Economic Value of the WOC nurse in Multiple Clinical Settings:
A Summary of Evidence Published in JWOCN
From the Deputy Editor and Editor-in-Chief
The negative impact of the COVID-19 pandemic continues to exert a sharply negative influence on the United States and global economy. These negative affect specialty care health care providers such as WOC nurses, producing a ripple effect that also affects our intimate partners and families. Acting on a Society-wide initiative from WOCN Society President Stephanie Yates, the Journal has initiated an ongoing special project that will last through the remainder of 2020 dedicated to providing you with the resources you need to adapt to the rapidly changing world we live in. This bulleted list is a summary of evidence and evidence based expert opinion published in JWOCN that documents the value of your knowledge and skills to the acute- and home-care settings. We hope it will prove useful whether you are reminding facility leadership of your ongoing value within your facility or health system, or seeking a new or expanded role in response to a reduction in practice hours and/or compensation.
Value of the WOC Nurse in the Acute Care Setting
Boyle DK, Bergquist-Beringer S, Cramer E. Relationship of Wound, Ostomy & Continence Certified Nurses and Healthcare-Acquired Conditions in Acute Care Hospitals. Journal of Wound Ostomy & Continence Nursing. 2017; 44(3):283-92.
- Acute Care Facilities (hospitals and hospital systems) who employ and use CWOCNs, CWCNs, and CWONs have better clinical (and economic) outcomes than hospitals lacking these services. Specifically, these facilities have lower hospital-acquired pressure injuries as compared to hospitals not employing these nurses.
- This positive outcome is attributed to the unique knowledge and skill set possessed by CWOCNs, CWCNs, and CWONs. Specifically, certified WOC nurses are highly influential in the implementation of skin assessment, nutritional support, and moisture management interventions as well as use of pressure redistribution surfaces and repositioning.
Medley JA. Cost-effectiveness of a WOC Advanced Practice Nurse in the Acute Care and Outpatient Setting. Journal of Wound, Ostomy & Continence Nursing. 2014; 41(4):307-10.
- Advanced practice WOC nurses in both the acute and outpatient settings provide fiscally beneficial services for patients by serving as educators, consultants and researchers.
- Use of AP WOC nurses in these setting substantially reduces costs and increases patient satisfaction, supporting the favorable rationale for why advanced practice nurses improve patient outcomes.
Saunders K. A View From Here: Building and Justifying a Comprehensive WOC Nurse Team. Journal of Wound Ostomy & Continence Nursing. 43(4):341-345, July/August 2016.
- The presence of a WOC nurse team improves patient outcomes and satisfaction, and aids in the identification of unmet needs.
- A WOC nurse teams ensures responsible fiscal stewardship of product usage, staffing, documentation, and scope of services.
- Active participation of WOC nurses in system-wide health system initiatives and committees improves overall quality of care and collaboration with other specialists improving multiple patient focused outcomes.
Lawrence K., Motta G. Reimbursement Opportunities for WOC Nursing Services: Medicare Part B "Incident to" Services Policy: A Fact Sheet. Journal of Wound Ostomy & Continence Nursing. 46(4):351-353, July/August 2019.
- WOC nurses who are knowledgeable about insurers' policies such as Medicare, Medicaid and commercial payers can improve appropriateness of billing and reimbursement for their professional services.
Value of the WOC Nurse in the Home Care Setting
Bliss DZ, Westra BL, Savik K, Yeufeng H, Borchert A. Effectiveness of Wound, Ostomy and Continence–Certified Nurses on Individual Patient Outcomes in Home Health Care. Journal of Wound, Ostomy and Continence Nursing. 2013; 40(2):135-42.
- WOC nurses in home health care are typically assigned to take care of patients with significantly worse wounds and major incontinence problems than patients not assigned to a WOC nurse.
- Under the care of the WOC nurse, and despite having more severe pressure injuries, surgical wounds, urinary and bowel incontinence, and urinary tract infections, these patients achieved substantial improvements and stabilization of these difficult care problems.
Bliss DZ, Westra BL, Savik K, Yeufeng H. Effectiveness of Wound, Ostomy, and Continence Nurses on Agency-Level Wound and Incontinence Outcomes in Home Care. Journal of Wound, Ostomy and Continence Nursing. 2013; 40(1):25-53.
- Home health agencies that use a WOC nurse have a lower incidence of patients who develop wounds, incontinence and urinary tract infection as compared with agencies with no WOC nurse.
- The specialty practice of WOC nurses increased important positive outcomes for agencies' in the areas of wound care, incontinence management, and prevention of urinary tract infections.
Vrtis, Mary C. The Economic Impact of Complex Wound Care on Home Health Agencies
Journal of Wound, Ostomy & Continence Nursing. 2013; 40(4):360-63.
- WOC nurses reduce costs by establishing cost-effective wound care formularies and consulting with prescribers and nurses to recommend appropriate use of dressings.
- WOC interventions in the home setting also reduce unnecessary nursing visits, decrease costs, and enhance optimal wound healing
Baich L, Wilson D, Cummings GG. Enterostomal Therapy Nursing in the Canadian Home Care Sector: What Is Its Value? Journal of Wound, Ostomy & Continence Nursing. 2010; 37(1):53-64.
- WOC nurses decreased the number of home visits for wound care, reduced the number of emergency department visits and hospital readmissions.
- Involvement of the WOC nurse in home wound care reduced wound healing times and promoted successful healing, reducing the direct costs of wound care.
Harris C, Shannon R. An Innovative Enterostomal Therapy Nurse Model of Community Wound Care Delivery. Journal of Wound, Ostomy & Continence Nursing. 2008; 35(2):169-83.
- Use of a WOC nurse reduced nursing visits, use of wound care supplies and decreased time to wound closure when compared to care without WOC nurse involvement.
- The level of WOC nurse involvement in direct care of patients with wounds was associated with reduced cost and reduced time to wound closure.
Teresa Kelechi, PhD, RN, CWCN, FAAN
Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN