RachRN11

To become a CWOCN (WOC certification), they require a bachelor's degree. There are other options, however. Look into wcei.net they offer a wound care specialty.

I wasn't sure if there was such a thing so I just googled it and this is what I got out of that search - CNA - MA Wound Certification Course | Certified for Nursing Wound Care Wound Care Training for Certified Nursing Assistants (CNAs) Skin and Wound Resource CNA Class — News Room - UNC Health Care Good luck with your endeavor!

Good questions. I'm not sure if my answer is the correct one but for the first one I would document something like "previously unstageable, now stage III ulcer presents with...etc" And same with the 2nd one "previously suspect deep tissue injury has evolved into unstageable with wound bed 100% covered with slough...etc."

I have a patient that we don't know what to do with. She is limited in her mobility so TCC may be a safety issue (more falls) but she isn't compliant with keeping pressure off her heel. How often do you use a total contact cast on a diabetic heel (plantar surface) ulcer? If you do use TCC, how often is the wound successfully healed? Thanks!

I was very fortunate with my job situation. I had made it known to my director (at the time) that I had a goal to become a wound nurse. Luckily, at the same time the wound clinic in the same hospital was looking for a wound nurse. So my name was passed along, they sent me to become certified (also very fortunate as it can be expensive) and had a new job when I returned. Technically I started working as just a WOC nurse (obtained the education but wasn't certified) and within the next 6 months I took the tests and became a CWOCN. I don't think that it's a dead end certification but that most places don't realize that they would benefit from having a CWOCN. You may have better luck marketing yourself to nursing homes or home health care agencies if you can't find an actual clinic. It also might help if you're willing to move, I occasionally see listings for wound nurses but they're often in other states (I live in Illinois) I had a classmate that got the certification without having a job to go back to (she returned to work on a general medical floor in a hospital) but within 6 months or so she got a new job at a new hospital as a CWOCN. It's tough going to achieve something without knowing whether you're wasting your time, but I do think if you obtain your CWOCN you will find a job eventually..it just might take a few months.

Please don't mistake me for confrontation, I was just curious as to why you'd use santyl if there is no slough? I'm thinking there's a secondary use that I don't know about and I would like to learn more :)

I think it depends on the clinic and what they want from their employees. For example, the clinic I work at is currently looking for an RN to hire with experience preferred but not required. We'll probably ask them to eventually get certified but they can begin working without one. We're a smaller wound clinic trying to build ourselves up. So, I think it's mixed and (not to be cliche) the best way to know is to ask the clinic you want to apply to. Sorry, I'm not much help! As for certification, there are options. You can become a CWOCN (certified wound, ostomy, continence nurse) which is typically seen as the "gold standard". Visit www.wocncb.org to get more info. There is also WCC (wound care certified) and DWC (diabetic wound certified) which I believe are just a one week classes then you probably have to take a test. Check out www.wcei.net Also CWS (certified wound specialist) which I don't know too much about but my co-worker did it online and then had to take a test. Hopefully some of that can get you started. Good luck!

