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An Interview with the President of the Wound Ostomy and Continence Nurses Society

Ayello, Elizabeth, A., PhD, RN, ACNS-BC, CWON, ETN, MAPWCA, FAAN

Advances in Skin & Wound Care: June 2018 - Volume 31 - Issue 6 - p 247–249
doi: 10.1097/01.ASW.0000532473.27218.ba
DEPARTMENTS: COMMENTARY

Elizabeth A. Ayello, PhD, RN, ACNS-BC, CWON, ETN, MAPWCA, FAAN, is Faculty, Excelsior College School of Nursing, Albany, New York; President, Ayello Harris & Associates, Inc, Copake, New York; and Clinical Editor, Advances in Skin & Wound Care, Philadelphia, Pennsylvania.

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Figure

This year, 2018, marks the 50th anniversary of the founding of the Wound, Ostomy and Continence Nurses Society (WOCN). To honor this momentous occasion, I delighted in the opportunity to discuss the organization with its president, Kelly Jaszarowski, MSN, RN, CNS, CWOCN.

EA: How and when was the WOCN founded? Did it have any other names?

KJ: The historic past of the WOCN dates back to 1968 and can be attributed to 2 individuals who touched so many lives. Wound, ostomy, and continence (WOC) nurses refer to Norma Gill Thompson, from Akron Ohio, as our founding mother (Figure 1). Norma was a woman who was plagued with chronic ulcerative colitis. She found relief from this disease when she underwent surgery resulting in an end ileostomy. In those times, ostomies were managed with dressings, not appliances. This did not, however, dampen Norma’s spirits. Instead, she shared her knowledge and comforted others with ostomies. About 3 years after her surgery, Norma’s path crossed with a leading colon and rectal cancer surgeon from the Cleveland Clinic, Dr Robert Turnbull (Figure 2). Dr Turnbull was aware of what Norma was doing in Akron and solicited her assistance with his patients’ rehabilitation. She agreed. And as they say, the rest is history; WOC nursing was born.

Figure 1

Figure 1

Figure 2

Figure 2

Norma was hired to work in Cleveland as an ostomy technician in 1958 by Dr Turnbull. In addition, she also continued to work with those in Akron. Norma would travel by train to and from Cleveland seeing patients there by day and in Akron in the evenings. As I understand it, she often saw them in her home. She also met with manufacturers to discuss and design appliances. Dressings were just not a very viable option for an ostomy. Naturally, word of this amazing woman started to spread. Many sought her for assistance in obtaining supplies. It was not long before she began running out of space in her home. As a result, she opened up her own supply store.

In the early years, those caring for individuals with an ostomy were referred to as enterostomal therapists. By 1961, there was an increasing need for more enterostomal therapists. The first enterostomal therapy school was opened at Cleveland Clinic by Dr Turnbull and Norma. The main requirements included having a high school diploma and an interest in ostomies. The students were trained 1-on-1 and dedicated their lives to making others more comfortable.

The realization that this was a developing specialty became apparent in 1968 when a substantial number of individuals trained at the Cleveland Clinic were present at a meeting of the United Ostomy Associations of America held in Phoenix, Arizona. Dr Turnbull encouraged a group of 12 stoma therapists to meet and discuss starting a formal organization. These 12 individuals did just that, and the American Association of Enterostomal Therapists was born on September 6, 1968:

Alveda Ahnafield, Indianapolis, Indiana

Jean Alvers, San Francisco, California

Charlotte Blackman (Carter), Baltimore, Maryland

Kay Carlson, St Paul, Minnesota

Robert Draper, Somerville, New Jersey

Virginia Geimer, Chicago, Illinois

Norma Gill Thompson, Akron Ohio

Patricia Klemens, Los Angeles, California

Darlene Larson, Minneapolis, Minnesota

Edith Lenneberg, Boston, Massachusetts

Bertha Okun, Montreal, Quebec, Canada

Jane Walker, Atlanta, Georgia

The Society has experienced lots of change and growth since then. The first of several name changes was in 1969 when the word “North” was added. The organization became the North American Association of Enterostomal Therapy, or NAAET. Another name change occurred during the third conference in 1971 in Las Vegas, to the International Association of Enterostomal Therapy, or IAET. (That is actually the organization I joined as a new enterostomal therapist!) The IAET was not the last name change, however. The name was changed in 1992 to the WOCN.

A strong argument for the change was 2-fold. First, “enterostomal therapist” was a confusing term to healthcare providers and the lay public alike. In addition, the specialty had grown from focusing on individuals with an ostomy to individuals with ostomies, wounds, and incontinence. The suggested name change was to incorporate these specialty areas as well as better identify what we do.

Renaming the organization WOCN was not an easy endeavor. I can recall the membership comprised mainly nurses who did not want to lose the enterostomal therapy component of our history. There was much debate and discussion around this name change, proposed by the leadership at that time, including President Kristy Wright. I recall a very intelligent woman saying something very profound regarding the issue. It went something like this: “We elected these individuals to lead us. If this is what they recommend, then we should trust them.” That person was Norma Gill Thompson herself!

Today, the WOCN is a recognized nursing specialty society with more than 5000 members who practice in the field of WOC. Many members practice in all 3 disciplines or combinations of these. The Society publishes an internationally known journal, the Journal of Wound Ostomy & Continence Nursing. Further, the WOCN is involved in public policy and advocacy related to our nursing specialty.

EA: What do you think are the 3 major accomplishments of the WOCN?

