What Is Wound Care Nursing? The Ultimate Guide
Chronic wounds currently affect about 2.5 percent of the US population, and this prevalence is even higher among those aged sixty-five and over. Since the US government estimates that, by 2060, the elderly population will number 77 million, the prevalence of chronic wounds will only increase. Furthermore, chronic wounds are no trivial matter; diabetic foot ulcers, for example, have a comparable mortality rate to cancer. Therefore, due to both their severity and increasing prevalence, chronic wounds constitute a significant clinical, social, and economic challenge.
Are you a nurse interested in the wound care nursing specialty? Read on for everything you need to know about this fascinating and essential nursing specialty.
Wound Care Nursing Fundamentals?
Everyone gets a cut or scrape every once in a while; these wounds usually begin to heal within a few days and are fully healed within a few weeks without requiring medical attention. So what does wound care mean in medical terms?
Some wounds do not go through this normal healing process and may remain open for more than a month. These wounds are classified as chronic or non-healing wounds. Patients with chronic wounds usually also have other major health conditions, such as diabetes or obesity, complicating the healing process.
The following are common types of non-healing wounds:
- Pressure sores
- Surgical wounds
- Radiation sores
- Foot ulcers due to poor blood flow, diabetes, chronic bone infection, or swollen legs
Furthermore, many wounds have difficulty healing due to the following conditions or situations:
- Diabetes
- Weak immune system
- Bone infection
- Nerve damage
- Poor circulation
- Poor nutrition
- Excess alcohol use
- Smoking
- Being inactive or immobile
Chronic wounds may take months to heal, and some may never heal completely. When a patient has a non-healing wound, the care team, including doctors, nurses, and physical therapists, will examine the wound, check blood flow around the wound, determine why it is not healing normally, and create a treatment plan. Treatment plans include the following goals:
- Healing the wound
- Preventing the wound from becoming infected
- Preventing limb loss
- Preventing the occurrence of new wounds or the return of old wounds
- Helping patients stay mobile
Aside from cleaning and dressing the wound, wound care nurses may assist with or provide the following types of treatment as ordered by a physician:
- Debridement and other ways of removing dead skin and tissue
- Hyperbaric oxygen therapy
- Compression stockings
- Ultrasound
- Artificial skin
- Negative pressure therapy
- Growth factor therapy
- Skin grafts
What Is a WOC Nurse?
You might have heard of wound care nurses referred to as WOC nurses, but what does the abbreviation stand for? WOC stands for wound, ostomy, and continence. WOC nurses may specialize in one of these areas or all three. They can become certified through the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB®) after obtaining nursing experience in these areas of care.
A WOC nurse commenting on a wound care thread on Reddit offers the following definition and explanation of the term WOC:
“Now, a WOC nurse holds three speciality certifications--wound care, ostomy care, continence care. You don't have to certify in all three to be a Wound care nurse specifically, but you will have more career opportunities open to you if you also train in Ostomy Care, and having Continence care completed really helps in guiding care for prevention of skin breakdown r/t incontinence (though most don't continue their Continence accreditation because most bigger facilities don't really utilize you for that--they've all ready got urology, who can also perform surgical interventions). So there are variations of the three that people use-- W Nurse, WO Nurse, etc (but typically the blanket term is WOC Nurse…”
What Is a Wound Care Unit in a Hospital?
There usually isn’t a hospital unit specially dedicated to wound care, but hospitals employ WOC nurses to oversee the care and treatment of patients with non-healing wounds throughout units.
In fact, many hospitals outsource their wound care to wound care management companies working alongside hospitals. These companies offer the following services:
- Comprehensive wound care for surgical, traumatic, and chronic wounds, including compression therapy, advanced dressings, and wound debridement
- Coordinating interdisciplinary patient care
- Providing health and wound care education for patients and healthcare providers, including nutritional counseling and diabetic education
- Providing ongoing primary care in areas such as oncology, cardiology, vascular surgery, plastic surgery, and orthopedic surgery
Aside from hospital units and hospital wound care centers, wound care is offered at freestanding outpatient wound clinics, in long-term care settings, and in home health care.
