Appendix A: Sample WOC Nurse Position Description: Hospital (Acute Care)

Position Title: WOC Nurse

Department: Division of Nursing or Department of Patient Services

General Description

The hospital-based WOC nurse serves as a clinical resource and consultant for the acute and rehabilitative care of patients with selected disorders of the gastrointestinal, genitourinary, and integumentary systems such as acute and chronic wounds (eg, complex draining wounds, fistulae, pressure ulcers, vascular ulcers), ostomies, percutaneous tubes, and continence disorders. Professional responsibilities are carried out through direct patient care, clinical consultation, education, research, and administration.

Qualifications

  1. Education and experience
    1. BSN (required) or MS (preferred).
    2. Two to four years of recent, relevant nursing experience (preferred).
    3. Graduation from a WOCN-accredited wound, ostomy and continence (WOC) nursing education program, or satisfactory completion of an accredited program within 6 months after assuming the position.
  2. License and certification
    1. Current RN licensure.
    2. Current certification in tri-specialty (CWOCN) by the Wound, Ostomy and Continence Nursing Certification Board.
    3. Current certification in cardiopulmonary resuscitation.

General Duties and Responsibilities (this list is representative rather than inclusive)

  1. General duties/responsibilities
    1. Utilizes the nursing process when directing or delivering care to patients with WOC needs including assessment, diagnosis, outcomes identification, planning and implementation (eg, coordination of care delivery, health teaching and promotion, consultation), and evaluation.
    2. Utilizes and maintains current physical, psychosocial, clinical assessment, and therapeutic communication skills to determine individual patient needs and expected outcomes.
    3. Participates in committees or task forces related to wound, ostomy, and continence issues.
  2. Wound/skin care
    1. Provides consultation for individuals with altered skin integrity (eg, pressure ulcers, draining wounds, fistulae) to develop individualized plans of care and attain expected outcomes.
    2. Provides guidance to staff in implementing protocols to identify, control, or eliminate etiologic factors for skin breakdown, including selection of appropriate support surfaces.
    3. With a physician's order, provides appropriate debridement of devitalized tissue (eg, conservative sharp debridement, silver nitrate [AgNO3] cauterization of nonproliferative wound edges, hypergranulation tissue, or to control minor bleeding).
    4. Provides appropriate education to patients, caregivers, and staff regarding skin care, wound management, care of percutaneous tubes, and draining wound/fistulae management.
    5. Validates pressure ulcer data collection for nursing quality indicators (eg, pressure ulcers and restraint use).
  3. Ostomy care
    1. Provides pre- and postoperative education to patients (and their families) who are undergoing ostomy surgery, with consideration of the need for physical and psychological adaptation.
    2. Marks the stoma site preoperatively by determining the appropriate site for stoma placement with consideration of the patient's anatomical markings, physical capabilities, and lifestyle.
    3. Assesses the stoma and stoma functioning and initiates appropriate procedures for stoma care (eg, removes rod/sutures, measures/fits a pouching system, teaches care of stoma/peristomal skin and pouch).
    4. Provides appropriate educational information to patients, including postoperative and discharge instructions about care, referrals, and supply needs.
    5. Serves as a resource for patients after discharge through telephone consultation or outpatient services.
  4. Continence care
    1. Identifies risk factors for urinary or fecal continence disorders.
    2. Assesses patients with urinary and/or fecal continence disorders.
    3. Establishes an appropriate management program to include dietary and fluid management; bowel training or stimulated defecation program; bladder retraining, prompted voiding, or a scheduled voiding program; pelvic muscle reeducation without biofeedback; indwelling catheter management; recommendations regarding containment/absorptive products and devices and skin care; and education and counseling for patients/caregivers.
    4. Identifies patients requiring referral for assessment/management of complex urinary or fecal continence disorders.
  5. Education
    1. Participates in developing and implementing procedures and protocols, based on current national guidelines, to deliver care to patients with the following:
      • Urinary or intestinal disorders resulting in the need for an ostomy.
      • Conditions requiring wound management.
      • Impaired or altered skin integrity.
      • Urinary and/or fecal continence issues.
    2. Assists the nursing and medical staff in maintaining current knowledge and competence in WOC care by providing the following:
      • Formal or informal continuing education programs.
      • Clinical rounds.
      • Lunch and learn sessions.
      • Orientation sessions.
      • Collaborative practice committees.
      • Nursing councils.
    3. Attends continuing education programs related to WOC nursing to maintain current knowledge and skills.
  6. Research
    1. Collaborates with leadership and multidisciplinary clinical practice teams to establish protocols, which support best practices to achieve optimal clinical benefits for patients needing WOC care.
  7. Administrative duties
    1. Maintains and submits required activity and statistical reports to the appropriate department supervisor.
    2. Contributes to the selection of cost-effective supplies and equipment related to WOC care, which might need to be individualized for different units/departments.

Appendix B: Sample WOC Nurse Consultant/Clinical Expert Position Description: Hospital (Acute Care)

Position Title: WOC Nurse Consultant/Clinical Expert

Department: WOC Nursing

Clinical Ladder: Level IV

Supervisor: VP of Nursing and Clinical Services

Supervision Exercised: Autonomous

General Description

The WOC nurse functions as a consultant and expert clinical nurse to assess, plan, implement, evaluate, and reassess (as indicated) the care of patients with abdominal stomas, acute or chronic wounds (eg, draining wounds, fistulae, pressure ulcers), and/or continence disorders.

Qualifications

  1. Education and experience
    1. BSN (required) or MS (preferred).
    2. Graduation from a WOCN-accredited wound, ostomy and continence (WOC) nursing education program or satisfactory completion of an accredited program within 6 months after assuming the position.
  2. License and certification
    1. Current RN licensure.
    2. Current certification in tri-specialty (CWOCN) by the Wound, Ostomy and Continence Nursing Certification Board.
    3. Current certification in cardiopulmonary resuscitation.

General Work Requirements

  1. Normal work hours per day.
    1. Normally works 32 to 40 hours per week.
    2. Normal work hours are 8 AM to 4:30 PM, Monday to Friday, excluding recognized holidays.
  2. Mental demands
    1. Exceptional mental alertness is required.
    2. Must be able to make clinical decisions regarding individualized patient care plans and establish priorities to provide effective, efficient care.
  3. Working conditions
    1. Frequent use of body substance isolation and contact precautions.
    2. Contact with patients under a wide variety of circumstances.
    3. There is a high probability that unexpected situations will occur.
  4. Physical demands
    1. Must be able to meet basic physical requirements: frequent walking, standing, lifting, or bending.

Primary Duties and Responsibilities: The following statements describe the principal functions and duties of the job and are not to be considered a detailed description of all requirements inherent in the position.

  1. Demonstrates competence and knowledge in the assessment, diagnosis, planning, implementation, and evaluation of care for patients of all ages with WOC needs.
  2. Provides consultation for individuals with altered skin integrity (ie, pressure ulcers, draining wounds, fistulae) to develop an individualized plan of care and attain expected outcomes.
    1. Provides guidance to staff in implementing protocols to identify, control, or eliminate etiologic factors for skin breakdown, including selection of appropriate support surfaces.
    2. With a physician's order, provides appropriate debridement of devitalized tissue (eg, conservative sharp debridement, silver nitrate [AgNO3] cauterization of nonproliferative wound edges, hypergranulation tissue, or to control minor bleeding).
    3. Provides appropriate education to patients, caregivers, and staff regarding skin care, wound management, care of percutaneous tubes, and draining wound/fistulae management.
  3. Provides pre- and postoperative education to patients (and their families) who are undergoing ostomy surgery, with consideration of the need for physical and psychological adaptation.
    1. Marks the stoma site preoperatively by determining the appropriate site for stoma placement, with consideration of the patient's anatomical markings, physical capabilities, and lifestyle.
    2. Assesses the stoma and stoma functioning and recommends appropriate procedures for stoma care (eg, measures/fits a pouching system, teaches care of stoma/peristomal skin and pouch).
  4. Assesses patients with urinary and/or fecal continence disorders.
    1. Recommends an appropriate management program to include dietary and fluid management; bowel training or stimulated defecation program; bladder retraining, prompted voiding, or a scheduled voiding program; pelvic muscle reeducation without biofeedback; indwelling catheter management; and recommendations regarding containment/absorptive products and devices and skin care.
    2. Provides education and counseling for patients/caregivers.
  5. Develops expected outcomes that reflect realistic, measurable, and patient-centered goals.
  6. Communicates the individualized plan of care to the interdisciplinary health care team and establishes criteria requiring reassessment or follow-up education.
  7. Participates in interdisciplinary collaboration to provide safe and therapeutically effective interventions across the continuum.
  8. Evaluates individual patient/family outcomes in response to the plan of care and the WOC nurse's clinical interventions.
  9. Provides outpatient services within the scope of WOC nursing practice (eg, stoma clinic, wound centers).
  10. Manages the WOC nurse's office and its operations.
  11. Provides guidance for the use of specialty support surfaces (eg, rental beds, chairs, lifts) and monitors for their appropriate use.
  12. Provides educational opportunities to update other health care professionals about current guidelines/standards of care for patients/populations with WOC needs or risks.

Additional Responsibilities/Duties

  1. Seeks opportunities for professional growth.
  2. Demonstrates and supports the organization's mission, values, and goals.
  3. Contributes to professional or consumer publications.
  4. Collaborates with community resources and organizations.
  5. Complies with reasonable requests to perform other duties.
  6. Maintains/demonstrates knowledge and skills to perform competently as required by the employer or state board of nursing (eg, conservative sharp debridement).

Appendix C: Sample WOC Nurse Consultant/Clinical Expert Position Description: Home Health

Position Title: WOC Nurse Consultant/Clinical Expert

Department: Home Care

Responsible to: Director of Nursing

General Description

The WOC nurse provides care in the home care setting to patients with acute or chronic wounds (eg, draining wounds, fistulae, pressure ulcers), ostomies, and continence disorders. Utilizing the nursing process, the WOC nurse provides hands-on care and educates clinicians, patients, and their families. The WOC nurse collaborates/coordinates care with nurses, the physician, and other health care team members to implement the plan of care and meet the rehabilitation needs for patients with wound, ostomy and continence (WOC) needs. Additionally, the WOC nurse performs other related tasks for documentation and supply management.

Qualifications

  1. Education and experience
    1. BSN (required).
    2. Graduation from a WOCN-accredited WOC nursing education program or satisfactory completion of an accredited program within 6 months after assuming the position.
    3. Two to 4 years of RN experience (preferred).
  2. License and certification
    1. Current RN licensure.
    2. Current certification in tri-specialty (CWOCN) by the Wound, Ostomy and Continence Nursing Certification Board.
    3. Current certification in cardiopulmonary resuscitation.