I've been a CWOCN for only 2 years so I may not know a lot of info. But to answer some of your questions: I work in a hospital where we have an outpatient clinic and I also see inpatients as well when I'm consulted. On the inpatient wound side, I'm consulted when a patient has a wound that needs more of an "expert" opinion on it's treatment. I evaluate the wound and come up with what I think is the best treatment. Whether that be some type of dressing or even referring out to a specialty practice (podiatry, vascular, surgery, etc.). I don't do every dressing change (unless it's a wound VAC or compression wrap), I come up with the plan that the floor RNs can carry out then I re-evaluate the patient and the treatment once or twice a week depending on how extensive the wound is. On the inpatient ostomy side, I'm mostly consulted for new ostomy patients or if a patient is having trouble with their ostomy. For patients who don't have an ostomy but will be getting one, I teach them about basic ostomy care and mark their abdomen where an ostomy could go (surgeon ultimately has the final decision). For a new ostomate fresh out of surgery, I meet with them about 3 times (or more if needed) and teach them how to care for their ostomy. Inpatient continence side isn't really used. If I worked with a urologist I would definitely use the continence aspect of CWOCN more frequently. I do caution other RNs that catheters and rectal tubes can damage sphincters and that they should be removed as soon as possible otherwise the patient may face incontinence issues in the future, but that's about the extent of it. On the outpatient wound side, patient's get referred to our wound clinic. We meet, evaluate and come up with the best treatment. Depending on the dressing, we'll teach the patient how to change it or the patient will come back to use every so often and we'll change the dressing. Sometimes they have home health care or are from a nursing home, so we pass our recommendations on to them. I occassionally get a referral for an person with an ostomy who is having trouble with their pouches or has skin breakdown. They come in on an outpatient basis where I evaluate what's going on and try to come up with a solution. Whether this is field is in demand is kind of mixed. Yes, I think it should be in demand because there are a lot of wounds out there that aren't being treated appropriately. We have patients who come in after having the same wound for years and years. From what I've seen, you won't see many job postings looking for a CWOCN. What you may have to do is market yourself and tell them why having you would be greatly beneficial. I was very fortunate to get to where I am now - I was interested in becoming a wound nurse, the wound clinic needed one and viola, I had a job. I know this isn't reality for a lot of people but I do still think it's worth obtaining your CWOCN. It'll definitely make you more marketable! For my training, I went to Cleveland and had education at Cleveland Clinic. I actually lived in Cleveland for 2 months (how long the on-site education is). I believe the online version is 6 months then you have to find a preceptor to get your clinical hours in, but I may be wrong. Once you get your education, you're then a WOCN. You'll have to take 3 tests (one for wound, one for ostomy, one for continence) in order to be fully certified. Now, you can always opt out of taking any of the 3 tests. So, if you only want to be certified in wound, you can choose to not take the ostomy and continence version. Your certification would be CWCN (certified wound care nurse). Ostomy only would be COCN, CCCN would be continence only. You can mix and match as well (be certified in 2 and not all 3). You have to recertify every 5 years, which means you'll have to take the 3 (or however many you want) tests again. I suggest going to wocncb.org . That's the certification board's website. It will walk you through the different cities that offer education, what all you need to be accepted into the class and whatever else you need. That's where I got all of my information when I was looking, anyway. Good luck in whatever you decide to do! I'm okay with (trying to) answer any more questions if you have any!

Yes, what you're feeling is normal. YOU are normal! Nursing school is rough..really, really rough. I'm pretty sure I wanted to switch my major every semester because nursing school stressed me out too much. But hey, I made it and YOU WILL TOO! Honestly, the best answer I can give is that you will feel more comfortable the more experience you get. I would be willing to bet that if you look back on this post come the end of the semester or your clinical rotation you will feel 10x better about things. It's good to have a little stress, it shows that you care and you want to do a good job. However, be kind to yourself. You are still learning. You're still a student. You don't know everything (heck, no nurse knows everything!) and if there's a time to make a mistake, it's while you're in school (although you will continue to make mistakes after school...that's life). The instructor points things out that are "wrong" in your charting to help you learn, that's their job. Even if you were the best student and hardly made a mistake, I bet your instructor would still tell you that something needs fixed. If you are really worried, ask your instructor how you're doing and if they feel like you're staying on track. Don't give up. Just keep on keepin' on and be kind to yourself. Give yourself the chance and opportunity to learn and grow not only into a nursing career but as a human being. It's okay to be stressed, it's normal to be anxious. You are fine and you will continue to be fine and one day you will be on the other side of this and be giving other stressed out/anxious students advice and encouragement!