What Is the Role of a Wound Care Nurse?
In addition to performing general nursing duties, wound care nurses are resources for physicians and clinical staff for wound management. Nurses specialized in wound care assess wounds, plan care goals, implement treatment, and evaluate patient outcomes. They also educate patients, family members, and other healthcare staff on topics regarding wound management, support surfaces, selection of dressings and other therapies, and prevention of pressure ulcers.
What Does a Wound Care Nurse Do?
Although the responsibilities of a wound care nurse may vary from setting to setting, their duties may include the following:
- Performing treatments and providing services within the nursing scope of practice
- Assessing, reassessing, and managing wounds in collaboration with an authorized provider
- Providing wound prevention and wound, ostomy, and incontinence care
- Administering prescribed medications correctly based on each patient’s condition
- Executing skin care programs to promote skin integrity
- Implementing policies and procedures to manage patients with draining wounds, fistulae, or tubes, prevent wounds, and care for wounds and incontinence
- Evaluating the effectiveness of care plans and revising care plans based on a patient’s response to treatment
- Coordinating and supervising patient care
- Maintaining extensive knowledge of the anatomy, physiology, and disorders of the gastrointestinal, genitourinary, and dermal systems
- Staying current with advances in wound care and applying current wound management theory
- Formulating teaching plans for patients, family members, and other staff
- Acting as a resource person for physicians, nurses, and other hospital staff
- Serving as a liaison among physicians, patients, and manufacturers of clinical products
How Long Does It Take to Become a Wound Care Nurse?
Although licensed practical nurses (LPNs) may also work in wound care after a one-year nursing program, most employers seek registered nurses (RNs) with bachelors of science in nursing (BSNs) or masters of science in nursing (MSNs). Completing a BSN takes approximately four years, and an MSN usually takes an additional two years. Employers may also require a minimum of one or two years of nursing work experience and certifications.
General nursing certifications relevant to wound care that employers may require include Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Trauma Nursing Core Course (TNCC). Each of these certifications can be obtained in one or two days. In addition, many employers will require specialized wound care certifications, although they may accept that nurses pursue these certifications after being hired.
WOC Nurse Certification?
The Accreditation Board for Specialty Nursing Certification (ABSNC) and the National Commission for Certifying Agencies (NCCA) accredit the following WOCNCB certification programs for RNs:
- Certified Wound Ostomy Continence Nurse (CWOCN®)
- Certified Wound Ostomy Nurse (CWON®)
- Certified Wound Care Nurse (CWCN®)
- Certified Ostomy Care Nurse (COCN®)
- Certified Continence Care Nurse (CCCN®)
Any of these certifications require fulfilling the following eligibility criteria:
- Having a current RN license
- Holding a bachelor’s or a higher degree
- Completing one of the following:
- Graduating from an accredited WOC (or WCET international) Nursing Education Program within the past five years
- Accumulating 1,500 direct patient clinical hours for each certification specialty within the previous five years working as an RN, 375 of which hours must have been accrued within the past year, in addition to fifty continuing education credits for each specialty
Additionally, the WOCNCB offers a certification for RNs wishing to specialize in foot care: the Certified Foot Care Nurse (CFCN®). It also offers the Wound Treatment Associate-Certified (WTA-C) credential for LPNs wishing to specialize in wound care.
Finally, the WOCNCB offers the following certification options for advanced practice registered nurses (APRNs) wanting to specialize in wound, ostomy, and/or continence care:
- CWOCN-AP®
- CWON-AP®
- CWCN-AP®
- COCN-AP (SM)
- CCCN-AP (SM)
Click here for additional information on these examinations, including eligibility criteria.
How Much Does a Wound Care Nurse Make?
Since wound care nurses work in numerous settings and may have varying levels of education, the average salaries of WOC nurses can also vary significantly.
The following are average RN salaries in different settings where WOC nurses may work:
- Outpatient care centers: $93,070
- Hospitals: $80,260 to $85,020
- Home health care services: $78,190
- Offices of physicians: $73,860
- Nursing care facilities (skilled nursing facilities): $72,260
In turn, advanced practice WOC nurses may earn the following average salaries in different healthcare settings:
- Home health care services: $133,170
- Hospitals: $122,960 to $131,830
- Outpatient care centers: $129,190
- Offices of physicians: $114,870
- Offices of other health practitioners: $108,890
What Is Wound Care Nursing Like?
Besides seeking objective information, such as responsibilities, certifications, and salary, nurses want to hear from real wound care nurses to understand what this nursing specialty is really like: Is it hard? Is it interesting? Which wounds are most common? Therefore, to help satisfy your curiosity, let’s take a look at some testimonials from real WOC nurses:
“The most common wounds that I see are diabetic ulcers, pressure injuries, and post surgical wounds. However, when you peel the skin back (given some difference of fat deposits, nerve endings, etc), it pretty much all heals in the same manner with the same products…” Reddit – u/Ordinary_Rope_8204
“I work at an outpatient wound care clinic and I love it. Similar vibe to a fast paced doctor's office. I can't speak to working as a wound care nurse for inpatients or for a SNF. I would imagine it could be overwhelming at times being responsible for all those patients and getting calls pulling you in a bunch of different directions. Every hospital and facility will be different. If the bedside nurses are understaffed/overworked, wound care may also be understaffed/overworked. But really- it may be worth a shot if you like wound care. It's been a game changer for my career and I can't imagine going back to bedside.” Reddit – u/sarcasticjellybean
Why Choose Wound Care Nursing?
In addition, here are some reasons why wound care nurses love their jobs:
“I love pretty much everything about what I do…I enjoy a predictable schedule (4days a week/36 hours). One Saturday out of every five. I love the critical thinking and planning, acting, assessing, and planning some more. I love that my patient interactions are limited…I am always so fascinated by the disease process or mechanism of injury. I love the collaboration between surgical, ortho, vascular, plastics, dietetics, case management, podiatry, etc.” Reddit – u/nixnuckingfuts
“I really love the job. I work with 3 other CWOCNS and have about 8-12 patients to see each day. I love having more autonomy and I feel like the providers trust us and our expertise more than when I was on the floor…I really like the one on one time with the patients, I don't feel as though I have 4-5 other patients constantly asking for pain meds, water, etc. I really get to give the patient all of my attention at that time and then I move on for the day…I work 4, 9 hour shifts a week, no holidays or weekends ( I feel really lucky about that). There is so much variety within the specialty, so I feel like I can really master the area without feeling bored. One of my favorite parts is seeing real progress as we follow up with the patients.” Reddit – u/Lemoniegoodness
What Makes a Good Wound Care Nurse: Tips for New Nurses?
Besides licensure, certifications, and work experience, employers seek wound care nurses with certain soft skills and personality traits. The following are characteristics of a great wound care nurse:
- Ability to make decisions independently
- Being tactful and polite with patients, family members, and other staff, as well as in all other interactions
- Ability to work with ill, elderly, disabled, upset, and possibly hostile people
- Possessing leadership skills
- Ability to collaborate effectively with other staff
- Ability to cope with the mental and emotional stress
- Possessing flexibility and personal integrity
For new nurses, qualifying for a wound care nursing position might seem like an extremely distant and difficult goal. However, the experience of a wound care nurse on Reddit defies this conception:
“Wound care nurse here! I started out doing home care, where part of my position was to work in a wound care clinic. I loved it, and started educating myself about wound care to the point that I was the go-to person for my colleagues. I decided to go back to school for my masters to be a clinical nurse specialist (with a focus on wound care, naturally). I ended up landing a position in a hospital as skin and wound consultant (before I even had my masters), and then as a CNS for home care!...Basically if you have a real interest, educate yourself, get to know some clinicians who work in wound care, and make connections! Also, apply for jobs you aren't qualified for, that's how I ended up with my last 2 positions! 😄”
Final Thoughts on Wound Care Nursing
Has wound care nursing caught your attention? If you don’t yet meet the wound care job or certification requirements, consider picking up PRN nursing shifts in settings that offer wound care, such as long-term care facilities, to help you accrue the necessary clinical practice hours.
On the other hand, if wound care does not seem right for you, continue exploring other nursing specialties until you find your ideal career path.