General Duties and Responsibilities (this list is representative rather than inclusive)

  1. Direct care
    1. Assists in caring for patients with stomas (eg, stoma site marking), acute or chronic wounds (eg, draining wounds, fistulas, pressure ulcers), and continence disorders.
    2. Initiates assessment, planning, and implementation of care for patients with WOC needs.
    3. Provides comprehensive postoperative care and education to patients with fecal or urinary diversions and their families.
    4. Evaluates, selects, and recommends supplies and equipment for patients with ostomies, acute or chronic wounds, and continence disorders.
  2. Consultation
    1. Serves as a consultant to the nursing staff, physicians, and other members of the health care team.
    2. Attends patient care conferences and staff meetings as needed and communicates patients' special needs to appropriate members of the health care team.
  3. Education
    1. Instructs nursing personnel in the care of patients with ostomies and acute or chronic wounds (eg, draining wounds, fistulas, pressure ulcers).
    2. Provides in-service educational programs as needed to staff, physicians, and other health care team members, in cooperation with the education coordinator to influence organizational best practices related to WOC nursing care.
    3. Maintains current knowledge and competence in WOC specialty nursing by participating in professional programs and organizations.
    4. Orients new nursing personnel and selected nursing students to the role of the WOC nurse.
  4. Research
    1. Develops and monitors standards of care and assists in the formulation and evaluation of procedures, protocols, and policies to maintain best practice.
    2. Engages in research, measurement of quality outcomes, and safety projects, as appropriate.
  5. Administration
    1. Evaluates, selects, and recommends supplies and equipment for patients with ostomies, draining wounds, fistulae, pressure ulcers, acute or chronic wounds, and continence disorders.
    2. Documents patient care in accordance with home health and nursing department policy.
    3. Performs other appropriately assigned duties, as required.

Appendix D: Sample WOC Nurse Position Description: Clinical Nurse Specialist

Position Title: WOC Clinical Nurse Specialist (AP-CNS)

Department: Nursing

Responsible to: Assistant Administrator for Nursing Services

General Description

The wound, ostomy and continence (WOC) clinical nurse specialist (CNS) demonstrates wound, ostomy, and continence professional activities that contribute to advancing the evidence and art of WOC specialty practice. The WOC CNS serves as a clinical resource for patients with wounds, ostomies, and continence disorders. Professional responsibilities are carried out through direct patient care, education, consultation, research, and administration.

Qualifications

  1. Education and experience
    1. Master's degree in nursing required.
    2. Graduation from a WOCN-accredited WOC nursing education program or satisfactory completion of an accredited program within 6 months after assuming the position.
    3. Three years of nursing practice.
  2. License and certification
    1. Current state license as an advance practice nurse (CNS, NP).
    2. Current certification in tri-specialty (CWOCN) by the Wound, Ostomy and Continence Nursing Certification Board.
    3. Current AP-CNS certification by American Nurses Credentialing Center.

General Duties and Responsibilities (this list is representative rather than inclusive)

  1. Clinical practice
    1. Provides comprehensive assessment of patients/situations.
    2. Initiates and interprets diagnostic tests and procedures as indicated.
    3. Provides direct care to selected patients.
    4. Determines diagnosis or nature of the problem.
    5. Identifies expected outcomes and plans individualized care to promote continuity across the continuum.
    6. Implements and coordinates plans for integrating systems and community resources.
    7. Assists in solving complex problems.
    8. Provides health education to selected patients and caregivers.
    9. Responds to changes in health care and safety initiatives.
  2. Consultation
    1. Integrates current evidence, clinical data, and information within theoretical frameworks when providing consultation.
    2. Evaluates the need for repeated consultations.
    3. Responds to identified needs of the health care team to enhance the work of others and effect change.
    4. Facilitates involvement of individuals and groups that have a direct interest in the situation or plan.
    5. Serves as a clinical consultant to committees (eg, safety, safe patient handling, infection control).
  3. Education
    1. Develops and implements educational programs for the health care team.
    2. Incorporates principles of teaching and learning in the planning, implementation, and evaluation of educational programs.
    3. Assists staff to identify learning needs.
    4. Participates in health education activities for the community.
    5. Serves as a role model to promote excellence by critical analysis of current research to expand clinical knowledge.
  4. Research
    1. Interprets, communicates, and incorporates current research findings and evidence-based guidelines into clinical practice.
    2. Conducts or contributes to nursing research.
    3. Identifies opportunities to mentor others in best practices to improve care processes.
  5. Administrator
    1. Provides leadership in the coordination and delivery of health care services across the continuum of care.
    2. Innovatively designs solutions to improve patient care, health services, and health outcomes related to WOC nursing care.
    3. Provides leadership in the development of care models for chronic issues related to WOC nursing care.
    4. Promotes clinical best practice standards as the basis for nursing practice.

Appendix E: Sample WOC Nurse Position Description: Nurse Practitioner in Adult Health

Position Title: WOC Nurse Practitioner in Adult Health (ANP)

Department: Patient Services

Responsible to: Director of Nursing Education, Director of Clinical Practice, or Medical Director of Primary Care

General Description

The WOC ANP functions as a generalist provider to the adult patient population with wounds, ostomies, or continence disorders, and functions in accordance with his/her State Nurse Practice Act. The wound, ostomy and continence (WOC) ANP has expert skills and is a leader in coordination of resources to facilitate achievement of health and wellness at an optimum level for each patient.

Qualifications

  1. Education and experience
    1. Successful completion of a recognized nurse practitioner program with a master's or doctor of nursing practice degree.
    2. Additional education in wound, ostomy, and continence nursing (required); graduation from a WOCN-accredited WOC nursing education program or satisfactory completion of an accredited program within 6 months after assuming the position (preferred).
    3. Minimum 2 years as an RN and 1 to 2 years as a nurse practitioner (preferred).
  2. License and certification
    1. Current state license as a nurse practitioner advance practice nurse.
    2. Current certification in tri-specialty (CWOCN) by the Wound, Ostomy and Continence Nursing Certification Board.
    3. Current NP certification by the appropriate national certifying body (eg, ANCC, AANP).
    4. Eligibility and acquisition of prescriptive privileges within 1 year (if required by practice).

Physical Requirements

  1. Physical requirements include those necessary to provide or influence patient care in the clinical setting (eg, ability to lift and/or move objects within job requirements, ability to stand for prolonged periods of time).
  2. Sensory requirements include the ability to articulate and comprehend the spoken and written English language (eg, acceptable vision and hearing).

General Duties and Responsibilities (this list is representative rather than inclusive)

  1. Assesses the physical and psychosocial status of clients via interview, health history, physical examination, and diagnostic tests.
  2. Interprets data, develops and implements therapeutic plans, and follows through on a continuum of client care across the health-illness spectrum and life span.
  3. Performs in accordance with organizational and work role performance standards. Tables 1 and 2 provide performance standards and related measurement criteria to meet organizational and work role requirements, respectively.
Table 1. Organizational Standards and Related Measurement Criteria
Performance Standards Measurement Criteria
  1. Responsibility: Acts responsibly as a member of the organization.
  1. Works independently, requesting assistance of the organization when needed.
  2. Anticipates problems and works to solve them.
  3. Performs duties willingly.
  4. Demonstrates appearance and hygiene appropriate to the delivery of quality service.
  5. Actively participates in all efforts to maintain a safe, clean environment.
  6. Recognizes that fulfilling the organization's mission involves successfully managing financial and other resources.
  7. Actively creates innovative, cost-effective systems throughout the organization to continuously improve the management of all resources.
  1. Sensitivity: Demonstrates sensitivity to customers' needs.
  1. Works collaboratively with other team members; treats other team members with consideration, courtesy, and respect, even in stressful situations.
  2. Continuously improves communication within the organization and with patients, visitors, and colleagues.
  3. Cooperates with other hospital departments.
  4. Encourages people to express ideas; encourages personal growth and learning for all; considers suggestions from other members of the team.
  5. Responds to patients, family members, hospital team members, and everyone else in a manner that indicates a desire to meet their needs and exceed their expectations.
  1. Accuracy: Demonstrates knowledge and attention to detail to ensure proper service to customers.
  1. Completes work in an accurate and thorough manner to ensure proper service to customers. Attention to detail is evident.
  2. Seeks information necessary for accurately completing job duties.
  3. Maintains current knowledge and skills necessary to perform competently.
  1. Timeliness: Recognizes time as the individual's most valuable resource.
  1. Responds promptly to customers' needs.
  2. Carries out work assignments within the allotted time.
  1. Ethics: Demonstrates a commitment to protecting the rights of customers.
  1. Discusses patient- and staff-related issues only in a confidential manner and setting, and only with those who have a right to know.
  1. Attendance: Maintains a satisfactory attendance record.
  1. Individual is in the disciplinary process with a minimum of a written warning.
  2. Individual has satisfactory attendance.
  3. Individual has perfect attendance.
Table 2. Work Role Performance Standards and Related Measurement Criteria
Performance Standards Measurement Criteria
  1. The ANP functions as an expert clinician in assessing, planning, evaluating, and revising care for the adult population.
  1. Provides direct care consistent with standards of practice by identifying, managing, or referring actual or potential problems of patients.
  2. Orders diagnostic and therapeutic interventions consistent with standards of practice.
  3. Demonstrates the ability to incorporate complex biopsychosocial dimensions into the nursing process at an advanced level.
  4. Demonstrates the knowledge and ability required to incorporate life span milestones into the nursing process (ie, age appropriateness, growth and development, aging).
  5. Collaborates with members of the health care team to facilitate coordinated delivery of care across the continuum.
  6. Requests consultation when specialized needs are identified.
  7. Utilizes prescriptive authority in a manner consistent with standards of practice.
  1. The ANP assumes a leadership role in implementing nursing practices to promote continuous quality improvement and desirable patient outcomes.
  1. Practices in accordance with current standards and research.
  2. Demonstrates continuous quality improvement in individual practice.
  3. Provides leadership to other nurses on the health care team in the use of research findings in current practice (eg, development of institutional standards and staff education).
  4. Participates in departmental and hospital efforts to continuously improve systems.
  1. The ANP demonstrates leadership in the development, implementation, and evaluation of community and patient education programs.
  1. Demonstrates an ability to provide individualized patient and family education related to health maintenance, illness, wellness, and prevention.
  2. Demonstrates knowledge of community needs and interests and develops creative, innovative mechanisms for meeting those needs.
  3. Provides leadership to other nurses on the health care team in the use of educational techniques.
  1. The ANP continually improves clinical avenues to provide optimal care while maximizing the use of resources.
  1. Participates in the attainment of budget objectives.
  2. Uses all information available to monitor use of resources, identify trends, and develop plans of action to ensure efficient practice.
  3. Maintains current knowledge of reimbursement issues as they apply to the ANP's individual practice.
  4. Seeks avenues for revenue generation in a creative, innovative, manner.
  1. The ANP creates an atmosphere for positive communication across all departments that plays a role in the continuum of care.
  1. Initiates or participates in team-building activities.
  2. Facilitates communication and collaboration among all members of the health care team.
  1. The ANP adheres to the policies and procedures outlined in the exposure-control plan regarding universal precautions; blood-borne pathogens; disposal of needles, syringes, and sharps; cleanup procedures for blood and body fluid spills; and storage, handling, and disposal of medical waste.
  1. Demonstrates knowledge and understanding in the policies and procedures outlined in the exposure-control plan.
  2. Practices safe work techniques and utilizes proper engineering controls to minimize the risk of blood-borne pathogen exposure.
  1. The ANP utilizes appropriate personal protective equipment when performing a task that presents a risk of exposure to blood-borne pathogens.
  1. Demonstrates knowledge of the appropriate level of personal protective equipment to be used in relation to a specific task.
  2. Degree of compliance is measured by personal observation by the immediate supervisor and managers and feedback from other supervisors and managers.
  1. The ANP adheres to hospital policies and procedures related to mandatory continuing education and annual health assessment.
  1. Completes annual records on mandatory continuing education assessment requirements and submits them to the human resources department.
  2. Completes annual health assessment form as required; maintains current inoculations.
  3. Submits the department-/state-required current license upon issuance or renewal to human resources.

