Daily Workload / Caseload

[Noyse, BSN, RN]

I am considering a WOCN program.  But am interested in perspectives from the group.  Also, any additional information that you think I should know would be very much appreciated.

1) For hospital-based WOCNs are most of them their own separate consult service?  Or are they attached to a single department?  What is the workload like for a hospital-based WOCNs?  How many patients per day?  An old post from 2015 indicated that some are stretched thin (2 nurses for a 450 bed hospital) averaging 8 hrs / 12 pts = 40 mins / pt.  That's a full day if you consider some of them may be new ostomy pts and then there is documentation.  Is this old post still true?

2) How much time is spent on documentation/paperwork vs actual patient care?  How many attributes are documented for each wound?  In the Homecare Homebase EMR used in home health, there are 34 questions for each wound.

3) I realize that every clinician must assess the entire patient and wounds are a symptom of a systemic breakdown.  But how much of the non-wound patient care does the WOCN wind up doing?

4) Also, are there LTC/nursing facility-based WOCNs?  What is their workload like?

5) Is it true that home health care WOCNs mostly work by computer?  How many assessments per day are they responsible for? 

6) Do WOCNs typically work weekends and holidays?

7) Is compensation on a per-year, per-day, per-hour, or per-patient basis?  Does compensation include benefits such as health insurance and vacation?

Thank you in advance.

[EtakRN]

I've been an inpatient WOCN for about 6 years. To answer your questions-

1) I've worked within 2 general team models. The first was within an independent, RN-led, WOCN team. We had higher management over us (CICU manager) who was very supportive but deferred to out knowledge for all WOC-related clinical issues. The other is within an NP-led team. Our lead is an NP who is also specialized in wounds. She oversees us and the outpatient wound care clinic. We see anywhere from 8-12 patients a day. As you noted, really depends on the patient how much time they require. I am currently the only WOCN for a 350 bed urban hospital and I feel quite stretched. 

2) I spend more time with the patients than I do documenting. It probably shakes out to 5ish hours with the patients and 3ish doing paperwork. Some days are heavier on the paperwork, as we oversee the wound committee, NDNQI, report to upper management related to HAPUs... There is a lot of behind the scenes responsibility. 

3) My assessments are pretty focused. I'm not doing full body exams unless whatever I'm consulting for requires it. (Ex: If I'm seeing a venous leg ulcer, I do a LE exam and ask pertinent questions, but I'm not listening to their heart/lungs). I do a decent amount of basic care in the sense that a decent amount of patients I turn are soiled and I clean them up. I try to avoid getting too sucked in, but when the primary nurses and techs are swamped I help. 

4) / 5) I don't have experience outside of the hospital.

6) I have never worked weekends as a WOCN and holidays have always been optional. However, from what I hear this varies between facilities. 

7) In every job I've held I've been compensated hourly and as a full-time employee receive PTO and health insurance. 

In my experiences interviewing and working, certified WOCNs are rare and in very high demand. With a few years of WOC experience, this gives you a lot of bargaining power. It's a great specialty- It's fun, fast paced, you get to work with every team in the hospital. There's also a lot of other skills that come with it- data analysis, team leading, presentation giving. Obviously I love it, hope you do too!

[Noyse, BSN, RN]

@EtakRN Thank you so much for your candor and your thorough answer.  That gives me a lot of good mental preparation for what lies ahead.

For any others out there I would be interested in your experiences too.  Especially Question 2.  I am also very interested in anyone who works in a outpatient clinic and what that is like.