Nurse practitioners and clinical nurse specialists who sub-specialize in wound, ostomy, and continence (WOC) care are responsible for the treatment and management of disorders affecting the gastrointestinal, genitourinary, and integumentary (digestive, urinary, skin) systems. As such, their scope of care typically involves the treatment of ostomies, stomas, acute and chronic wounds, and urinary and fecal incontinence.
Wound, ostomy, and continence nurses provide a multidisciplinary approach to treatment across a continuum of care and in a number of settings. Although WOC nurses have traditionally been an integral part of acute care teams, they are becoming an increasingly vital component to outpatient care and are now more frequently found practicing in long-term care facilities or providing in-home care. This has been driven largely by the increasing size of the elderly population as well as changes in healthcare policies.
Wound, ostomy, and continence nurses, in addition to being educated and trained to provide acute and rehabilitative care, are also often a tremendous source of comfort and support, both to patients and their families. The physical challenges that ostomies, stomas, acute and chronic wounds, and urinary and fecal incontinence present for the patient often produce emotional and social issues that need to be addressed. As such, WOC nurses are trained to deal with all aspects of wound, ostomy, and continence issues, including the provision of support, guidance, and counseling.
Within hospital or inpatient settings, physicians, case managers, social workers, or staff nurses may refer patients to WOC nurses, while outpatient WOC nursing services generally require a physician’s referral. In any case, WOC nurses always work in collaboration with members of a healthcare team to provide a comprehensive plan of care.
WOC nurses specializing in wound care are commonly found in acute, long-term, and in-home health care settings. They often treat and manage pressure ulcers, traumatic and draining wounds, surgical incisions, and tubes and fistulas.
Their scope of practice often includes:
- Treating skin reactions
- Preventing skin breakdown
- Treating and managing vascular ulcers, pressure ulcers and diabetic ulcers
- Initiating preventative measures
- Providing comprehensive wound management, including reducing causative factors, controlling odor, assessing nutritional needs, and providing and applying topical therapies
- Educating the patient, the patient’s family, and any other support persons on care techniques
- Assessing and treating draining wounds and fistulae
- Designing pouch systems for draining wounds and fistulae
- Implementing preventative actions to reduce the incidences of pressure ulcers and vascular ulcers
- Providing instruction on proper wound dressing
- Educating the patient, the patient’s family, and other support persons on ulcer prevention and treatment
WOCs nurses specializing in ostomy care are skilled to provide inpatient and outpatient care, as well as pre- and post-operative education, support and counseling for individuals who undergo surgery for colostomies, ileostomies, or urostomies. Their scope of practice often includes:
- Providing self-care, diet, and lifestyle education and support
- Preventing peristomal/stomal complications
- Providing rehabilitative care
- Assessing stoma site marking so as to decrease long-term complications and encourage pouching system adherence
- Reviewing and modifying pouch system problems
- Addressing and preventing peristomal skin complications
WOC nurses specializing in urinary and fecal incontinence often work in outpatient settings, such as long-term care facilities, and also provide in-home care. These nursing professionals provide a wide range of services that address causative factors, restorative strategies, and lifestyle/quality of life issues. Their scope of practice often includes:
- Selecting and recommending collection devices or undergarments
- Providing instruction on pelvic muscles exercises
- Counseling the patient, the patient’s family, and other support persons on hygiene and skin care
- Providing instruction on self-catheterization
- Identifying contributing factors and suggesting dietary and environmental modifications
Many WOC nurses have advanced training in nursing, along with post-graduate or post-baccalaureate certificates in wound, ostomy, and continence care through educational programs that can be completed through a combination of home study and on-site experience. Most WOC programs require, at minimum, that nurses be baccalaureate prepared.
It is common for WOC nurses to first obtain their Master of Science in Nursing, and then go on to receive their post-master’s certificate in wound, ostomy, and continence care. Some colleges and universities offer WOC training within their master’s programs, while many more offer post-master’s certificates once the nurse has obtained an MSN. All WOC programs contain both a didactic and clinical component. The curriculum of post-master’s certificate programs builds on the theoretical knowledge and clinical experience of the master’s prepared nurse.