Appendix F: Sample WOC Nurse Position Description: Independent Practice

Position Title: WOC Nurse Consultant

General Description

The independent WOC nurse, working under a contractual agreement between the nurse and the contracting organization, functions as a consultant for patients with complex draining wounds, fistulae, pressure ulcers, vascular ulcers, ostomies, and skin problems related to fecal and/or urinary continence disorders. The nurse is responsible and accountable for assessing, planning, implementing, and evaluating the care related to the aforementioned conditions.

Qualifications

  1. Education and experience
    1. BSN required or MSN (preferred).
    2. Graduation from a WOCN-accredited wound, ostomy and continence (WOC) nursing education program.
    3. Two to four years of relevant and recent experience as an RN (preferred).
  2. License and certification
    1. Current licensure as an RN.
    2. Current certification by the Wound, Ostomy and Continence Nursing Certification Board in one or more areas of WOC specialty nursing practice for the services to be provided (ie, tri-specialty [CWOCN], wound care nurse [CWCN], ostomy care nurse [COCN], continence care nurse [CCCN], or foot care nurse [CFCN]).

General Duties/Responsibilities (this list is representative rather than inclusive)

When developing a contract for independent practice, the WOC nurse should consider the following duties/responsibilities and specifically determine which services will be provided by the WOC nurse, and these should be delineated in the contract.

  1. Direct patient care: Serves as the primary patient educator for patients undergoing ostomy surgery who are referred to the WOC nurse.
    1. Provides preoperative visits and stoma site selection for elective procedures.
    2. Assesses, develops a plan of care for complicated pouching issues, and evaluates the outcomes.
    3. Provides education to patients and significant others regarding the care of the stoma and peristomal skin, and any special considerations that should be reported to the physician or the WOC nurse.
    4. Assists with selection and instruction of patients in the use of an appropriate pouching system and accessories, including where and how to obtain supplies.
    5. Determines if alterations in the pouching system are needed due to abdominal features, activity, adherence problems, diet, odor, or flatus and instructs patients/families and staff of those alterations.
    6. Coordinates discharge plans including follow-up visits with the WOC nurse as necessary and makes referrals for home health services if needed.
  2. Consultation
    1. Provides consultation for patients referred with complex draining wounds or fistulae.
      • Selects and applies or recommends an appropriate system to contain drainage, recommends interventions to protect the surrounding skin, and provides the necessary instructions to the staff and the patient.
    2. Provides consultation for patients referred with or at risk for impaired skin integrity (eg, pressure ulcers, vascular ulcers, patients needing pressure redistribution devices).
      • Recommends local wound care management.
      • Recommends modalities to relieve or eliminate the cause(s) of the skin breakdown.
      • Evaluates the progress or lack of progress toward wound healing and recommends changes in procedure or products as indicated.
    3. Provides consultation to patients referred with fecal and/or urinary continence disorder.
      • Assesses the patient for the cause and type of continence disorders.
      • Collaborates with the physician regarding the plan of care to control or manage continence disorders.
      • Evaluates the patient's response to therapy and recommends alternative approaches as needed.
      • Provides required instruction/education to the patient, family, and staff regarding concepts of bowel/bladder control.
    4. Provides in-service education to staff of the contracting facility.
      • Provides education to staff regarding WOC care as agreed upon.
      • Obtains CE approval for educational programs, when indicated and agreed upon.

Appendix G: Sample WOC Nurse Position Description: Industry

Position Title: Director of Professional Services

Responsible to: President, CEO, or Senior Vice President

General Description

The director of professional services shall assume responsibility for assisting the corporation in providing products and services in accordance with the corporate mission statement and philosophy. The director implements quality standards, develops educational programs and materials, and offers consultation to other members of the team in the area of clinical expertise.

Qualifications

  1. Education and experience
    1. BSN; master's degree from an accredited school of nursing preferred.
    2. Graduation from a WOCN-accredited wound, ostomy and continence nursing education program.
    3. Minimum of 2 to 4 years of experience as an RN preferred.
    4. Prior teaching, management, and leadership experience preferred.
    5. Working knowledge of quality management.
  2. License and certification
    1. Current RN licensure.
    2. Current certification by the Wound, Ostomy and Continence Nursing Certification Board in one or more areas of wound, ostomy and continence specialty nursing practice for the services to be provided.

General Duties and Responsibilities (this list is representative rather than inclusive)

  1. Develops, implements, and directs the corporation's quality assurance program in conjunction with input from senior operations personnel and develops a plan to introduce the program to the field.
  2. Defines the quality standards.
  3. Establishes a patient advocacy hotline and a patient evaluation response system.
  4. Develops a business plan that describes the structure, reporting mechanism, financial projections, and expected outcomes.
  5. Informs field centers of quality assurance standards as requested.
  6. Apprises senior operations personnel and local centers of regulatory guidelines promulgated by professional state practice associations (eg, Food and Drug Association, Department of Transportation, Compressed Gas Association). Establishes a monitoring mechanism to evaluate the center's regulatory compliance.
  7. Develops protocols and other collateral materials for review by senior management for home medical equipment centers to guide professional and patient care practices in home. Provides clinical/patient care consultation about the company's services, as required.
  8. Reviews client care and administrative policies and procedures encompassing the following:
    1. Intake procedures.
    2. Follow-up visit standards.
    3. Patient grievance procedures.
    4. Medical supervision procedures.
    5. Infection control guidelines.
  9. Monitors all product recall notices that affect field centers and notifies senior operations personnel and centers as appropriate regarding product recalls.
  10. Provides guidance to field home medical equipment centers regarding patient incidents. Assists in the investigative process as requested for incidents that may result in litigation. Serves as a liaison between the field centers and the corporate legal staff for all patient-/product-related incidents.
  11. Coordinates and networks with corporate and regional offices and departments to promote continuity and the efficient use of resources.
  12. Analyzes existing practices and provides recommendations as requested to senior and regional management regarding methods and procedures that facilitate integration of the corporation's spectrum of services, thus yielding improved service to patients, cost economies, and greater market penetration.
  13. Provides guidance to field home medical equipment centers and clinical staff in the provision of professional services. This includes supervision of performance evaluations, continuing education, and development of standardized procedures and practices.
  14. Assists senior management in the development of new programs as required, including the following:
    1. Analysis of needs.
    2. Development of a business plan.
    3. Assistance with program implementation.
    4. Production of collateral materials relating to professional and patient care practices for new programs.
  15. Provides consultation to field centers as requested regarding clinical and patient care issues and practices.
  16. Provides coordination of continuing educational offerings provided by the corporation to the community.

Appendix H: Sample Position Description: Certified Wound Care Nurse

Position Title: Certified Wound Care Nurse (CWCN)

Department: Nursing

Responsible to: Director of Nursing, Nurse Manager, or WOC Nurse Supervisor

General Description

The certified wound care nurse (CWCN) has the responsibility and accountability for utilizing the nursing process in the prevention and treatment of acute and chronic wounds throughout the organization. The CWCN functions primarily as a consultant providing direct patient care and education to selected patients and provides staff development in wound care.

Qualifications

  1. Education and experience
    1. BSN required.
    2. Graduation from a WOCN-accredited education program or specialty course, or satisfactory completion of program within 6 months of assuming new position.
    3. Minimum 2 to 4 years of RN experience preferred.
  2. License and certification
    1. Current RN licensure.
    2. Current certification in wound care nursing (CWCN) by the Wound, Ostomy and Continence Nursing Certification Board.

General Duties and Responsibilities (this list is representative rather than inclusive)

  1. Provides consultation and assistance to staff in developing and implementing protocols used in the identification and management of patients with potential or actual alteration in skin integrity.
  2. Provides guidance to staff in implementation of protocols to identify, control, or eliminate etiologic factors for skin breakdown, including selection of appropriate support surfaces.
  3. Establishes protocols and guidelines for appropriate and cost-effective use of therapeutic support surfaces.
  4. Evaluates the patient's response to treatment and the progress toward wound healing and makes adjustments and modifications in care as indicated.
  5. With a physician's order, provides appropriate debridement of devitalized tissue (eg, conservative sharp debridement, silver nitrate [AgNO3] cauterization of nonproliferative wound edges or hypertrophic granulation tissue, and to control minor bleeding).
  6. Provides consultation and assistance to staff in developing a plan of care to manage patients with draining wounds and fistulae (eg, containment of drainage and odor, protection of perifistular skin).
  7. Provides consultation and assistance to staff in developing a plan of care for patients with percutaneous tubes (ie, tube stabilization, site care, appropriate drainage collection system).
  8. Provides appropriate education to patients, caregivers, and staff regarding skin care, wound management, care of percutaneous tubes, and management of draining wounds/fistulae.
  9. Provides follow-up for patients with acute and chronic wounds (eg, draining wounds, fistulas) or percutaneous tubes through outpatient clinic visits and/or phone consultations.
  10. Initiates appropriate referrals for medical or surgical interventions.
  11. Assists staff to maintain current knowledge and competence in the areas of skin and wound care through orientation, regularly scheduled in-service programs, and by reviewing/updating policies and procedures according to national guidelines.
  12. Maintains records and statistics and submits reports to the employer.
  13. Analyzes stocked items and recommends appropriate additions and deletions to assure the quality and cost-effectiveness of products used for skin and wound care.
  14. Conducts product evaluations or contributes to research studies related to skin and wound care and submits reports and recommendations based on the results.
  15. Serves on systemwide committees and participates in systemwide projects as requested.
  16. Attends continuing education programs related to wound management.

Appendix I: Sample Position Description: Certified Ostomy Care Nurse

Position Title: Certified Ostomy Care Nurse (COCN)

Department: Nursing

Responsible to: Vice President/Director of Nursing, Nursing Manager or a WOC Nurse Supervisor

General Description

The certified ostomy care nurse has the responsibility and accountability for utilizing the nursing process in the management of patients with fecal and/or urinary ostomies throughout the organization. The certified ostomy care nurse functions primarily as a consultant providing direct patient care and education to selected patients and provides for ongoing staff development in ostomy care.

Qualifications

  1. Education and experience
    1. BSN required.
    2. Graduation from a WOCN-accredited wound, ostomy and continence (WOC) nursing education program or specialty course, or satisfactory completion of a program within 6 months of assuming new position.
    3. Minimum 2 to 4 years of RN experience preferred.
  2. License and certification
    1. Current RN licensure.
    2. Current certification in ostomy care nursing (COCN)by the Wound, Ostomy and Continence Nursing Certification Board.

