Bed, Bath & Beyond
An aging population and rise in diabetes spur demand for wound, ostomy, and continence nurses

By Scott Williams
August 23, 2004

Janice Beitz, RN, PhD, CS, CNOR, CWOCN, jokingly tells people she’s an expert in pee, pus, and poop. That may not sound like a glamorous job, but wound, ostomy, and continence (WOC) nurses like Beitz will tell you their jobs are challenging, rewarding, and increasingly in demand.

Beitz, associate professor and graduate program director at La Salle University School of Nursing in Philadelphia, said the demand for WOC nurses is, and will continue to be, spurred by the aging of the U.S. population, the rise in diabetes and its side effects, and health care’s focus on prevention.

“An increasing number of elderly people are institutionalized at extended care facilities and increasing numbers of people provide home care services,” Beitz said. “Both [populations] have wounds and have problems with continence, and some may have ostomies.”

Laurie McNichol, president of the 4,300-member Wound, Ostomy and Continence Nurses Society (WOCN), said WOC nursing is one of the industry’s newer specialties. The profession traces its roots to 1968 and a patient named Norma Gill-Thompson who received an ostomy and, after her surgery, realized how much she and others needed postoperative support from other patients and the health care profession. That lay movement gradually evolved into a nursing specialty with its own certifications and a growing body of knowledge.

That includes the WOCN, the only national organization for nurses who specialize in the prevention of pressure ulcers and the management, education, and rehabilitation of people with wounds, ostomies, and continence disorders.

Nurses needed

Not only is the population aging overall, McNichol said, but the number of “old-old,” which she defines as those aged 85 and older, is growing, too. That age group is the fastest-growing segment of the U.S. population, she said, and people in that group tend to take a number of medications that result in bowel and bladder problems.

“The need is growing and there aren’t enough of us,” McNichol said.

The WOCN website [ www.wocn.org ] documents the need as follows:

• 5 million Americans suffer from chronic wounds.
• 1.5 million to 1.8 million new wound cases are added each year.
• Pressure ulcers occur in as many as 10% of patients in acute care settings and as many as 28% in long-term care settings.
• Half a million Americans have a stoma and require teaching, counseling, and supportive care.
• More than 11 million Americans suffer from documented urinary incontinence.

The need for WOC nurses has grown so much in recent decades that some nurses have even carved out subspecialties within the specialty itself. Some focus on one area such as continence or wound care. Many WOC nurses work at wound care clinics.

Junji Navarro, RN, MSN, CWCN, CWS, a WOC nurse in Las Vegas, specializes in wound care. He’s a certified wound care nurse and a certified wound specialist. The CWCN credential is given by the WOCN and the CWS by the American Academy of Wound Management.

A proper education

Navarro, originally from the Philippines, is a full-time nurse instructor at Community College of Southern Nevada and a part-time WOC nurse at Silver Hills Health Care Center, where he formerly served as assistant director of nursing. He said the WOCN and the American Academy of Wound Management are, in his opinion, the only two reputable organizations bestowing certifications in wound management.

Other organizations hold five-day seminars and grant initial designations that Navarro says don’t give nurses nearly enough education on treating wounds. “The thing right now is everybody claims to know a little bit about wound care,” he said, “but they really fail to understand what wound care is all about.”

Wound care is not as easy as some people think, he said, and those who don’t thoroughly understand it can become confused by the many treatment options available. But to those who have gone through certification and have a thorough understanding of the problem and the array of solutions, it’s valuable to have many different medications from which to choose.

Beitz said another factor driving the need for WOC nurses is lawsuits over pressure ulcers. Many health care facilities are realizing that it’s cheaper to hire a WOC nurse to educate people on avoiding pressure ulcers than it is to deal with litigation. A WOC nurse also is able to document cases in which a patient receives the best possible care and problems have occurred anyway. That, too, can prevent lawsuits or, at a minimum, reduce the chance that a facility will end up paying a large award.

WOC nurses work in private homes, nursing homes, and subacute facilities (especially referral centers), in which patients are too sick to go to long-term care facilities and not sick enough to go to a hospital, Beitz said. They also work in acute care settings in hospitals and wound healing centers that are either freestanding facilities or in hospitals.

Many work as staff members for these facilities while others work as independent consultants. That and because WOC nurses have a lot of autonomy even in staff positions make the profession appealing to many, Beitz said. Others enjoy the higher-than-average pay for nurses and that WOC nursing involves continual education and problem-solving.

The path

To become a WOC nurse, one must have at least a bachelor’s degree in nursing, McNichol said, and then complete a WOC certification program through one of seven schools in the nation offering such a program. The programs are offered in person and via the Internet. Nurses who complete the program must then pass a certification exam given in all 50 states, McNichol said.

Credentialing is handled by the Wound, Ostomy and Continence Nursing Certification Board in Milwaukee. McNichol said 30% of WOC nurses have master’s degrees, and Beitz predicts that in the next decade, all WOC nurses will need to have a master’s degree because of the rapidly expanding knowledge base needed to do the job.

Beitz said it’s not uncommon for WOC nurses with a bachelor’s degree to make between $50,000 and $60,000 minimum and for advanced practice nurses — in this case, clinical nurse specialists and nurse practitioners — working as WOC nurses to make $75,000 or more. She said some who go into administrative positions make $100,000 or more.

“More and more people are realizing this is a good job to get into,” she said.

Kurt Cummings, RN, BSN, CWOCN, a WOC nurse in Abbeville, Ala., said the hospital where he works — Southeast Alabama Medical Center in Dothan — sent him to WOC school because he had experience as a WOC nurse and as a salesman for a company that made special beds for the prevention and treatment of pressure ulcers.

“You can call yourself a WOC nurse, but until you take the boards and get certified you can’t call yourself a CWOCN,” he said.

Cummings said he enjoys the autonomy that comes with being a WOC nurse.

“You pretty much do your own thing,” he said. “You make assessments and make decisions on what needs to be done.” He said most surgeons don’t know much about wound care and leave it up to WOC nurses to handle it.

“Their attitude is, ‘You know about wounds, I don’t do it. Fix it.’ You get a lot of respect from the surgeons and from your coworkers,” Cummings said.

Navarro, for one, is bothered by the relative lack of interest among physicians. “I wish doctors would bother to care to attend [WOC] seminars and carefully assimilate or absorb what is discussed,” he said. “Then things would be a lot better.”

Although there aren’t a lot of job openings for WOC nurses, per se, Navarro says there are lots of opportunities at facilities that may not realize they need WOC-certified nurses.

“Our health care world needs to recognize that it is a specialty on its own and they need to hire the right people,” he said.