By Fabiola Jimenez, RN, ACNS-BC, CWOCN
Nursing has given me great opportunities; some of them I never imagined possible. I started as a medical surgical nurse in an oncology unit where the treatment of the day was gauze soaked in Dakin's solution for the management of post op radical neck surgery. I moved on to intensive care, travel nursing, Army nursing, and endoscopy. It was in endoscopy and working with the colorectal surgeons, who helped me get my clinical experience while pursuing a master's degree in nursing, where I found out that it all could be tied together with a certification in wound, ostomy, and continence (WOC), and a wound care nurse is born!
The patients we served in the gastrointestinal clinic needed every aspect of the WOC nurse's role and training, and so I took the steps for certification. Not feeling strong in online learning, I was captured by the idea of going back to the college campus and within 10 weeks, I successfully completed the WOC course at the Nell Hodgson Woodruff School of Nursing at Emory University. I felt as if I had been given superpowers. All of my instructors were supportive, stressing evidence-based practice, and encouraging research. Lectures felt like motivational speeches. I was enthralled by some of the very simple to complex advances in wound care. The use of Manuka honey and silver-impregnated alginate dressings I had never heard of. Dry gauze and paper tape replaced by silicone borders—these are simply awesome. For stoma care, the convexity appliances and moldable technology were impressive, and learning the detailed assessment for continence care was stimulating.
Certification as a Wound Care Nurse
Pumping myself up to take the certifications, the song "This Girl is on Fire" by Alicia Keys became my mantra. Meanwhile, I was waiting to find the right job, in the right place, at the right time. Once again, like a brand-new graduate nurse I found myself wearing those rose-colored glasses! Naively, my impression was that my future job as a certified WOC nurse (CWOCN®) would be so easy. How hard could it be to demonstrate evidence and place it into practice, when almost every day resources like WoundSource are providing me with information, resources, articles, videos and blogs from experts about what are the best evidence-based practices, assessments, and products?
Organizational and Cultural Challenges
I found my dream job back at the nearby acute care community hospital, where I had worked 20 years ago. It was close to home, salary and benefits were just right, and best of all it felt like a homecoming. Many people still working here remembered me! It was going to be fun working with friends. I quickly found out that in general we are all resistant to change, that culture trumps the best formulated plans. I needed to convince my co-workers and managers that the phrase "we have always done it this way" did not apply within the rapidly changing world of wound care. For example, the use of a reusable incontinence pad, the continuous use of incontinence adult briefs, the use of baby powder, and the inappropriate use of baby wipes were some of the issues that needed to be addressed. I had a lot of work ahead of me.
Creative Approaches to Change Implementation
We needed to change practice for the benefit of our patients. I realized that many tools could be used to bring about change. First was to put in check my communication skills to convey the message and allow the listeners to understand that I was on their side and not creating more work for them. Sometimes, change felt like it could happen only one person at a time, just like changing hearts. I have used educational strategies that have been borrowed, modified, or invented to make learning wound care fun for my colleagues. An example is the "Wheel of Misfortune" — a picture board with numbered pictures of wounds: spin the wheel, match the number with the wound picture, and write down the type of injury. The challenge remains convincing the practitioner that change is good and a sign of the times in wound care research. In future blogs, I would like to share with you what has been effective within educational efforts, what strategies I have used when addressing management to embrace those changes, and last but not least, what I needed to change within myself in order to advance and improve wound care delivery in my facility. I needed a good dose of patience! And to realize that change takes time.
About the Author
Fabiola Jimenez is a Wound Ostomy Continence Nurse and Adult Clinical Nurse Specialist at Detroit Medical Center Huron Valley Sinai Hospital. She has been a nurse since 1988, when she entered the field after graduating from the University of Oklahoma. Throughout her accomplished career, her work has demonstrated a dedication to caring for patients and a lifelong commitment to educating herself and others.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.