General Duties and Responsibilities (this list is representative rather than inclusive)

  1. Provides consultation, direct care, and education to patients undergoing ostomy or continent diversion surgery.
  2. Visits patients preoperatively who are scheduled to undergo ostomy or continent diversion to provide informational, technical, and psychological support. Explains the surgical procedures and the rehabilitation process, selects and marks a potential stoma site, completes and charts the nursing assessment of the abdomen and psychological status.
  3. Initiates appropriate procedures for stoma care.
    1. Assesses the stoma and stoma functioning and alerts the physician to any problems.
    2. Removes sutures and/or the support rod.
    3. Measures and fits the stoma with a pouching system. Selects and provides appropriate products for the patient based on knowledge of the type of stoma, skin sensitivities, body contours, and disease processes. Orders supplies as needed.
    4. Instructs and demonstrates to patients and/or significant others the correct procedures to care for the stoma, peristomal skin, pouching system, and intubation and irrigation techniques (if indicated).
    5. Explains the availability of supplies/equipment and procedures for reordering.
    6. Provides counseling and educational literature to patients and their significant others.
  4. Provides consultation and assistance to staff in developing a plan of care to manage patients with an ostomy or continent diversion.
  5. Coordinates counseling services for patients and makes appropriate referrals to psychiatry, dietetics, social services, occupational therapy, or others that may be recommended by the physician.
  6. Provides follow-up for patients with ostomies or continent diversions through outpatient clinic visits and/or phone consults and initiates appropriate referrals for medical or surgical intervention.
  7. Assists staff to maintain current knowledge and competence in the areas of ostomy and continent diversion care through orientation, regularly scheduled in-service programs, and by reviewing/updating policies and procedures according to national guidelines.
  8. Maintains records and statistics and submits reports to the employer.
  9. Analyzes stocked items and recommends appropriate additions and deletions to assure the quality and cost-effectiveness of the products used for ostomy and continent diversion care.
  10. Conducts product evaluations or contributes to research studies related to ostomy care and submits reports and recommendations based on results.
  11. Serves on systemwide committees and participates in systemwide projects as requested.
  12. Attends continuing education programs related to ostomy and continent diversion care.

Appendix J: Sample Position Description: Certified Continence Care Nurse

Position Title: Certified Continence Care Nurse (CCCN)

Department: Nursing

Responsible to: Vice President/Director of Nursing, Nurse Manager or a WOC Nurse Supervisor

General Description

The certified continence care nurse (CCCN) has the responsibility and accountability for utilizing the nursing process in the management and treatment of patients with fecal and urinary continence disorders throughout the organization. The CCCN functions primarily as a consultant providing direct patient care and education to selected patients and provides staff development in continence care.

Qualifications

  1. Education and experience
    1. BSN required.
    2. Graduation from a WOCN-accredited education program or specialty course, or satisfactory completion of program within 6 months of assuming new position.
    3. Minimum 2 to 4 years of experience as an RN, preferred.
  2. License and certification
    1. Current RN licensure.
    2. Current certification in continence care nursing (CCCN) by the Wound, Ostomy and Continence Nursing Certification Board.

General Duties and Responsibilities (this list is representative rather than inclusive)

  1. Identifies risk factors for urinary and/or fecal continence disorders.
  2. Assesses patients with urinary and/or fecal continence disorders. Assessment includes the relevant history, a focused physical examination, a record of bladder and bowel elimination and incontinent episodes, simple bedside cystometry, and identification of complicating factors.
  3. Establishes an appropriate management program to include dietary and fluid management; bowel training or stimulated defecation program; bladder retraining, prompted voiding, or a scheduled voiding program; pelvic muscle reeducation without biofeedback; indwelling catheter management; recommendations regarding containment/absorptive devices and skin care; and education and counseling for patients/caregivers.
  4. Identifies patients requiring referral for assessment/management of complex urinary or fecal continence disorders.
  5. Provides consultation and assistance to staff in developing and implementing plans and protocols to identify and manage patients with potential or actual fecal and/or urinary continence disorders.
  6. Evaluates the patient's response to treatment and the progress of the continence care program and makes adjustments and modifications to care as indicated.
  7. Provides follow-up for patients with fecal and/or urinary continence disorders through outpatient clinic visits and/or phone consults and initiates appropriate referrals for medical or surgical intervention as needed.
  8. Assists staff to maintain current knowledge and competence in the areas of skin care and continence care through orientation, regularly scheduled in-service programs, and by reviewing/updating policies and procedures according to national guidelines.
  9. Maintains records and statistics and submits reports to the employer.
  10. Analyzes stocked items and recommends appropriate additions and deletions to assure the quality and cost-effectiveness of the products used for continence management.
  11. Conducts product evaluations or contributes to research studies related to continence and submits reports and recommendations based on results.
  12. Serves on systemwide committees and participates in systemwide projects as requested.
  13. Attends continuing education programs related to continence management.

Advanced Continence Care Skills: The following additional care may be provided if the CCCN has advanced continence care skills.

  1. A comprehensive assessment that includes performing the following examinations as indicted:
    1. A detailed physical examination and evaluation for prolapse and urethral hypermobility.
    2. Complex multichannel urodynamic studies, with or without fluoroscopic imaging and anorectal manometry studies.
  2. Management/interventions including pelvic floor rehabilitation and reeducation via electrical stimulation and biofeedback and fitting and placement of vaginal pessaries.

Appendix K: Sample Position Description: Certified Foot Care Nurse

Position Title: Certified Foot Care Nurse (CFCN)

Department: Nursing

Responsible to: Vice President/Director of Nursing, Nurse Manager, or a WOC-FC Nursing Supervisor

General Description

The certified foot care nurse (CFCN) has the responsibility and accountability for utilizing the nursing process in the management and treatment of patients with selected foot and nail disorders throughout the organization in accordance with licensure and educational preparation. The CFCN functions primarily by providing direct patient care to selected patients with foot/nail care needs and provides staff development in foot, skin, and nail care.

Qualifications

  1. Education and experience
    1. BSN preferred.
    2. Graduation from a WOCN-accredited wound, ostomy and continence (WOC) nursing education program or specialty course that includes foot/nail care, didactic and clinical; or completion of a specific foot/nail care continuing education course that includes foot/nail care, didactic/clinical, under the supervision of a foot/nail care expert.
    3. Minimum 2 to 4 years of experience as an RN, preferred.
  2. License and certification
    1. Current RN licensure.
    2. Current certification as a foot care nurse (CFCN) by the Wound, Ostomy and Continence Nursing Certification Board.

General Duties and Responsibilities (this list is representative rather than inclusive)

Three levels of foot/nail care have been described as basic, level I; intermediate, level II; and advanced, level III (Kelechi & Luckacs, 1996). The levels of care are based on the level of need of the patient and the qualifications of the staff who provide the care, which can vary according to state licensing laws and specific agency policies. For example, some states require a physician's order for nail debridement, while others do not (Etnyre, Zarate-Abbott, Roehrick, & Farmer, 2011).

  1. Basic foot/nail care, level I & intermediate foot/nail care, level II
    1. Identifies risk factors for foot disorders or ulcerations.
    2. Assesses patients with identified risk factors or actual foot disorders for:
      • Risk of ulceration.
      • Risk of amputation.
      • Mobility and the need for footwear or mobility aids.
      • Quality-of-life issues related to foot pathology.
    3. Provides assistance to staff in developing and implementing protocols used in the identification and management of patients with actual/potential disorders of the feet.
    4. Provides hygiene, trims toenails, and debrides thick toenails, corns, and calluses of selected at-risk patients.
    5. Establishes an appropriate management and education program to include foot assessment, prevention of injuries, hygiene, and skin and nail care.
    6. Identifies patients requiring referral to other specialists for assessment/management of complex foot disorders or ulcerations.
    7. With a physician's order, initiates dressings and other therapies such as compression.
    8. Evaluates the patient's response to treatment and the progress of the foot care management program.
    9. Provides follow-up for patients with foot disorders through outpatient clinic visits and/or phone consultation.
    10. Assists staff to maintain basic current knowledge and competence in the areas of prevention and skin care of the feet and lower extremities.
    11. Maintains records and statistics and submits reports to the employer.
    12. Analyzes stocked items and recommend appropriate additions and deletions to assure the quality and cost-effectiveness of products used for foot/nail care.
    13. Conducts evaluations of the products that are used for foot/nail care.
    14. Serves on systemwide committees and participates in systemwide projects as requested.
    15. Attends continuing education programs related to foot/nail care.
  2. Advanced foot/nail care, level III

    If the CFCN has advanced foot/nail care skills based on licensure and educational preparation, in addition to the basic level I and intermediate level II care, the following advanced care can be provided:

    1. Provides prompt interventions for specific foot complications.
      • Patient assessment and advanced care are performed and referrals made for diagnostic tests or specialty care.
      • Patients are reassessed by the CFCN as indicated for foot complications at least 4 times annually.
    2. Makes referrals for patients with complications who need ongoing assessment or care in the community until the condition no longer warrants the services.
    3. Pares (ie, sharp debridement) corns and calluses (selected RNs with competency).
    4. Prescribes appropriate pharmacological treatments for selected disorders of the feet or lower extremities (APRN with prescriptive authority).
    5. Performs digital blocks and excises ingrown toenails (APRN).

References

Etnyre, A., Zarate-Abbott, P., Roehrick, L., & Farmer, S. (2011). The role of certified foot and nail care nurses in the prevention of lower extremity amputation. Journal of Wound, Ostomy and Continence Nursing, 38(3), 242–251. doi: 10.1097/WON.0b013e3182152e93.

Kelechi, T., & Lukacs, K. (1996). Foot care in the home: Nursing and agency responsibilities. Home Healthcare Nurse, 14(9), 721–731.

Appendix L: Sample Position Description: Wound Treatment Associate

Position Title: Wound Treatment Associate

Department: Nursing

Responsible to: Director of Nursing or WOC Nurse Supervisor

General Description

Under the direction of an advanced practice WOC nurse, specialty WOC nurse, and/or MD, the wound treatment associate is responsible for provision of routine skin care, identification of patients at risk for pressure ulcer development, implementation of prevention protocols for patients at risk for pressure ulcer development, and assisting with the provision of comprehensive wound care and monitoring for patients with skin tears, incontinence-associated dermatitis, dehisced incisions, pressure ulcers, and lower extremity ulcers.

Qualifications

  1. Education and experience.
    1. Minimum of diploma, associate degree, practical/vocational nurse education, or completed training as a military medic/corpsman.
    2. Two years of clinical experience in nursing.
    3. Strong interpersonal skills.
  2. License and certification
    1. Licensed RN, LPN/LVN or military medic/corpsman (no license required).
    2. Certificate of successful completion of a Wound, Ostomy and Continence Nurses Society–endorsed Wound Treatment Associate Education Program.

