My Scope of Practice: Don’t Sweat the Small Stuff
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”Were there none who were discontented with what they have, the world would never reach for anything better.” – Florence Nightingale, English pioneer of modern nursing
As many wound, ostomy, and continence nurses would tell you, they don’t treat just a wound. They treat the whole patient. This holds particularly true for Janette Dietzler, MSN, RN, CWS, COCN, FACCWS. As a manager, clinician, and educator, Janette is treating the wound, the patient, and all related issues with an eye to the big picture.
Janette attended Missouri Baptist Hospital School of Nursing (St. Louis, MO) in the 1980s. During this time, she worked as an EMT on a small rural ambulance district and as a nurse’s aide in a nursing home near her house. Both of these jobs helped reaffirm her career choice and her passion for wound care. After graduating, she worked in several different hospitals to accommodate her husband and growing family. In 1991, she was hired by St. John’s Mercy Home Health Agency. Eight years later, she was offered the opportunity to work for Unity Health Systems in a position where she would support a large physician group as the Wound Care Specialist, helping to manage high-risk patients.
In 2000, Janette was hired as compliance coordinator to address skin and wound care at St. Anthony’s Medical Center, a 767-bed facility that serves more than 918,000 residents in the St. Louis area. Her role gradually evolved to Clinical Coordinator, where she assembled the Skin and Wound Assessment Team (SWAT) of nurses trained in skin, wound, and ostomy care. “As the inpatient Clinical Coordinator, I was able to grow the SWAT program from conception to completion, re-writing the skin and wound program to ensure pressure ulcer prevention was addressed from the moment a patient entered the facility through discharge,” Janette says.
With the newly developed skin, wound, and ostomy policies (including educational events) in place, staff understanding and awareness of pressure ulcers increased and the incidence of hospital-acquired pressure ulcers significantly decreased at a time in healthcare where, in many cases, few facilities were aware of their incidence rates.
By 2006, a clear need had emerged for outpatient services in wound care. In response, Janette and the program director Ellie Sicola developed an outpatient treatment center for St. Anthony’s. Although they started with little more than a receptionist and four treatment rooms, the new program grew so quickly they met their 3-year Performa in the first year. In 2011, the center saw some major changes. An ostomy clinic and new hyperbaric oxygen treatment center were added and a standardized Skin Care Protocol was developed to be followed by all areas of the hospital to improve communication between levels of care and ensure delivery of cost-effective, optimal patient care.
Patient costs have become a huge problem for many treatment centers, including St. Anthony’s. “Unfortunately, the most challenging aspect of wound and ostomy care is insurance reimbursement,” Janette says. “It affects everything. Many patients today do not have insurance. For those who do, providers have to jump through many hoops to help get them care. Sometimes it can be very difficult to achieve the best possible outcomes.” But that doesn’t stop Janette and the rest of her team from trying. Sometimes they rely on creative alternatives to expensive products, such as using maternity pads in place of army battle dressings to cut costs.