Well some of these aren't the nicest of comments. We all have bad days and we all rant. I would certainly rather you rant on here than take out your frustration on a patient and/or family member. Pretty sure I've written down things about what I wish I could say to patients but can't...I KNOW everyone has thought of it so to say that you should re-evaluate your quality of care is just plain rude and unneccessary. Health care is very frustrating. Patient's and family members can be difficult to deal with but that doesn't mean you aren't doing a good job. Some people are just plain difficult, end of story and no matter what you do they will stay that way. Nursing is an often thankless job, we hear that over and over again. I'm all for ranting and writing out your feelings so you can get them out and not internalize them. Keep doing you and ignore those who say you aren't doing a good job because they obviously have no idea if you are or are not based on one single post.

I can understand annoyance, but this is a free website that invites anyone to sign up. Also, you can simply just stop clicking on the question links and your problem would be solved.

I wear Skechers Go Walk (or Go Walk 2), they're slip-on shoes with memory foam. Super comfortable and light weight.

Whoa....calm down, it's just a cartoon (and website).

I think you need to just breathe and be kind to yourself. You haven't failed at those things you mentioned in your post. You are still a student and you are still learning. I can also be an overly anxious person with the first gut reaction of running and quitting, but you have to dig deep and push yourself through uncomfortable situations. We've all made mistakes, a lot of mistakes, that's how we learn. By the way, does BSL stand for blood sugar level? If so, next time have the patient put their hand in a dependent position (hanging down) so blood will go to the finger tips. You can also try a warm blanket to help dilate the capillaries. It's okay to not want to hurt the patient, but sometimes you have to cause a little pain. If it happens again, just laugh it off and try again. Give yourself a chance to keep trying. If you need to, find a quiet corner, bathroom stall, or stock room to breathe and calm down for a minute or two. Then give yourself a quick pep talk and get back out there! You got this!

When I was a student, I once "wasted" 3 catheters on the same patient because I kept hitting the wrong hole. Don't sweat it, nursing takes practice and you'll get there :)

I'm a wound care nurse and work with a PT who specialized in wounds, used to work with a PTA who also did wound care until she switched jobs. They both had been doing wound care for 14+ years. Wound care shifts between PTs and RNs frequently and it's not that uncommon to have a PT/PTA do wound care. It can be within their scope of practice if they choose to specialize in it. PTs are master/doctorate degrees so they know a lot about the science of the body. You may find OTs who do lymphedema care as that's something they can specialize in as well.

I was not a fan of floor nursing. I disliked how hectic, demanding and unpredictable it could be. I was given a wonderful opportunity to earn my wound, ostomy, continence certification and now I work as the hospital wound nurse. My schedule is whatever I make it to be. While I may have many patients "under my care" so to speak, I don't see them daily. I evaluate the wound and recommend a treatment for the floor nurses to carry out. So I see the patient once or twice week to check up on the wound. Nursing is a great career and there are many nurses that don't even work in hospitals or directly with patients. I'm not sure where to lead you but to google. A lot just take a special certification which is less schooling (I had to go to classes for 2 months to get my certification). Good luck and I hope you find your calling! Don't give up on nursing yet!

I'm not positively sure about this, but since you submitted your paperwork to Illinois, you'll get a license for Illinois. In order to obtain a license in a different state, I think you just have to fill out paperwork and maybe pay some money. Although, Missouri and Illinois may have reciprocity. I'd send a quick e-mail to the board of nursing for each state and see what they have to say.

I've been a CWOCN for almost two years now. I work at a small hospital so I get maybe 1 stoma patient a month, if that. The bane of my existence as a stoma RN is the pesky ostomy bridge. I can't seem to apply the pouch correctly to stop leaks. Once the ostomy bridge is out, I'm good, but until then it's a battle. One problem I think is that my pouch flanges are small and don't completely cover the ostomy bridge. My hospital uses Hollister ostomy products, the bridge is like an X and is sutured down at each of the 4 ends. The stool tunnels under the bridge and out the pouch sides. Should I use a ring? Hydrocolloid sheet? Tape down the edges? I've tried to outline the bridge with ostomy paste and it works sometimes but not all the time. I don't want the patients to think I have no idea what I'm doing so any suggestions would be greatly appreciated! Thanks!