Duties and Responsibilities

  1. Collaborates with other team members to provide routine care that keeps skin healthy.
  2. Collaborates with other team members to identify patients at risk for pressure ulcer development and to provide appropriate preventive care using established protocols.
  3. Identifies patient at risk for skin tears and for incontinence-associated dermatitis and initiates appropriate preventive care.
  4. Collaborates with other team members to identify and address causative and contributing factors to skin breakdown.
  5. Collaborates with other team members to assess and address systemic factors affecting wound healing.
  6. Collaborates with other team members to provide ongoing and comprehensive assessment and documentation of wound status and progress in wound healing.
  7. Collaborates with other team members to select appropriate dressings and to maintain a physiologic environment for wound healing.
  8. Identifies patients who require referral to a wound specialist, vascular surgeon, or other specialist for any of the following issues: evaluation for deterioration or failure to progress, management of closed wound edges (epibole), instrumental debridement of necrotic tissue, and differential assessment and management of lower extremity ulcers.
  9. Performs the following procedures when ordered and appropriate:
    1. Applies compression wraps.
    2. Measures ankle brachial index.
    3. Obtains swab wound cultures.
  10. Provides or assists with appropriate education regarding skin and wound care to patients, families, and staff.
  11. Collaborates with other team members to maintain an appropriate inventory of products for skin and wound care.
  12. Participates in quality improvement programs.

Note: Each nurse is accountable for practicing in accordance with the specific requirements of the licensing boards in the state(s) in which he/she practices. Job titles and specific role functions are determined by the employing organization and should be consistent with state board of nursing licensing regulations and requirements.

Appendix M: Sample WOC Nurse Performance Appraisal: Acute Care

Date: _________

Employee Signature: ________________

Manager Signature: _________________

Meets Clinical Nurse IV Maintenance Criteria

Knowledge/Education, Leadership/Management, Clinical Practice, Quality/Safety, Research/Innovation.

Completes annual required RN education

Demonstrates maintenance of required annual competencies (if applicable):

Assessment Rating Scale:1 □ 2 □ 3 □ 4 □ 5

(1 = below expectations; 3 = meets expectations; 5 = exceeds expectations)

  Score
  1. Performs essential functions identified in the position description.
□ 1 □ 2 □ 3 □ 4 □ 5
  1. Demonstrates organizational values in the work environment.
□ 1 □ 2 □ 3 □ 4 □ 5
  1. Performs essential functions to maintain a safe environment of care.
□ 1 □ 2 □ 3 □ 4 □ 5

Manager/Supervisor Comments:______________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

Employee Comments:_____________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

Appendix N: Sample WOC Nurse Practitioner Performance Appraisal Form

Job Title: Nurse Practitioner

Department: Patient services

Job Criteria and Performance Standards

Scoring: Each performance standard scored on a scale of 1 to 5 (1 = below expectations; 3 = meets expectations; 5 = exceeds expectations).

Criterion 1: Provides diagnosis and treatment of common acute illnesses, prevention and maintenance health care to patients with stable chronic illnesses, and performs interim physical examinations for healthy patients within practice guidelines.
1. Performance Standards Score
1.1. Elicits appropriate present and past medical history and reviews systems. □ 1 □ 2 □ 3 □ 4 □ 5
1.2. Performs appropriate physical examination and orders appropriate diagnostic studies. □ 1 □ 2 □ 3 □ 4 □ 5
1.3. Discriminates between normal and abnormal findings in history and physical. □ 1 □ 2 □ 3 □ 4 □ 5
1.4. Establishes appropriate differential diagnosis. □ 1 □ 2 □ 3 □ 4 □ 5
1.5. Assesses stability of chronic illness and compliance with present therapy and monitors for complications of disease or therapy. □ 1 □ 2 □ 3 □ 4 □ 5
1.6. Establishes appropriate treatment plan. Assesses need for hospitalization or physician intervention. □ 1 □ 2 □ 3 □ 4 □ 5
1.7. Determines timing for follow-up and orders appropriate referrals. □ 1 □ 2 □ 3 □ 4 □ 5
1.8. Counsels regarding health maintenance and disease prevention and provides anticipatory guidance as appropriate.
Exceeds Standard
1.9. Demonstrates high degree of effectiveness in fulfilling standard as observed by supervisor.
□ 1 □ 2 □ 3 □ 4 □ 5

Comments:_____________________________________________________________________________________ _______________________________________________________________________________________________

Criterion 2: Provides health education to patients about ways to improve, promote, and maintain health status, including but not limited to providing educational information on disease/disease processes, self-care practices, and positive lifestyle choices (eg, diabetes, safe sex, weight loss, and smoking cessation).
2. Performance Standards Score
2.1. Assesses learning capabilities and readiness of population or individuals and tailors education to meet age, developmental, and educational needs. □ 1 □ 2 □ 3 □ 4 □ 5
2.2. Prioritizes learning needs and documents them accordingly. □ 1 □ 2 □ 3 □ 4 □ 5
2.3. Ensures that time frame and subject matter are appropriate for target audience/individual. □ 1 □ 2 □ 3 □ 4 □ 5
2.4. Utilizes appropriate teaching materials (eg, handouts, audiovisuals, demonstration) and documents use and patient outcome. □ 1 □ 2 □ 3 □ 4 □ 5
2.5. Initiates, designs, and completes educational programs for patients, families, and targeted audiences.
Exceeds Standard
2.6. Demonstrates high degree of effectiveness in fulfilling standard as observed by supervisor.
□ 1 □ 2 □ 3 □ 4 □ 5

Comments:_____________________________________________________________________________________ _______________________________________________________________________________________________

Criterion 3: Maintains accurate records, medication lists, and documentation of care and follow-up for administrative purposes and reimbursement of services.
3. Performance Standards Score
3.1. Adheres to agreed-upon format/protocol for documentation of records. □ 1 □ 2 □ 3 □ 4 □ 5
3.2. Maintains appropriate level of documentation to promote/support level of complexity when compared against/to service fee charges. □ 1 □ 2 □ 3 □ 4 □ 5
3.3. Reviews and updates problem list at least on annual visit/episodic visit by patient and initiates problem and medication lists for new patients. □ 1 □ 2 □ 3 □ 4 □ 5
3.4. Documents telephone calls with patients and specialists. □ 1 □ 2 □ 3 □ 4 □ 5
3.5. Documents visit in concise, clear, logical, and legible manner.
Exceeds Standard
3.6. Demonstrates high degree of effectiveness in fulfilling standard as observed by supervisor.
□ 1 □ 2 □ 3 □ 4 □ 5

Comments:_____________________________________________________________________________________ _______________________________________________________________________________________________

Criterion 4: Maintains competence in clinical practice.
4. Performance Standards Score
4.1. Identifies the knowledge and skills needed through self-assessment, peer review, and supervisory review. □ 1 □ 2 □ 3 □ 4 □ 5
4.2. Participates in a variety of educational activities in order to maintain and increase competency. □ 1 □ 2 □ 3 □ 4 □ 5
4.3. Maintains licensure/certification. □ 1 □ 2 □ 3 □ 4 □ 5
4.4. Uses continuing education opportunities as a basis for expanding knowledge and improving clinical skills and incorporates these into the daily practice. □ 1 □ 2 □ 3 □ 4 □ 5
4.5. Participates in developing, implementing, and interpreting quality assurance/risk management programs.
Exceeds Standard
4.6. Demonstrates high degree of effectiveness in fulfilling standard as observed by supervisor.
□ 1 □ 2 □ 3 □ 4 □ 5

Comments:_____________________________________________________________________________________ _______________________________________________________________________________________________

Criterion 5: Supervises and intervenes with clinical issues and supports/directs triage by clinical staff when necessary. Implements clinical education and training of clinical staff when necessary.
5. Performance Standards Score
5.1. Provides constructive feedback as it relates to performance, patient flow, and patient care issues. □ 1 □ 2 □ 3 □ 4 □ 5
5.2. Provides in-services and clinical education for staff members on an “as-needed” basis. □ 1 □ 2 □ 3 □ 4 □ 5
5.3. Is available for feedback on call back and triage issues as needed. □ 1 □ 2 □ 3 □ 4 □ 5
5.4. Identifies barriers to patient care flow or delivery and assists at formulating corrective action. □ 1 □ 2 □ 3 □ 4 □ 5
5.5. Serves as a role model for patient interaction and conflict resolution for clinical staff. □ 1 □ 2 □ 3 □ 4 □ 5
5.6. Works collaboratively with health team members, both in and out of office setting, to ensure continuity of care and complete delivery of prescribed care.
Exceeds Standard
5.7. Demonstrates high degree of effectiveness in fulfilling standard as observed by supervisor.
□ 1 □ 2 □ 3 □ 4 □ 5

Comments:_____________________________________________________________________________________ _______________________________________________________________________________________________

Criterion 6: Adheres to the drug formulary developed by the practice.
6. Performance Standards Score
6.1. Prescribes within the nurse practitioner scope of practice for state/licensing body. □ 1 □ 2 □ 3 □ N/A
6.2. Ensures updated and accurate practice agreement as set forth in rules and regulations for licensing authority. □ 1 □ 2 □ 3 □ N/A

Comments:_____________________________________________________________________________________ _______________________________________________________________________________________________

Criterion 7: Demonstrates regard for the dignity and respect for all patients, families, guests, and representatives of other organizations as well as fellow employees, volunteers, and medical staff in support of the practice's mission to provide consistent, quality health care services in a professional, caring, and responsive environment.
7. Performance Standards Score
7.1. Maintains confidentiality of patient and of patient/practice information with no infractions. □ 1 □ 2 □ 3 □ N/A
7.2. Consistently displays a caring and responsible attitude, represents the practice in a positive manner, and conducts all activities respecting patient/customer rights and expectations.
Exceeds Standard
7.3. Consistently makes extra efforts to achieve patient/customer expectations while discharging job responsibilities.
□ 1 □ 2 □ 3 □ 4 □ 5
7.4. Regularly maintains a neat appearance and adheres to department/corporation expectations for dress, including the wearing of appropriate identification. □ 1 □ 2 □ 3 □ 4 □ 5
7.5. Interpersonal relations with other health care workers are regularly fostered in a courteous and friendly manner as evidenced by supervisory observation and peer input.
Exceeds Standard
7.6. The employee continuously exhibits self-initiated behaviors as outlined previously.
□ 1 □ 2 □ 3 □ 4 □ 5
7.7. Resolves conflicts with staff members by following established communication norms with limited involvement by supervisor to initiate resolution. □ 1 □ 2 □ 3 □ 4 □ 5
7.8. Consistently receives and gives suggestions and constructive criticism in a professional manner. □ 1 □ 2 □ 3 □ 4 □ 5

Comments:_____________________________________________________________________________________ _______________________________________________________________________________________________

