From my experience in Alaska, a Tx nurse is a great asset, but if having one spoils the floor nurses so that they end up sloughing off all Tx-related involvement into the lap of that Tx nurse, then the Tx nurse gets so busy with paperwork, documentation, renewing orders, assessments, committee mtgs, consults & rounds, MDS coordinators and DON constantly riding them for the latest data, etc... that they won't have any time for actual wound care & treatment! They'll be forced to go qoD, q3D, then tempted to go q4d "if it looks OK". etc... OR, some will prefer to take care of the patients really well and let the paperwork slide, which is fine for the patients, but puts the facility and every nurse who works there at great legal risk. Still other Tx nurses might burn out quickly and need to be replaced by other people who may or may not end up being right for the position (many people are not right for the position).
A good Tx nurse has to be supported and appreciated by all staff. CNAs need to actually position pts, people need to do proper admits and weekly assessments (with proper staging, description and grouping of wounds)...
Floor staff need to understand that if their Tx nurse fails, then they'll be back to performing med pass AND Tx simultaneously. A good Tx nurse also has to be pretty strict and tough with those nurses who will try to pass off admits, weekly assessments, brand new skin tears, etc.
The job of the floor staff is (~generally) to get everything into the TAR for the Tx nurse to treat. The job of the Tx nurse is to come into work, look at the TAR, and follow through on what's in there and branch out from that fountain of information (ah, it sounds so easy until you actually work one week of Tx getting elbowed in the face by senile patients who think you are molesting them).
And it's that "~generally" word that some nurses will take advantage of (the slippery slope)... if the Tx nurse is seen doing admin things, people's "wishful thinking" will kick in every time they are faced with dealing with wounds or Tx issues... they will start ignoring any Tx-related orders that come in, calling over the Tx LVN and delegating to them as if they were a CNA for every bruise, etc. The Tx nurse has to say "NO" to all of these things and demand staff compliance with the policies set up by the skin committee and facility. That, or, the facility needs to employ more Tx nurses. Another slippery slope.The Tx nurse needs a very tight set of parameters and job description, yet also have the ability to step in and do extra stuff voluntarily. Basically floor nurses need to be held accountable for getting everything into the TAR. Supervisors need to pass a test on staging and describing wounds. CNAs need plenty of training on prevention and skin issues, maybe even describing staging so they can report what it looks like to the nurses. Having unclear roles and responsibilities gives the slackers plenty of room for excuses and reflects negatively on those doing the best job. At least that's how it works in Alaska.
Here's a little trick for Tx LVNs: when somebody asks "do you want to come do the assessment for the new admit?!" (you are at the end of your shift and yet you have 7 pts who direly need their treatments). DO THE FOLLOWING: 1) ignore the guilt trip being laid upon you, and then 2) mentally translate that question to: "do you want genital herpes?" Your mouth will automatically provide the correct answer, which is "NO". Because you have treatments to execute (just as others have "meds to pass", and after that you have complex documentation and reporting to provide just like everyone else.