? Of course not, but likely, sooner rather than later.
Q. How has the increase in obesity and diabetes rates impacted demand for WOC nurses?
A. Both conditions have great negative impacts on wound healing, increasing the need for knowledgeable wound care nurses. Obesity puts increased tension on surgical wounds, creating potentials of dehiscence; adipose tissue is poorly perfused, predisposing wounds to infection and delaying healing; and typically, these same patients are more at risk for other comorbid conditions. Diabetes has inherent complicating factors. Uncontrolled blood sugars compromise the entire vascular system, creating a cascading effect of negative events when working to heal wounds. And since obesity is frequently seen in our diabetic population, the risk for complications in healing wounds grows exponentially.
Q: What advancements in WOC nursing have particularly excited you?
A. I have been very excited about the skin substitutes for use in place of skin grafts. I see great hope from ongoing stem cell research, which has potential to impact some of our more difficult wounds. I also find amazing the technologies and numbers of new wound care dressings that is almost a daily education.
Q: What initiatives at WOCN should nurses be aware of?
A. There are four that I would like to mention specifically although there are many more that could be shared. WTA Program: Its purpose is to provide basic wound care education to nonspecialty nurses and medics so they may become the eyes at the bedside for wound care patients, working under the direction of a WOC nurse, advanced practice nurse or physician. WOCN Mobile App: We now have all of our evidence-based guidelines for lower extremity arterial disease; lower extremity venous disease; lower extremity neuropathic disease; pressure ulcers; and ostomy available on iPhones, iPads and Android devices. Also included is a wonderful image library. Support Surface Algorithm: This year, WOCN held a consensus conference, inviting leading WOC nurses as well as others to develop an evidence-based/consensus-based algorithm for the selection of support surfaces to both prevent and treat pressure ulcers. WOCN Core Textbooks: Through the efforts of some of our leading WOC nurse educators and writers, we will soon be releasing our new core textbooks on Wound, Ostomy and Continence.
Q: Tell us about your career journey.
A. I have been in wound care, or more appropriately wound ostomy and continence nursing, since 1993, over half of my nursing career. Having had some experience in caring for a rather large and difficult wound prior to becoming a nurse my husbands wound from injuries sustained in Vietnam I found caring for wounds challenging and rewarding. Our small community hospital had an ET nurse who would pull me in on the really difficult and hard-to-manage cases and I was hooked. In order to become a WOC nurse, I had to go back to school to get the BSN which was required to even enter the program. I returned to my previous hospital and opened an inpatient WOC department. After several years I realized that WOC nursing was a wide-open field. I returned to college, gaining my MSN as a clinical nurse specialist and then a post-graduate degree as a family nurse practitioner. I then opened an outpatient WOC care clinic, seeing patients for two home health agencies and in four long term care facilities. I have stayed in the field because helping patients to heal provides me with a feeling of great satisfaction. I have the joy of being able to say that I have never dreaded going to work.