Criterion 8: Demonstrates responsibility for individual performance and efficient utilization of products, supplies, equipment, and time to ensure the timely completion of duties and to promote financial viability through provision of services at a reasonable cost.
8. Performance Standards Score
8.1. Maintains consistent level of productivity as influenced by impinging factors of access, practice load, and complexity of care. □ 1 □ 2 □ 3 □ 4 □ 5
8.2. Performs other support functions to enhance the workflow. □ 1 □ 2 □ 3 □ 4 □ 5
8.3. Provides proper notification for all absences or tardiness, scheduled shift, and scheduled time off in accordance with company policy. □ 1 □ 2 □ 3 □ 4 □ 5
8.4. Consistently uses products, supplies, and equipment in an efficient manner, keeping waste within practice limits as observed by peers and administration.
Exceeds Standard
8.5. Regularly exceeds company standards and regularly suggests more efficient ways to complete tasks.
□ 1 □ 2 □ 3 □ N/A

Comments:_____________________________________________________________________________________ _______________________________________________________________________________________________

Criterion 9: Employee follows established safety precautions and procedures in the performance of all duties to ensure a safe environment.
9. Performance Standards Score
9.1. Regularly performs job tasks in accordance with company policy and procedures, including appropriate use of equipment and machines and appropriate use in wearing of personal protective equipment and safety equipment. □ 1 □ 2 □ 3 □ 4 □ 5
9.2. Demonstrates a complete knowledge of body mechanics by consistent use in the work setting as evidenced by no injuries sustained as a result of improper body mechanics in the evaluation period. □ 1 □ 2 □ 3 □ 4 □ 5
9.3. Demonstrates a concern for cleanliness of self and work area and practices proper infection control and universal precautions techniques.
Exceeds Standard
9.4. No observable variances during the review period.
□ 1 □ 2 □ 3 □ 4 □ 5
9.5. Responds to codes in accordance with emergency procedures. □ 1 □ 2 □ 3 □ N/A
9.6. Regularly maintains work area and equipment in a neat and orderly manner, assists in the cleaning of other work areas, and corrects any malfunctioning equipment or environmental conditions as observed by administration. □ 1 □ 2 □ 3 □ 4 □ 5

Comments:_____________________________________________________________________________________ _______________________________________________________________________________________________

Smart Goals

Goal and Target Date

Employee Name: _____________________________________________________________________

Employee Signature: _________________________________________________________________

Department Director/Supervisor Name: __________________________________________________

Department Director/Supervisor Signature:_______________________________________________

Date: _________________________

Date Issued/Approved: _________________________

Appendix O: Sample Structured Orientation Plan and Skills Checklist

Overview

The purpose of this form is to document completion of the orientation process and demonstration of skills in the critical components of wound, ostomy and continence nursing care. This form can be adapted with areas to place a checkoff or dates when the orientation/skills were completed. Additional skills or content areas can be added to meet the needs of the facility and/or the WOC nurse.

Utilization Guidelines

  1. Each nurse hired by the___________________ organization is assigned to receive 1 full day of orientation with the WOC nurse(s).
  2. The WOC nurse will utilize the Structured Orientation and Skills Checklist to ensure that:
  3. Following orientation to the WOC nurse role and the critical procedures, the skills checklist form will be completed by the WOC nurse with the following distribution:
  4. If the WOC nurse and the orienting nurse are unable to complete all of the components of the structured orientation, the appropriate supervisor will be notified and a follow-up plan will be established to complete the orientation and skills demonstration process.

Wound, Ostomy and Continence Care Orientation Guide and Skills Checklist

  1. WOC nurse role.
    1. Services provided/indications for referral.
    2. Referral process.
    3. WOC nurse and staff nurse roles and responsibilities.
  2. Wound care
    1. Critical assessment parameters:
      1. Identify location.
      2. Measure dimensions and depth in centimeters: length measured at longest head-to-toe dimension and width measured at widest point (side to side) perpendicular to the length; depth measured straight into wound at deepest point.
      3. Determine presence of sinus tracts and undermined areas: location and depth in centimeters.
      4. Stage pressure ulcers; classify other type of wounds as full/partial thickness.
      5. Assess status/appearance of wound bed (eg, granulating, necrotic, infected)
      6. Assess wound edges (open/closed).
      7. Assess exudate—volume, color, odor.
      8. Assess status of surrounding tissue (eg, intact, macerated, inflamed).
    2. Principles of management/dressing options.
      1. Importance of eliminating causative factors.
      2. Importance of providing nutritional support and glucose control.
    3. Guidelines for topical therapy.
      1. Options for wound with dry eschar.
      2. Options for superficial wound with minimal amounts of exudate.
      3. Options for superficial wounds with moderate to large amounts of exudate.
      4. Options for deep or tunneled wounds with minimal to moderate amounts of exudate.
      5. Options for deep or tunneled wounds with moderate to large amounts of exudate.
      6. Special considerations for leg ulcers.
      7. Importance of differential assessment and WOC nurse consult when needed.
      8. Venous ulcers: Importance of elevation and compression.
      9. Arterial ulcers: Issues regarding debridement and occlusion.
      10. Neuropathic ulcers: “Offloading” for plantar ulcers.
  3. Ostomy care.
    1. Pouch emptying.
      1. Indications and frequency.
      2. Guidelines for instruction to patient (eg, removing pouch clip, draining pouch, cleansing tail, reattaching clip).
    2. Pouch change: Fecal diversions.
      1. Guidelines for sizing pouch opening.
      2. Guidelines for cleansing and drying skin.
      3. Peristomal skin protection: Guidelines for paste application and use of skin sealants if needed.
      4. Procedure for centering and applying pouch.
        • One-piece.
        • Two-piece.
    3. Pouch change: Urinary diversion.
      1. Guidelines for sizing pouch opening.
      2. Guidelines for cleansing and drying skin and for “wicking” the stoma.
      3. Peristomal skin protection: Guidelines for use of skin sealants, if needed.
      4. Procedure for centering and applying pouch.
        • One-piece.
        • Two-piece.
    4. Management of peristomal skin breakdown
      1. “Crusting” procedure (eg, use of skin barrier powder and skin sealant).
      2. WOC nurse referral for severe or nonresponsive skin breakdown.
    5. Dietary/fluid modifications (teaching guidelines).
      1. Colostomy: No absolute restrictions, reduction or “timing” of gas-producing foods, fiber/fluids needed to prevent constipation.
      2. Ileostomy: Importance of increased fluid intake, cautious intake of high-fiber foods to prevent food blockage.
      3. Urinary diversion: Importance of adequate fluid intake.
  4. WOC nurse availability for bowel and bladder retraining/assistance with continence issues.

Appendix P: Sample Annual Conference Planning Time line

Suggested Time Frame and Actions to Be Taken: Starting 36 Months Prior to the Date of the Program.

36 Months in Advance

Form the Planning Committee

30 Months in Advance

Site Selection/Negotiation

24 Months in Advance

Topic Selection/Objectives/Program Schedule/Evaluation

Exhibitors

Registration/Budget Projections

18 Months in Advance

12 Months in Advance

6 Months in Advance

5 Months in Advance

4 Months in Advance

2 Months in Advance

1 Month in Advance

1 Week Prior

At Conference

End of Conference

Postconference

Appendix Q: Sample Conference Forms: Budget, Application for Exhibit Space, Exhibitor Evaluation, and Conference Evaluation

  Budget for Prior Year Actuals for Prior Year Current Year Budget Comments
Income        
Exhibits $ – $ – $ – This column is important to complete. When you are determining a budget line item, please note how you arrived at that figure.
Registration $ – $ – $ – ie, registration income – 100 Members at $∗∗= $ and 50 Nonmembers at $50 =
Event Sponsorship $ – $ – $ –  
Commercially Supported Symposia $ – $ – $ –  
Unrestricted Educational Grant $ – $ – $ –  
Postmeeting List Sales $ – $ – $ –  
Total Income $ – $ – $ –  
Expenses        
Abstract Management $ – $ – $ –  
CE Administration $ – $ – $ –  
Marketing Annual Conference $ – $ – $ –  
Audiovisual $ – $ – $ –  
Audience Response Units $ – $ – $ –  
Awards $ – $ – $ –  
CD ROM $ – $ – $ –  
Commercial Supported Symposia $ – $ – $ –  
Decorator $ – $ – $ –  
Disability Accommodations $ – $ – $ –  
Equipment Rental $ – $ – $ –  
Food and Beverage $ – $ – $ –  
Gratuities $ – $ – $ –  
Gifts/Amenities $ – $ – $ –  
Insurance–Cancellation $ – $ – $ –  
Meeting Space Rental        
Membership Booth/Book Store $ – $ – $ –  
Opening/Closing Speaker $ – $ – $ –  
Photography $ – $ – $ –  
Posters $ – $ – $ –  
Printing $ – $ – $ –  
Registration $ – $ – $ –  
Shuttle Service $ – $ – $ –  
Signs $ – $ – $ –  
Speaker Honoraria $ – $ – $ –  
Speaker Housing $ – $ – $ –  
Speaker Per Diem $ – $ – $ –  
Speaker Web site $ – $ – $ –  
Speaker Travel $ – $ – $ –  
Sponsored Items $ – $ – $ –  
Supplies $ – $ – $ –  
Total Direct Expense $ – $ – $ –  
Copies $ – $ – $ –  
Management Fees $ – $ – $ –  
Miscellaneous $ – $ – $ –  
Postage/Shipping $ – $ – $ –  
Staff Travel $ – $ – $ –  
Tele/Fax/E-mail $ – $ – $ –  
Total Meeting Management $ – $– $ –  
Total Expenses $ – $ – $ –  
Net Income (loss) $ – $ – $ –  

Sample Conference Forms: Exhibitor Evaluation Form

Conference or Seminar Name:

Date:

Location:

In order for _______________ to provide optimum arrangements for our exhibitors, we would appreciate your cooperation in completing this questionnaire. Please fill in the circle for rating of your choice.

  Excellent Good Fair Poor
1. Please rate the interest level and quality of conference attendees in the exhibit hall.
2. How would you rate overall attendance in the exhibit hall?
3. How would you rate the effectiveness of the following exhibit days?
 a. Date — Exhibits Open — time
 b. Date — Exhibits Open — time
 c. Date — Exhibits Open — time
 d. Date — Exhibits Open — time
4. How would you rate the adequacy of the exhibit hours?
5. How would you rate the effectiveness of the exhibitor lead program?
6. Please rate the quality of the following:
a.  Exhibitor Registration Process
b.  Hotel Accommodations
c.  Exhibit Hall Design
d.  Booth Location
e.  Decorating
f.  Cost of Booth
g.  Overall Exposure to Attendees

Sample Conference Forms: Conference Evaluation Form

Conference or Seminar Name:

Date:

Location:

To assist us in evaluating the effectiveness of this meeting and to make recommendations for the future, please complete this conference evaluation form by filling in the circle for the appropriate rating. Please complete the speaker portion of this form at the conclusion of each lecture. Return this form to the registration desk at the end of the conference along with the white copy of your certificate of attendance and contact hours form. Thank you for attending this meeting!

Section I. Overall Conference Evaluation

  Strongly Agree Agree Neutral Disagree Strongly Disagree
1. I feel the conference achieved the following objectives:
 a. (List objective)
 b. (List objective)
2. The conference met my personal objectives.
3. The program was well organized.
4. The exhibits provided an adequate environment for learning.
5. The program book was easy to read and helpful.
6. The individual sessions were relevant to the conference goals.
7. The individual sessions assisted me in achieving my learning goals.