First - congratulations on joining the fulfilling career of nursing! I just want to point out that you being concerned and want to better yourself is a good sign! Hang on to that, it shows that you are a good nurse, even if you don't always feel like it. Med-surg floors are ruthless. They're tough, they're busy, they're chaotic. So what you are experiencing is not out of the ordinary. Which doesn't make it less sucky, but don't feel like it's just you. Also, I know you may feel like you should be better at this but you've only been at this for a little under a year! Nursing is all about experience. My preceptor told me, when I first started, that the first 6 months I will feel like I know absolutely nothing, it would take me a year to begin to feel comfortable and it would probably be a good 2 years before I actually knew what I was doing. Nursing is mostly experience. I first started out nursing on a surgical floor where we could have up to 9 patients each (not that we liked it...at all) so it could also get a little chaotic. What I found worked for me was after getting report, I would set up the patient's medications (we had computers on wheels that had drawers and lock on it). As I was passing medications that were due, I would also do the assessment. After that was done, I would go back around and help people get up, walk and what not. But what worked for me may not work for everyone. The key is to try different routines until one of them works, establish a good rapport with your CNAs so you respect each other and work together. Sometimes health care is a lot of trial and error (that's why it's called a practice). Regarding real-time charting - we were expected to do that too, but sometimes it just isn't possible. Do what you can. Patient's come first, not charting. What helped my reporting was exactly what you are thinking of doing - I made my own sheet. Since I made the sheet, I was able to follow my train of thought better and give more cohesive reports. I think the most important thing for you to do is to be kind to yourself. Realize that you are new to this and that it takes time. We've all been there. I realize that some nurses forget that they were once new too, but most of us understand and empathize. We're all there with you in spirit. You got this!

Go for your dream! You'll never know what you can accomplish if you give up before even trying. I'm pretty bad at math myself but if you are determined and you study you'll get through it. Chemistry is hard (at least for me) I went to every extra teaching session my professor had because in reality, I was paying them to teach me and they were going to do it! Study groups are good too, you'll get different perspectives on the same problem. Look up any tutors your school offers too. If you ever find yourself struggling, talk to your professor and see if they can provide any extra help. Nursing school in itself is kind of a road of misery (haha!) but worth it in the end. Don't give up on yourself!

You won't know if someone will hire you if you don't try. You could continue with your current job while applying to others and see where that gets you. :) The first year or so is rough as a new nurse. Everything is really overwhelming. I remember my preceptor telling me that I'd have no idea what I was doing for the first 6 months, I'd begin getting comfortable at 1 year and I'd actually know what I was doing at 2 years in. It all takes experience, so just hang in there! The saying "it'll get worse before it gets better" is pretty accurate for first time nurses. As for the IV sticks, a nurse I used to work with showed me how to practice. Take kerlix (rolled gauze) and an old IV tubing (like from a piggyback) and wrap it around the kerlix in all sorts of directions. Stuff the kerlix/IV tube into a medical glove and then practice starting IVs on that. It gives you the feel of skin (sort of) and the kind of "popping" sensation that happens when you get into a vein. Also helps with muscle memory and confidence. Good luck in everything!

This may have already been suggested but you could put menthol lip balm under your nose when you know you're going to be encountering some gross smells. You could also try wearing a mask, or putting fragrance drops (like mint) into the mask and wearing it into the room (although it can come off as rude to the patient. You could state that you have a cold and don't want to spread it, maybe?). Overtime I think you'll get used to it though. :)

You could try barrier cream or maybe it's a yeast infection and needs some nystatin.

Being a new grad RN, as you said, I wouldn't overload yourself. It can be easy to get overwhelmed in one job. I'd stick with the full time job and either go per diem with the second job or just quit it altogether. I say start slow then work up the momentum if you find yourself bored on your days off.