KJ: One of the major accomplishments of the WOCN is its establishment of itself as a community of professionals dedicated to those with wounds, ostomies, and incontinence. While the Society is a nursing specialty organization, other healthcare professionals may join the organization. The Society supports its members’ practice through advocacy, education, and research.

Another major accomplishment is WOCN’s recognition by the American Nurses Association (ANA) as a nursing specialty. This was accomplished by compiling years of research and documentation of the specialty into a document—more like a book—describing the Scope and Standards of Nursing Practice as well as developing designation criteria for WOC nursing as a specialty. The ANA’s recognition of WOC nursing as a specialty acknowledges that WOC nurses adhere to high standards of practice.

These high standards are exemplified in the educational process to become a WOC nurse. The WOCN has established education standards for WOC nursing. The formal schools that offer WOC nursing education, at the very minimum, adhere to these standards and are accredited by the WOCN.

The establishment of the Society in these manners has also received the attention of the Centers for Medicare & Medicaid Services. Often, the Society, as well as individual WOC nurses, are sought out by the Centers for Medicare & Medicaid Services for comment on various initiatives. In fact, the WOCN has a committee dedicated to public policy and advocacy. Just recently, this committee responded to a call for comment regarding a clinical quality measurement under development on hospital harm and hospital-acquired pressure injury. In addition, a position statement on the inclusion of ostomy supplies in competitive bidding is under development.

Basically, then, WOCN’s establishment of itself as a nursing specialty and community of healthcare professionals dedicated to those with wounds, ostomies, and continence needs through advocacy, education, and research is the major accomplishment of the Society.

EA: If Norma Gill were alive today, what would you like to ask her?

KJ: There are several questions I would ask her! First, I would ask her if the specialty has grown and progressed as she would have liked it to or imagined it would. Has ostomy surgery and the devices to manage these conditions advanced as she would have thought, or are advancements not occurring sufficiently? I would want to know what she would have done differently or what needs to be done differently. Finally, I would ask her if she is proud of the WOCN and WOC nursing today.

EA: How are you celebrating the 50th anniversary of WOCN?

KJ: This entire year is focused on celebrating the Society’s historic past and limitless future. A big part of this celebration will occur during the WOCN annual conference in Philadelphia from June 3 to 6. Where better to celebrate than in our country’s most historic location? This celebration is intended to capture and share as many memories as possible. Members are asked to share their memories by completing a survey, e-mail photographs to share@wocn.org, and upload photos and videos to Facebook, Twitter, and Instagram, tagging @wocnsociety. In addition, there are celebratory initiatives that will be introduced throughout the year using all of our communication channels. I can honestly say I am honored and fortunate that this celebration is occurring during my presidency!

EA: How is WOCN partnering with nurses to address the most important issues for WOC nurses today?

KJ: The WOCN recognizes 2 of the most important issues in healthcare, which are access to care and access to quality, reasonably priced medical supplies. Access to care includes access to a certified WOC nurse. The WOCN has supported legislation that provides for nurse practitioners to order home care services, supports reform for local coverage determinations, and supports maintaining funding for the Federal Nursing Workforce Programs. Further, the WOCN has urged Congress to pass the Lymphedema Treatment Act.

The WOCN is partnering with the ANA, National Nursing Research Roundtable, and Palliative Care Nurses, to name just a few. Our Society is an organizational affiliate member of the ANA, which provides additional opportunities to partner with other nurses and nursing organizations as well as share what the WOCN and WOC nurses have to offer. Symposium presentations have been made at the annual conference of the Case Managers Society of America, as well as at the annual conference of the American Organization of Nurse Executives. Both of these presentations focused on transitioning the WOC patient from acute care to home. The WOCN has collaborated with the American College of Surgeons on the development of the ostomy skills kit for home.

The WOCN also collaborates with the United Ostomy Associations of America on various initiatives. One such initiative is the inclusion of ostomy supplies in competitive bidding. (Neither organization supports this inclusion.)

These efforts are just a small fraction of how WOCN is reaching out and collaborating.

EA: What would you like to see the WOCN accomplish in the next 5 years and in the next 50 years?

KJ: I believe we have to acknowledge that the WOCN cannot be the “be-all and end-all” for those we serve. Instead, we need to collaborate with and align ourselves with others who can fill in the gaps. For example, much more research is needed in the field of WOC nursing. However, most WOC nurses are not researchers; they are clinicians. That being said, collaboration can help to fill in this gap. Through collaboration, WOCN’s voice, as well as the voice of those we collaborate with, becomes more impactful. In turn, those we advocate for and educate reap these benefits.

Telehealth is becoming more and more the “norm” for medical care. I would like to see WOC nurses prepared and participating in telehealth. I know many WOC nurses now do have telehealth incorporated into their practice; ultimately, this may result in the need for WOC nurses to be advanced practice nurses. Advanced practice may become the entry level for WOC nursing to meet the needs of those we care for as a result of the ever-changing healthcare arena and its financial focus.

In 50 years, healthcare will look very different from today, and I would like to see that WOCN and WOC nursing have survived and adapted. I believe there will be more “communities” or groups of healthcare providers, and WOC nurses would be an integral part of those communities. In addition, I would like to see the WOCN positioned so it is part of an organizational community that conducts and disseminates research, advocates for those served, and educates others.

EA: Thanks for taking the time to share with us!

KJ: Thank you, Elizabeth, for the opportunity to share my nursing specialty and organization with others. I am truly blessed to be able to say I am a member of the WOCN and a WOC nurse!

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