inpatient wound versus outpatient wound clinic

[diva_nurse]

Hello wocn nurses

Will be starting webwoc wound/ostomy program and wanted to know the pros and cons of working inpatient wound dept versus outpatient wound clinic

Thanks

[Candogal]

I can only give you an outpatient view as I have only worked a 2 out-patient clinics. You see the same patients over and over again most seem like a weekly basis which means that you have time to educate and see the wounds progress. It's usually an 8-4ish job- no weekends, no major holidays. The majority of the patients are stable. You are never alone-there will always be another nurse or doctor-it's a real team environment (again this is just my experience). It's pretty low stress. Of course you stand all day and it's busy at times. The main doctors tend to be podiatrists as there are a lot of below the knee wounds. You pretty much always get a full half hour lunch break.

[woundnurse4u]

I have worked in both arenas.

Out-patient clinics are great because they tend to be more cutting edge and have access to some interesting treatment modalities. I learned a lot more than about specific treatments. You will be busy in an out-patient setting but the pace is different. You will also develop a different relationship with the clientele, something that you can't easily do in a fast paced hospital environment. The downsides were dealing with insurance issues, client non-adherence, getting HHC on board with the plan of care (as in HHC nurses not following physician orders), and keeping the flow of appointments moving (you never know when you will get a client who needs crisis management). And because you will be working in such a small area, you do not have the dilution that you get in a hospital. If someone is having a bad day then you are going to know about it.

Acute care is great in that you will see wounds in some of the worst conditions and it is a little more challenging to work on complex cases. I learned a lot about procedures (you don't deal with revascularization surgery in an outpatient setting). The upside is that you have a captive audience and if you need to get diagnostics done, it isn't as much of a hassle since the resources are right there. You will have your hands on the most extreme cases and you will be challenged as a clinician. You will work with every patient care department from the ER to the OR to the ICUs. You will also be involved with policy and practice, staff education, and product evaluation. You could also be involved in qualitative research and performance improvement initiatives as well as Quality endeavors. You will get a VERY comprehensive job experience. The downside is that you deal with a lot more politics and issues that nurses don't want to deal with. Hospital politics, cost containment issues that are so extreme they interfere with good patient care, risk management and legal issues, and added responsibilities that may have nothing to do with your department.