Section II. Evaluation of Conference Quality

  Excellent Good Average Fair Poor
1. Overall Conference
2. Exhibits:
 a. Grand Opening
 b. Quality/Space
 c. Time Allowed
 d. Location
3. Hotel Facilities
4. Conference Registration
5. Special Event
6. Helpfulness of:
 a. Planning Committee
 b. Monitors/Moderators
 c. Registration Personnel
 d. Hotel Staff

Section III. Content/Speaker Evaluation

N/A = Not at All 1 = Poor 2 = Average 3 = Above Average 4 = Outstanding

Appendix R: Role of the WOC Nurse or Continence Care Nurse in Continence Care

∗Note: This document was approved and adopted by the WOCN Society Board of Directors in 2009 and is available in the WOCN Public Library: http://www.wocn.org/PublicLibrary

Background

Incontinence (ie, loss of bladder and/or bowel control) is a significant health care problem, which affects an individual's physical and psychosocial life. The social costs of incontinence are high and even mild symptoms affect social, sexual, interpersonal, and professional function. Incontinence creates a burden on families and caregivers and has a significant economic impact on society.

The incidence of incontinence increases with age and is greatly impacted by factors that affect independent living. In 2000, the cost of incontinence was $12.6 billion. With increasing numbers of people who are 65 years of age and older, dealing with issues relating to incontinence will have a major economic impact on society.

Urinary Incontinence

Urinary incontinence is a stigmatized, underreported, underdiagnosed, and undertreated condition that is erroneously thought by many to be a normal part of aging.

Fecal Incontinence

Fecal incontinence is the inability to control the passage of gas and/or liquid or solid stool.

Combined Urinary and Fecal Incontinence (Dual Incontinence)

Dual incontinence impacts 25% of all US adults during their lives.

Role of the Continence Nurse

The continence nurse provides expert care to patients with urinary and/or fecal incontinence by conducting a focused assessment, performing a limited physical examination, synthesizing data, developing a plan of care, and evaluating interventions. The role includes, but is not limited to, serving as an expert clinician, consultant, educator, and/or administrator/manager in various health care settings.

Continence nursing management is based on an in-depth knowledge of normal voiding and defecation physiology, common alterations in bowel/bladder function and their sequelae, and a basic understanding of common diagnostic studies (eg, urinary analysis, culture and sensitivity, studies of the urinary and lower digestive tract).

Continence Nurse Competencies

Specific competencies of the continence nurse include the following skills and abilities:

Role of the Advanced Practice Continence Nurse

The advanced practice continence nurse provides expert care to patients with urinary and/or fecal incontinence by conducting a focused assessment, performing a comprehensive physical examination, synthesizing data, developing a plan of care, and evaluating interventions. The role includes, but is not limited to, serving as an expert clinician, consultant, educator, and/or administrator/manager in various health care settings.

Advanced Practice Nurse Continence Competencies

The advanced practice continence nurse possesses the competencies of the continence nurse and in addition has the following advanced competencies in accordance with an advanced level of education at the master's level and in accordance with state practice regulations:

Conclusion

The continence nurse is in an excellent position to meet the needs of patients with urinary and/or fecal incontinence across all practice settings. The continence nurse is skilled in the collaborative practice approach required for comprehensive patient management in today's health care environment.

Authors:

2008–2009 WOCN Continence Committee

2008–2009 WOCN Professional Practice Committee

Phyllis Kupsick, MSN, CS-FNP, CWOCN

Kate Lawrence, MSN, RN, CWOCN

Barbara Sadler, BSN, RN, CWOCN

Adopted by the WOCN Board of Directors: May 6, 2009

References

Bell, M., & DeMarinis, M. (2006). The psychological cost of incontinence. ECPN, 109, 13–14.

Bennett, H. (2005). Waking up dry: A guide to help children overcome bedwetting. Elk Grove Village, IL: American Academy of Pediatrics.

Bharucha, A., Zinsmeister, A., Locke, G., Seide, B., McKeon, K., Schleck, C., et al. (2005). Prevalence and burden of fecal incontinence: A population-based study in women. Gastroenterology, 129, 42–49.

Farrell, S. (2006). Cesarean section versus forceps-assisted vaginal birth: It's time to include pelvic injury in the risk-benefit equation. Canadian Medical Association Journal, 166, 337–338.

Hu, T., Wagner, T., Bentkover, J., Leblanc, K., Zhou, S., & Hunt, T. (2004). Costs of urinary incontinence and overactive bladder in the United States: A comparative study. Urology, 63, 461–465.

Landefeld, C., Bowers, B., Feld, A., Hartmann, K., Hoffman, E., Inglber, M., et al. (2008). National Institutes of Health state of the science statement: Prevention of fecal and urinary incontinence in adults. Annals of Internal Medicine, 148, 449–458. Retrieved May 5, 2008, from http://www.annals.org/cgi/content/full/0000605-200803180-00210v1

Lenderking, W., Nackley, J., Anderson, R., & Testa, M. (1998). A review of the quality of life aspects of urinary urge incontinence; Importance of patients' perspective and explanatory lifestyle. Journal of the American Geriatrics Society, 46, 683–692.

Martin, C. (1997). Urinary incontinence in the elderly. Consultant Pharmacist, 12. Retrieved from http://www.ascp.com/publications/tcp/1997/aug/elderly.html

Muller, N. (2005). What Americans understand and how they are affected by bladder control problems: Highlights of recent nationwide consumer research. Urologic Nursing, 25, 109–115.

National Association for Continence. (2008). What is incontinence? Retrieved May 5, 2008, from http://www.nafc.org/bladder-bowel-health

Palmeri, B., Giorgia, B., & Bellini, N. (2005). The anal bag: A modern approach to fecal incontinence management. Ostomy Wound Management, 51, 44–52.

Resnick, N. (1998). Improving treatment of urinary incontinence (commentary letter). Journal of the American Medical Association, 280, 2034–2035.

Saffel, D. (2006). Medication in the treatment of urinary incontinence. ECPN, 109, 27–31.

Shamliyan, T., Kane, R., Wyman, J., & Wilt, T. (2008). Systematic review: Randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Annals of Internal Medicine, 148, 459–473.

U.S. Department of Health and Human Services. (2007). Fecal incontinence. NIH Pub. 07–4866. Retrieved April 26, 2009, from http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/fecalincontinence.pdf

Von Gontard, A., Schaumburg, H., Hollmann, E., Eiberg, E, & Rittig, S. (2001). The genetics of enuresis: A review. Journal of Urology, 166, 2438–2443.

Appendix S: WOCN Business Plan Template Workbook

Table of Contents

Acknowledgments

Developing a Business Plan

Appendix S–I. Sample Business Plan Template With Data

Appendix S–II. Sample Business Plan for Always Wright Consulting Services

Appendix S–III: A Business Financial Glossary

Acknowledgments

Contributors to the WOCN Business Plan Template Workbook

Wound, Ostomy and Continence Nurses Society

This document was developed by the WOCN Professional Practice Committee.

Business Plan Template Workbook Task Force:

Bianca Jones

Wound Care Nurse Consultant

UHS-Pruitt Corp

Norcross, GA

Sonya Perry, MSN, RN, CWOCN

Charleston Area Medical Center

Charleston, WV

Myra Varnado, BS, RN, CDE, CWOCN

LSU Hospital System

New Orleans, LA

Date Submitted: January 10, 2011

Resubmitted: April 18, 2011

Revised: May 2, 2011

Board Approval: July 26, 2011

Copyright© 2011 by the Wound, Ostomy and Continence Nurses Society. Date of Publication, August 2011.

No part of this publication may be reproduced, photocopied, or republished in any form, in whole or in part, without written permission of the Wound, Ostomy and Continence Nurses Society.

Developing a Business Plan

In this section, you will find a business plan template workbook designed to identify the specific components of a business plan and guide you through creating one for an existing or new business/product. As a wound, ostomy and continence (WOC) clinician, managerial leader, consultant, or advanced practice nurse, planning is an integral component of meeting organizational, departmental, and professional practice goals.

The concepts within this template will benefit the WOC nurse across a variety of health care settings. As a WOC nurse clinical leader, you know the advantage you provide in managing resources cost-effectively and affecting improved outcomes related to wound, ostomy, and incontinence care (Wound, Ostomy and Continence Nurses Society [WOCN], 2010). Whether you are a novice or experienced WOC nurse, your expert assessment and individualized plan of care influence long-term clinical outcomes across care systems.

Completion of a professional business plan demonstrates commitment to your goals for implementing best practices, serves as an educational tool that highlights your focus on improved patient outcomes, and provides an instrument for the expression of professional values.

Each part of the business plan template provides brief theoretical background, using questions to help you gather the information that will create a meaningful plan for your business model. You may find that not all content areas will apply to every business plan depending upon your business model as a sole proprietor or in a partnership.

Included in the business plan template are as follows:

A sample business plan with data follows the workbook template. The information contained in the sample is fictitious and should not be considered valid to your plan. (See Appendix S–I: Sample Business Plan Template With Data.)

The business plan table of contents includes:

The real value of creating a business plan lies in the process of researching and thinking about your goals in a systematic manner, more so than the finished product in hand. The act of planning helps you think through concepts thoroughly, study and research uncertain facts, and look at ideas critically. This takes time on the front end but often avoids costly mistakes later. The entire business plan template may take days and sometimes weeks to complete. Each question should be given serious thought and outside resources should be reviewed before completing most questions. After all the questions are answered, the actual business plan can be written. A formal written business plan will provide the greatest benefit to your process.

Planning a new business/product can be both exciting and intimidating. This business plan template will make the planning process easier. Adequate planning is the foundation of a successful business/product.

Introduction

  1. “He who fails to plan, plans to fail.” Proverb
    “Success in business is threatened if you can't see the forest for the trees.” Unknown “In the absence of clearly defined goals, we are forced to concentrate on activity and ultimately become enslaved by it.”—Chuck Conradt (Marquis & Huston, 2006)
  2. Planning requires time: It typically takes several weeks to complete a good business plan. Most of that time will be utilized in research and rethinking/reworking your ideas and assumptions. Make time to complete the task thoroughly.
    Be realistic and do not underestimate the time you will need to create a thorough and meaningful business plan or proposal. Whether you strive to improve clinical processes or you are requesting another WOC position to better meet current patient needs, planning will influence accomplishment. After the initial business plan is implemented, revising should be an ongoing process. You should collect information in your day-to-day activities and update the business plan 2 to 3 times a year. Minimally, you should revise your business plan with new goals and strategies at least once a year.
  3. Why develop a business plan?
    A business plan is essential because it allows you to:
    1. Lay out the master blueprint to show a logical progression of steps needed to reach the established goal. It is a powerful management tool that also helps you consider alternatives or possibly a better way of doing things.
    2. Communicate your business plan to your own team. This is important in order to keep everyone on the same track and to be able to measure progress.
    3. Communicate your business plan to others to gain their support. This may come in the form of resources, financing, reimbursement, “word of mouth” referrals, or just plain moral support.

