Career Change to Wound Care

[coolbreezegurl]

Hello All, let me just start out by saying I love this site because there are so many experienced nurses out there willing to give great advice. That being said I would like some input from wound care nurses. I am currently working in critical care and this is all I've ever known. I graduated from nursing school in Dec 2013 and went directly into the Intensive Care Unit (basically thrown to the wolves) and this is where I have been for the past 1.5 years. I just earned my BSN this past May so I am looking for a change to a better environment. The facility I work at is one of those "despicable" hospitals (for anybody who hasn't read that article on this site, its a great read, I identified all too well with the nurse in the illustration). Things are only getting worse, and I am frustrated because I feel I have hit a wall and I am not learning anything new. The physician/nurse communication isn't all that great and there is a huge disrespect for nurses that borders on contempt at times when it comes to some of the physicians who have been there forever. Our facility is about to be purchased by a mystery company yet they keep putting off the announcement as to who is actually purchasing us and I think it is because there are some pending indictments. I just can't keep waiting for this company to get it together. I don't think I hate critical care, I think I just hate working in a place where nurses don't get any support. Our hospital caters to the physicians and patients and could care less if they run their nursing staff into the ground and create unsafe situations for patients (for which the nurse will ultimately be blamed).

I applied for a wound care position at another company with the intention of just doing PRN to get my feet wet and see if I like it. However, after talking with the recruiter for the second time she says they want to interview me for a full-time inpatient position with the understanding that I would eventually get certified in wound care, and they are willing to give me all the training I need (which is why PRN would never work, too much training needed). I have always thought of doing wound care, and of course in an ICU we see some nasty wounds (surgical wounds, pressure ulcers, venous stasis ulcers etc) so I have a tad bit of experience with wounds but nothing on the level of a professional wound care nurse. The job would be 8-4:30 Mon-Fri so it would take up more time (I'm used to working 3 twelves and getting my shifts over with and having several days off in a row). I need to know if what I am being offered is one of those opportunities that only comes once, and if I should jump on it or not. I love medication administration and critical thinking and titrating drips. I think I will miss this aspect of nursing if I go into wound care, yet I enjoy the idea of having more opportunities to educate patients, and develop a plan for how to treat them and monitor their progress. I think it would be very fullfilling. In the ICU I work nights and so I totally miss the patient education aspect most of the time (patient's sleeping, or vented/sedated no visitors around), also I don't have the freedom to discuss the patient with the physician because at night you can't just call them to discuss something none emergent without getting fussed at. I am still trying to get a grasp on my basic clinical skills, still trying to develop that nursing judgment and I just wonder if I am going to forget all that clinical stuff I have worked so hard to develop by switching to strictly wound care. With the schedule they are saying i would have to work I am sure I couldn't even stay on PRN in the ICU.

I would love to hear some input. Especially from someone who has been in my situation. Thanks in advance.

[CrunchRN, ADN, RN]

Jump on it!

[lovesongajp]

I can't say what's best for you but I am desperate to find the exact opportunity you're being offered. I would definitely jump on it! I have been applying to wound care jobs for months now without so much as even a callback. The education they are offering will look great on your resume regardless if you stay in the long term. Why not just try it and then if it's not your thing, try something else? I've been looking at programs to be a CWOCN and they run about $6500, not cheap out of pocket. Good luck with whatever you decide! I'm definitely super jealous! :)

[RNNPICU, BSN, RN]

Take it!!! I switched from 12s to M-F no weekends/holidays. At first I thought I would miss it, but now my life has normalized and is great. I have weekends off, normal dinner times, and even have the ability to do things in the evenings.

everything is a trade-off. Just as you found titrating drips, etc exciting, you will learn new skills, have new excitin adventures. You can't look at it as though you are losing something, think of it as gaining a completely new experience.

Have fun with it, you will gain an amazing new skill set.

[coolbreezegurl]

Thanks for all the replies so far. I am leaning towards taking it if it is offered to me. I set up an interview so I'm excited but so scared. I'm one of those people who will continue to be miserable just to avoid a scarey change. How irrational is that?! I just can't fight the feeling that I might really regret not trying to go for it even if ultimately I don't get hired. One thing that really appeals to me is that I might actually get to do more nursing and less waiting on people. I find that especially in the ICU patients/visitors get very needy and have the misconception that nurses are there as their servants. Sometimes they are so needy (usually the ones that aren't sick enough to be in ICU anymore) that I neglect my sick as crap patient because the not so sick one is on the call light asking for a million things and I tend to feel like a teenager working the drive thru at ARBYs instead of a professional adult who has gone through years of schooling. At least with wound care I would be interacting with the patient long enough to treat, teach, eval and then out and don't have to deal with nonesense as much hopefully.

@lovesongajp I believe you when you say you have had a hard time finding a wound care position. This is the first time I have seen one come up so that led me to believe it is not an easy field to get into.

@RNNPICU thanks for commenting on the schedule because I was really fretting over that. I really am hoping my life might normalize if I am working normal hours. In all honesty since I work nights I feel like I am almost always asleep on my days off. Also I agree that the wound experience will make me more marketable.

Thanks again

[Lize321]

Could you describe a typical day and like and dislike please.

[Turtle in scrubs]

It's tough. Defiantly a nice opportunity there, but I understand the hesitancy to give up the ICU. I'm in the process of transitioning from critical care to wound care. I love it, but it's early and I'm still learning a lot. I worry about down the road, missing much of the things I do enjoy about bedside nursing. If they are really hungry for you they may be willing to make a deal that you can do two shifts a month in the ICU. It's worth asking. Also, make sure you are asking "what" certification they are willing to pay for. There are a couple and they differ. Make sure you are getting what you want and what you feel would be the most marketable if you eventually leave that job. Good luck whatever you decide.

