My Scope of Practice: Blending the New with the Old

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Kelsey Bongiovanni

The great thing in the world is not so much where we stand, as in what direction we are moving. — Oliver Wendell Holmes

 Technology has advanced many areas of everyday life. Getting directions is simpler. Old friends are just a click away. You can shop from your couch. Likewise, patient care has been enhanced by many new tech-friendly tools. Physicians and nurses can upload patient information to a database; photos and assessments are stored in one place. But as with the use of all technology, healthcare providers must be careful not to become too immersed in the digital age and forget the value of hands-on, traditional care.

  Barbara J. Rozenboom, RN, BSN, CWON is adept at making the most of available technology while utilizing traditional bedside nursing skills. She attended Marshalltown Community College (Marshalltown, IA) in the early 1980s. She earned her LPN in 1982 before heading to Mercy School of Nursing (Des Moines, IA) to earn her RN diploma in 1987. While in school, Barbara worked as a staff nurse at Mercy Medical Center (Des Moines, IA) on a number of different units, including General Surgery and Urology, Surgical Intensive Care, and Post Anesthesia Recovery. In 1993, Barbara took a position as a staff nurse with the home care and hospice faction of Skiff Medical Center (Newton, IA).

   After working full-time for a couple of years, Barbara decided to go back to school, and in 1999 graduated from Graceland College (Lamoni, IA) with a Bachelor of Science in Nursing (BSN) degree. That same year she completed her WOCN certification through the WICKS Enterostomal Therapy School. “I was working in home care when I earned my BSN, and my employer at the time asked if I would be interested in going to WOC training,” Barbara says. “At the time, Skiff Medical Center was contracting with a WOC nurse and thought the position would be valuable to add to the facility services. I jumped at the opportunity. I had worked with patients with wounds and ostomies in both acute care and home care settings. I enjoy a challenging patient situation, and it is rewarding to develop a relationship with patients while providing education and tending to their specific needs. I found my niche in wound, ostomy, and continence care.”

 After more than 30 years as a nurse, 13 of which have been spent in the wound, ostomy, and continence arena, Barbara has seen a lot of change. She currently works as part of a team of WOC nurses for Iowa Health Home Care, an agency comprising eight home care agencies in Iowa and Illinois. The company utilizes current technology to advance the standard of care provided. “Bedside and home care nursing have changed immensely through my years as a nurse,” she says. “Initially, computer technology wasn’t a concern, but gone are the days of blue progress notes and a black pen. We utilize a computer software program to manage approximately 800 patients with wounds and ostomies statewide, working closely with the clinicians who make the home visits. They enter photos and assessments into the computer, and we review the documentation, coding, and treatment plan and collaborate with the nursing staff and physicians to ensure patients are receiving appropriate care and treatment for the type of wounds they are experiencing. This technology helps clinicians provide evidence-based, best-practice, cost-effective care for wound and ostomy patients in the home care setting. Practicing WOC nursing this way allows us to manage a large volume of patients. I don’t know that technology has increased our caseload, but it does allow us to be involved in more than just the most complex cases or a select few patients. It also provides us the opportunity to expand the wound and ostomy care knowledge of our clinicians, most of whom receive very little ostomy education in nursing school. WOC nurses have a wealth of information, experience, and resources to share.”

  As one of only three wound, ostomy, and continence nurses employed by Iowa Health Home Care, Barbara believes technology has allowed her and her colleagues to evaluate and monitor multiple patients more consistently than was possible only a few years ago. But while technology has made many areas of nursing easier, Barbara has learned that sometimes everything you need to know about a patient isn’t written in a report or visible on screen. Talking with a colleague about a patient, or to the patient himself, instead of relying solely on what is in the digital report can reveal vital information. “Ostomy patients benefit from face-to-face visits,” Barbara says. “We try to see our ostomy patients for at least one teaching visit at home. It also is gratifying to collaborate with nurses to help them understand the whole picture of what is going on with the patient and how the patient’s comorbid conditions and lifestyle choices affect their wound care. Computer technology is efficient, but I believe it sometimes takes away from the personal care and conversation between a clinician and patient.”

  As new technology continues to flood the market, Barbara will incorporate new ways with old to provide patients and clinicians the best of the two worlds in her scope of practice.

This article was not subject to the Ostomy Wound Management peer-review process.

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