The major areas of instruction in any WOC program include:
- Anatomy of Gastrointestinal, Genitourinary, and Integumentary Systems
- Pathophysiology for Selected Disorders within the Gastrointestinal, Genitourinary and, Integumentary Systems
- Medical/Surgical Treatment within the Gastrointestinal, Genitourinary, and Integumentary Systems
- Nursing Management of Patients with Altered Patterns of Elimination
- Nursing Management of Patients at Risk for Skin Breakdown and with Acute and Chronic Wounds
- Rehabilitation Concepts, Teaching, and Counseling Theory
- Principles of Leadership, Change Theory, Research Guidelines and Reimbursement Issues
The Wound, Ostomy, and Continence Nursing Certification Board (WOCNCB) allows WOC nurses to achieve certification in a number of specialty WOC combinations by offering the following certifications:
- CWOCN – Certified Wound Ostomy Continence Nurse
- CWON – Certified Wound Ostomy Nurse
- CWCN – Certified Wound Care Nurse
- CCCN – Certified Continence Care Nurse
- COCN – Certified Ostomy Care Nurse
- CFCN – Certified Foot Care Nurse
To qualify for WOCNCB certification, applicants must:
- Hold a current, valid RN license
- Hold a bachelor’s degree
- Fulfill one of the following educational and clinical practice requirements:
- Complete a WOCN Society accredited nursing education program within the five years prior to applying
The Wound, Ostomy and Continence Nurses Society (WOCN) currently accredits 8 WOC nursing education programs. Upon completion of these programs, nurses are eligible to site for the Wound, Ostomy and Continence Nurses Society national certification examination.
- Complete at least 50 contact hours or the equivalent in college work through a post-bachelor’s degree, for each specialty, within the five years prior to applying
The pathway must include at least 1,500 completed clinical hours within the five years prior to applying; 375 of those hours must be completed within the last year
The WOCNCB recently implemented an Advanced Practice Certification in WOC specialties. The first exam for the AP certification by exam will take place in July 2012. To apply for AP recertification through the WOCNCB, applicants must use a portfolio process known as the Professional Growth Program so as to demonstrate competency in specific professional growth areas. Applicants should contact their state board of nursing to determine how the WOCNCB AP certification can benefit their advanced practice specialty role. Designations for AP certification are as follows:
- CWOCN-AP – Certified Wound Ostomy Continence AP Nurse
- CWON-AP – Certified Wound Ostomy AP Nurse
- CWCN-AP – Certified Wound Care AP Nurse
- CCCN-AP – Certified Continence Care AP Nurse
- COCN-AP – Certified Ostomy Care AP Nurse
- CFCN-AP – Certified Foot Care AP Nurse
To qualify for AP certification, applicants must:
- Pass the WOCN certification by examination
- Achieve a graduate-level nursing education as either a nurse practitioner or clinical nurse specialist
- Provide evidence of professional activities that contribute to the “art and science of the WOCN specialty”
Applicants may also apply for AP certification through the Professional Growth Program if they currently possess current, entry-level WOCNCB certification.
Certification through the WOCNCB is renewed every five years. All exam dates are scheduled through Castle Worldwide Inc.
The American Board of Nursing Specialties has given accreditation status to the following examination programs: CWOCN, CWCN, COCN and CCCN. The WOCNCB is accredited by the National Commission for Certifying Agencies (NCCA).
Resources for Wound, Ostomy, and Continence Nurses
The Wound, Ostomy and Continence Nurses Society is a professional nursing society that supports members through educational, clinical, and research opportunities in the delivery of healthcare to those with wounds, ostomies, and incontinence issues.
The Journal of Wound, Ostomy and Continence Nursing is the official publication of the Wound, Ostomy and Continence Nurses Society. It is an international journal that provides continuing education for WOC nurses and includes, original, peer-reviewed articles regarding WOC nursing.
According to the Wound, Ostomy and Continence Nursing Society’s 2008 WOC Nursing Salary and Productivity Survey, the mean annual salary for a WOC nurse with a master’s degree was $83,000, with the top 25 percent earning $91,500. The mean annual salary for a WOC nurse with a doctorate degree during the same time was $90,000, with the top 25 percent earning $91,500.
Advanced practice WOC nurse practitioners earned a mean annual salary of $84,000 and advanced practice WOC clinical nurse specialists earned a mean annual salary of $82,888.
Advanced practice WOC nurses with prescriptive authority earned a mean annual salary of $83,000, and advanced practice WOC nurses without prescriptive authority earned a mean annual salary of $72,225.
The highest earners among WOC nurses were in an industry setting, earning a mean annual salary of $80,000, with the top 25 percent earning $95,000. WOC nurses in both long-term acute care and MD office settings earned an average of $80,000, with the top 25 percent earning $88,000.
The Pacific region of the United States had the highest WOC nursing salaries, with the average salary coming in at $90,000, and the top 25 percent earning $104,000. The New England region followed closely behind, where the average WOC nurse salary was $81,500, and the top 25 percent earned $91,140.
Advance for NPs and PAs National Salary Report 2011 showed that the average, full-time salary for a nurse practitioner in 2011 was $90,583, while a nurse practitioner in a hospital setting earned $96,124; a nurse practitioner in a gerontology setting earned $94,485; and a nurse practitioner in an in-home setting earned $93,785.