My Scope of Practice: A Rose by Any Other Name Could Be a Stoma
Ability is what you are capable of doing, motivation determines what you’ll do, our attitudes determine how well you do it. – Raymond Chandler, novelist and screenwriter
Sandra Rohr, BSN, RN, CWOCN once cared for a patient who wasn’t quite ready to come to terms with her stoma when she first returned home from the hospital. When Sandra walked through this woman’s house, she noticed it was decorated with pink flowers. While she explained to the woman the steps needed to change the pouch, Sandra mentioned that the stoma looked like a pink rose. The woman, who had been so saddened by her situation, smiled and sighed, perhaps with acceptance. This small moment reflects Sandra’s ability to recognize that each patient is unique and you can utilize that specialness to provide quality care. Sandra started her nursing career in 1989 at a long-term care center. From working with patients with chronic illnesses to helping people in need of immediate medical services, Sandra eventually transitioned into the role of Emergency Medical Technician (EMT). She worked with the local ambulance service for 8 years and saw numerous wounds over that time. Although her work experiences exposed her to two very different sides of healthcare, it wasn’t until she began working on the gastrointestinal floor of the University of Iowa Hospitals and Clinics that she fell in love with ostomy care.
After going back to school to earn her BSN from Mount Mercy College (Cedar Rapids, IA) in 1999, Sandra had the opportunity to immerse herself more deeply in the world of wound, ostomy, and continence care, when she began work as a home care IV infusion nurse with Option Care (Cedar Rapid, IA). Because of her passion for wound care, the company sent her to webWOC in 2005 to get her CWOCN.
By 2006, Sandra was ready to put IV nursing behind her and focus entirely on wound, ostomy, and continence care. She started a WOC consulting service, CarePro Health Services, that works with hospitals, wound clinics, home health agencies, and long-term clinics. More than 6 years later, Sandra’s WOC consulting service continues to educate and treat patients throughout Iowa. She maintains oversight of the business aspects of her company, but she still finds treating patients one of the perks of the job. “I really enjoy the independence and the ability to truly impact the patient’s outcome at the bedside,” Sandra says. “That smile from past patients who have been helped is worth more than any amount of money I could receive.”
CarePro Health Services is expanding. The company recently started a continence program and ventured into WOC care for long-term care. As part of the expansion, Sandra has started to focus more on education at all levels. It may take away some of the time she can spend at the bedside, but Sandra understands the importance of educating her staff and patients, especially with the standard of care constantly evolving and new medical products coming available. “I believe knowledge is the key!” Sandra says. “Patients and medical professionals often have a hard time with paradigm shifts, so helping everyone keep up with the fast pace of our ever-changing profession is crucial.”
Aside from remaining on the cutting edge of wound, ostomy, and continence care, Sandra knows that nurses are now expected to go above and beyond their traditional job description. “They are expected to understand the financial outcomes that impact our jobs and ultimately the care they are able to provide,” Sandra says. “I remember when we just did what was best for the patient, and now over the last few years, we see insurance and Medicare dictating what, when, and how patients receive their care. To address the need for information, I provide a great deal of inservicing and education for home health and hospice care. As part of my contracts, I offer one inservice yearly.”
To learn and stay on top of the many aspects of healthcare business, Sandra collaborates with pharmacists, integrative professionals, DME companies, and reimbursement specialists. A bonus to this collaboration is that she gets to witness the “Ah ha!” moments that can benefit practice.
Insurance companies may be influencing how and when care is given, but Sandra is using her ability to educate others in an effort to get all healthcare professionals on the same page when providing care for a patient. Sandra is committed to helping doctors and surgeons recognize they are treating a person, not just a diagnosis or a wound. “I think one of the barriers to giving optimal care is getting staff and upper management to include doctors in understanding the concept of treating the whole person,” she says. “I do a great deal of education on payment and coverage for wound and ostomy supplies. Once when I was working with a outlying wound clinic in a hospital in rural Iowa, I spent time with the wound physician, explaining dressing costs covered by insurance and how some staff at the care facility may not know what to expect or report. Where and by whom care is provided are factors in determining the best treatment and coverage.”
But most of all, Sandra has seen first-hand how taking the time to personally get to know each patient can enhance care. When Sandra encountered a patient who cleaned his stoma and pouch with a watering pot, she didn’t try to encourage him to do something more conventional. Instead she helped him where she could — in this case, providing 6-day appliance wear— and saw great results. “It takes the nurse’s creative abilities to help ostomy patients adjust; the first step in that process is gaining trust and learning about the patient,” she says.
Different tactics work for different patients; she seeks to find the rose in everyone’s life. It’s this understanding that Sandra has come to define as standard of care. For her, it’s not just knowing the best medical techniques. It’s the knowledge of the ways and willingness to gain the confidence and respect from patients that define her scope of practice.
This article was not subject to the Ostomy Wound Management peer-review process.