Dear Editor

I want to thank the Journal for shedding light on the issue of non-BSN credentialing in our specialty (Point Counterpoint September/October 2007). I want to express my support of Dr Beitz for her well researched and forceful comments. As a nurse educator teaching at a diploma and an associate-degree program, I fully support nursing education at all levels. I don't believe, however, as our former president Dorothy Doughty does, that certification of the non-BSN nurse and LVN/LPNs is good for our practice. As I previously stated, I support nursing education at all levels and the current rules allow nurses from associate degree and hospital-based diploma schools to take the same nursing boards. This doesn't mean that I support the certification of non-BSN nurses by any nursing specialty organization. The WOCN was courageous many years ago when it mandated BSN as the basic level for certification. It cannot and should not change its mind now. Just because there are other wound care organizations offering certification to nonprofessionals, I firmly believe that the WOCN should hold the line.

As far as offering certification to LPNs, I wonder if the WOCNB is aware that in some states, LPN programs accept and graduate students with just 2 years of high school. Let me illustrate some of my concerns with LPN certification with this very true story. Three years ago one of my nursing students in the LPN to RN program where I teach was very impressed that I was a CWOCN and told me, "I am a wound care nurse also." We discussed this and I learned that she was responsible for all the wound treatments and documentation at the nursing home where she was employed. I told her how impressed I was with her wound knowledge and said that if she ever decided to finish her bachelors and attend a WOC program I would do anything I could to assist her. She looked surprised and said, "I don't need to attend a program, I do everything now, I debride, and I order medications and treatments." I was stunned!! I asked her what she meant by debride and she told me she took the forceps and scissors and cut away dead tissue. I asked who trained or supervised her and she said it was no big deal-anyone could do it. Needless to say, I had to continue to pursue this very disturbing practice. I asked her if she realized that she was practicing above her scope of practice and if I wanted I could report this behavior to the New Jersey Board of Nursing. She said that all the doctors and the nursing home administrators knew this was her practice and they told her not to document anything if she did a debridement. I asked if she knew how to assess which patients were appropriate candidates for debridement and if she knew that certain medications needed to be discontinued or if some laboratory data should be ordered. She said no, but she only had one problem in all the years she was doing it. I ended the conversation by telling her if her practice didn't stop I would not hesitate to report it to the New Jersey Health Department, Medicare, and the New Jersey Board of Nursing. This seemed to get her attention. I made her promise me that her days of playing surgeon or nurse practitioner were over. Since she very much wanted the RN license she complied. I spoke to the nursing home Director of Nurses the next day and stressed that if the practice continued I would not hesitate to contact the appropriate authorities. Now, I realize that this is not your typical situation but it does give one pause!! If this is already happening without a "certificate," what will happen once a piece of paper or a test is given? I know that this is not everyone, and certainly, I know and work with extremely competent LPNs, who are proficient with wound treatments and complicated dressings.

I have been an active member of the Northeast Region and each year at our annual convention, I hear stories from my colleagues about certified wound, ostomy and continence nurses losing positions to LPNs certified at the "1-week wonder course." In a time when evidence-based practice and research are the buzz words, why would one of the premier wound organizations even be considering this? Could the millions of dollars already in the wound care market be the driving force behind this initiative? Are we looking for increased membership dues and certification fees? I don't see LPNs or even non-BSN RNs clamoring to become certified in ostomy management.

I firmly believe in nursing education and support any continuing education courses we could create that would increase the knowledge of all nurses and assist our patients to receive the excellent care that they deserve.

I worked very hard for my certification, and am now in the process of gathering all my points so that next year when I recertify it will be at the APN level. Our certification process is one of the most difficult and arduous of any nursing organization; don't diminish it by coming up with another level that will only serve to dirty the already muddy waters of wound care certification.

Sincerely,

Tracey J. Siegel, MSN, RN, CWOCN, GNP