[coolbreezegurl]

Turtle in scrubs, I'm so glad to hear from you since you are in my exact situation. What is it that you love about wound care that makes it worth leaving the ICU for you so far? I have thought about asking to do an ICU shift here and there but I feel like I would need alot more training because right now I am at a smaller hospital than the one I might potentially be doing WOCN at. I don't think I would have time to train in the ICU to do things their way and learn all the millions of things I need to learn for the WOCN position. I know exactly what cert they are willing to pay for. The manager already told me and wants me to apply to the school. I'm so excited. To update everyone I am still waiting for an "official offer." I will give updates down the road on if I really get the job. Thanks for the input. I had a chance to shadow and I think this is where I am supposed to be.

[Turtle in scrubs]

Ah yes.. I get it. If you were staying at the same facility and just asking to stay on in the ICU you were already trained in, that may work, but it would be a whole different deal going to a different facility.

Sounds like you are itching for a change and this deal looks like a good one. I'm guessing they are wanting a commitment that you will work for them in this role for X amount of years. Just make sure you are wiling to do that and worst case scenario you try something different after that. Nursing is good in that way.

As for what makes it worth the job change. Like you I'm frustrated by the poor communication/coordination between nurses and doctors. Not that we don't have some wonderful doc's and PA's, but we also have our fair share who I know my shift will be more challenging because of and my patients will suffer in the care they get. I'm tired of that. So far as a WOCN I've gotten more respect from physicians and I feel like I'm actually working with many of them who I was previously just doing tasks for.

More importantly I like the work. I love the education aspect - educating staff, patients, family members. I love the autonomy of making my own schedule of my days activities (for the most part), the ability to get creative (seeing an area of weakness i.e.. several patients with trach ulcers and being able initiate change to reduce this), the diversity of my day (consults, presentations, supply chain meetings, surgery rounds, etc), and the movement and interaction I have with the rest of the hospital.

Above all I like not leaving every shift feeling like I didn't give adequate care. Not that I was giving poor care, just that there was rarely enough time to give everyone the care I would have wanted. Oh, and eating lunch isn't a bad thing either Not that the life of a WOCN isn't busy. I have more than enough to keep me busy and my days are never boring. If you are a thrill seeker (can't wait for the next code to be called and always request the most unstable patient) then you may not find wound/ostomy care quite as satisfying as I do. If however you like a different sort of challenge, one that involves coordinating with most every discipline in a hospital (PT, risk management, SW, surgery, etc), means being the go to person and "expert", and being independent and self driven, then I think you will love it! Good Luck!

[lovesongajp]

I'm so excited, I finally have an interview scheduled for tomorrow for an outpatient wound care clinic at an area hospital as a wound care nurse! Do you guys have any tips or advice? Did you take the job, @coolbreezegurl?

[woundnurse4u]

Just a quick word about one of your comments. You describe some frustration with the "needy" patient. If that is one of the things that you are seeking to get away from, you will still encounter such patients in wound care.

It never ceases to amaze me- I have wound care patients who have terrible, extensive wounds and they are rather quiet yet appreciative. I have wound patients who scream if you make a move toward them without ever touching their body (and some who should get an Academy Award). I have wound patients who ensure that I spend a great deal of additional time adjusting the thermostat, positioning their fan just so, changing the television channel, getting them a cup of ice, going for some extra blankets, and adjusting the blinds in the windows. And closing the door but leaving the door open at a 15 degree angle.

No matter where you go in nursing, you are going to deal with reactive and needy patients.

In wound care, you will deal with patients who refuse to listen to patient education, refuse to be engaged in their own care, refuse to comply with the treatment recommendations, refuse to follow up with their physician, and refuse to take their medication. I have had wound care patients try to change the settings on their wound vacs and turn their vacs off. I have had wound care patients insist that "their way was better"- whether it is a homeopathic treatment that isn't working or some crazy concoction of multiple dressings that serves no real purpose. Wrap it tighter (until my circulation is cut off). Wrap it loosely (so that it falls down to my ankle).

It takes a great deal of patience to work with wound care clientele.

[coolbreezegurl]

@woundnurse4u yes I did mention that I don't like dealing with needy patients, but I know it's inevitable. I am just grateful that I won't be subjected to it for 12 hours straight, and I can quietly disappear to the other side of the hospital when I'm done with them for the day.

@turtle in scrubs I do believe you and I are living the same nursing life, LOL. No I'm not a thrill seeker by any means, and I will be glad to get away from the anxiety of having an unstable patient that might code. I think I did okay as an ICU nurse, but for the most part I just don't feel like i have the personality for it. Oh and guess what? I got through 1.5yrs of the iCU without EVER having a patient code on me, but the thought of it alone was enough to upset my stomach every shift.

SO to update everybody. I DID GET THE JOB!!!!! I start my classes August 15th and if everything goes well I will have my certs by August 2016. So excited!!! I am anxious to get started and see what this hospital is really like since I have been at the same hospital since I graduated from nursing school 1.5yrs ago. Looking forward to seeing how another facility does things. Also looking forward to getting trained thoroughly. The hospital I am leaving promised me an orientation that I never really got straight out of nursing school. I pretty much had to fend for myself and grasp whatever morsels of knowledge happened to come my way. I have been reassured that at my new facility that they take training and orientation very seriously and I will not be thrown to the wolves, and I really respect that. I start next week and I will post about it soon.