Example: For a personal business or consulting business plan with an agency, include team members such as business partners, attorney, accountant/banker, and technology/end user consultant. Other recipients of the business plan include your key physicians and/or clinical partners.

If you as the clinical expert are creating a wound care program or an outpatient stoma clinic from within an agency or facility, include administrators, managers, nurses, and WOC nursing peers as appropriate. Depending on the scope of your services or proposal, you may seek guidance from the human resource department, data analyst, or an expert in billing and reimbursement. The knowledge, advice, and support you gain by collaborating with other leaders and thoroughly planning are critical to the business/product's success.

  1. Keys to convincing others
    When others are looking at your business plan, their decision to support it depends heavily on the following areas:
    1. Your understanding of the current environment and your vision of the future: Your team's expertise—it is essential to identify the key attributes unique to a WOC nurse: the focused application of nursing science and practice to the care of persons of all ages with wounds, stomas, fistulae, drains, tubes, pressure ulcers, and incontinence (WOCN, 2010). You or your team must demonstrate that you have a balance of expertise in planning, educating, organizing, review/control, and leadership skills to impact patient care across health care systems.
    2. Your business/product—culturally sensitive and age-appropriate care planning for patients across a variety of delivery systems is essential. Holistic care and guidance for psychosocial, sexual, and body image adaptation promotes optimal client outcomes. You should be able to describe how your business/product is different from others and how it will address current and future health care needs.
      Example: You may provide consultation in a remote service area without a formally educated or certified WOC nurse.
      Refer to http://www.wocn.org and http://www.wocncb.org for more information about the value of board-certified WOC nurses. There are many ways that our training and expertise can influence positive measurable outcomes.
    3. Your marketing plan—market research is vital to the success of your business/product. There are 2 types of market research: (1) primary (gathering your own data) and (2) secondary (published information). You should have a strategy in place to market your business/product that includes expected growth as a result of marketing strategies. Wound, ostomy and continence nursing is a dynamic specialty that has been influenced by societal and health care needs of communities.
    4. Your projected financial statements—you should be able to show that support of the business plan will result in an expected financial outcome. This will include forecasted positive financial growth for your business/product and/or cost-effective utilization of resources with improved patient outcomes.
  2. Before you start
  3. Building your business plan

    Your business plan should look professional but not glitzy. It should be bound with a cover, printed on quality paper, and be produced with a laser or letter quality printer.

    Consistent color coordination with your business/product logo, business cards, and stationary provides a professional presentation. Create a theme. Establish a Web site (even if it is only 1 page). This will present a professional appearance for yourself/business/product. If you will be presenting your business plan to a prospective client, remember to bring several hard copies of your business plan and always have a copy for your review during your interview.

The Cover

When you design the cover page of your business plan, keep the following in mind:

  1. Keep it simple.
  2. Clearly identify the business/product.
  3. Include address and phone numbers.
  4. Always date it.
  5. Indicate a contact person.

Table of Contents

A table of contents is imperative to facilitate the reader finding critical information with ease. The following is an ordered list of the usual contents of a business plan.

  1. Executive Summary
  2. Present Situation
  3. Objectives
  4. Business/Product Description
  5. Market Analysis/Strategy
  6. Operational Plan
  7. Financial Projections
  8. Appendix

Executive Summary

An executive summary is a critical but frequently overlooked portion of a business plan. It must be designed to capture the intended reader's interest by summarizing the key points and highlights of the business plan. It is a crystallization of the entire business plan in a brief overview format. Due to the nature of the executive summary, it is always located at the beginning of the business plan; however, it is one of the last portions that you will write.

A few things to remember when writing the executive summary are as follows:

  1. Keep it brief—1 page, if possible.
  2. Hit the high points—do not get bogged down in details.
  3. Make it interesting—you may want to change the summary for each intended reader and concentrate on the areas of most interest to that reader. Example: If presenting to physical therapist, explain how WOC nurse and rehab work together as a team.

Begin with a brief description of your business/product, how you developed it, and what your mission/purpose is. Next, describe the business/product that you will provide and how it will benefit the customer and/or the reader. (These topics should be stated succinctly in a few paragraphs.) One reference guide could be the information from Wound, Ostomy and Continence Nursing Certification Board “Are your Nurses Board Certified?” Do not assume that everyone is knowledgeable about the specific expertise and professional/clinical benefits provided by the WOC nurse.

Next, write a paragraph or two describing the background information including the market analysis, customer characteristics, competitive analysis, critical success factors, and assumptions.

Then spend sufficient time explaining your goals and strategies for obtaining them. This will lead easily into a summary of the financial picture and projections.

Close the executive summary with a 1-paragraph conclusion that highlights the points that you want this particular reader to remember.

Present Situation

Explain what factors and information have brought you to the decision to start this business/product. How does your business plan support the facility's mission statement and organizational goals?

  1. External analysis
    The following factors are important when analyzing the external environment (remember to do your homework and research these areas below):
    1. Demographics of the anticipated target patient population.
    2. Technology requirements.
    3. Regulatory/political.
    4. Economic/reimbursement.

    What does the average person in your market area demographically look like? (You can usually find this information in the census bureau report; local, state, and federal reports; and other documents located in your local library or online.)
  2. Competitive analysis
    There are many types of competitors. Some of the most difficult competitors are the least obvious. The following are the 3 most common types:
    1. Input or resource—competes for the same resources as you.
    2. Process—provides a business/product that is different than yours but has many of the same results (ie, physical therapist, case managers).
    3. Output—does the exact same thing as you do.

  3. Internal analysis
    The following areas are the most common areas reviewed in an internal analysis.
    1. Past performance—can only be done when there is an existing business/product that has data from the past to analyze.
      1. Cost/profitability—reviews how profitable the business/product has been in the past. Profitability might be measured in actual revenue or net profit but could also be measured in other forms of benefits brought to an organization. Example: The business/product has been within budgeted expenses for the last 3 years and has had a net profit of “X” each year, or the business/product has stayed within the break-even projection and as a direct result of the business/product's activities, visits to the outpatient clinic have increased by 20%.
      2. Utilization—can be expressed in whatever units of measurement you prefer. It might be measured in any or all of the following: number of visits, hours, and patients. This is a representation of “volume” of service.
      3. Quality (customer perceived and technical)—technical quality is expressed as measurable outcomes and proven benefits. Perceived quality is from the customer's point of view. Sometimes what makes a customer satisfied is not necessarily technical quality. Example: Many patients have a high degree of satisfaction with a health care provider who is friendly and caring, even though his/her clinical skills may be less than adequate.
    2. Strengths and weaknesses—you must take a close look at what strengths and weaknesses you have. This can include an evaluation of your skills, your team's skills, financial strength, your support systems, your competitors, and any other factor that will impact your business/product.

Goals and Objectives

Formulate a vision of where you want to be in 1 and 2 to 5 years and how you are going to get there. It is fine to be enthusiastic, but you should also be realistic. It is easiest to first set long-term goals and then establish a few objectives for each time period describing how you will achieve the goals. Do not get locked into a yearly time period; monthly time periods are very appropriate, especially for businesses/products.

Business/Product Description

Develop a clear explanation of what the business/product does and how it benefits your customers. To get support or financing for a business/product and to attract customers, you must show that you have researched and identified the need for the business/product. Moreover, you must be able to clearly describe the business/product and the benefits that it provides.

In a large organization, you cannot assume that others know what you do as a WOC specialty nurse. What is your vision? One of greatest contributions of leaders is having a driving purpose, a vision. This purpose is exhibited through your knowledge, passion, and experiences, and is reflective and empowers the group or culture (Grossman & Valiga, 2005).

The following are specific areas you need to consider:

  1. Service portfolio—WOC services, direct care, education, research, and standards.
  2. Unique features—these are specific to your business/product.
  3. Value-added benefits—program development expertise, disease management.
  4. Pricing strategy—this is unique to your situation and should reflect the economic environment, health care reform, and regulatory or market demands.

Market Analysis and Strategy

Through market analysis, you can clearly identify your customers, your competitors, and your business/product's position in the market. This is the first and most important step in marketing. It is what will drive your marketing strategy and your promotional efforts. It helps you understand the needs of your customers, who your competition is, and where pitfalls lie. Give yourself adequate time to research and analyze this information. Market information can be obtained through analysis of past customer data, written or verbal surveys, and demographic information.

You can define your market in one way by the type of customer. The 3 types of customers are as follows:

  1. Decision maker—this is the customer who actually makes the decision to obtain your business/product. It may be the patient but also could easily be the physician or managed-care case manager, for example.
  2. Influencer—this customer influences the decision maker. It could be the patient's family, another nurse, and so forth.
  3. End user—this customer is the one who actually uses the business/product. The end user may also be the decision maker, but in health care the patient is frequently only the end user.

Once you have analyzed your market and your customers, you can begin to plan a marketing and promotional strategy. Based on the individual characteristics of each customer group, you can plan a strategy that will appeal to each. Keep in mind that one strategy does not usually apply to all 3 groups. Example: A case manager wants to hear how you will save money and achieve the expected outcomes. A patient, however, wants to know specifically what you will do and how available you are for phone calls.

When you plan your strategy, remember your Unique Service Advantage that you identified earlier. Focus strategies to highlight your uniqueness and benefits you bring to customers.

You will also need to decide what media you will use to market your business/product. If it is a business/product within an organization, a well-written, professional-looking business plan is the perfect medium. However, if it is an independent business/product, you will probably want to consider at least business cards, stationery, and perhaps brochures. Other techniques include the Internet, telephone books, human interest stories in the newspaper, speaking engagements, and face-to-face meetings. The key is to not get carried away and blow your budget on advertising and promotion. Start small, see what works, and then expand if you need to. Frequently, the most effective means of marketing a business/product is through word of mouth and networking. Go to where your customers are and talk to them!

Critical Success Factors and Key Assumptions

Critical success factors are the conditions that must be met to achieve the success of your business/product. They may be resource related or situation related. Example: Your continence clinic will succeed only if there is adequate dedicated space available in the current outpatient setting, or your independent practice will succeed only if you obtain a contract with the local 400-bed hospital.

Assumptions are similar to critical success factors; however, they differ in that the success of the business/product is not dependent on them. Assumptions may also be resource or situation related. Frequently, assumptions are financial or utilization (volume of business—number of patients, hours, visits, etc) related. Example: Available space in the outpatient clinic becomes an assumption if there are several other space options available. Example: You assume that you will get a contract with the local 400-bed hospital and have based your financial analysis on that assumption. This is not a critical success factor if there are other contract options available.

Qualifications

The success of your business/product depends on the skills that you and your team possess. In addition, gaining support from others for your business/product will also depend on your ability to demonstrate that qualified individuals will be involved. Therefore, as you write your business plan, describe who will be in charge of the different aspects of the business/product and what other expertise you will use. Example: If you are the sole proprietor of an independent practice, you will want to describe your abilities, and the outside advisors that you have chosen (ie, attorney, accountant, etc).

For a business/product, it is likely that you will have several members of a team. The skills and responsibilities of each team member need to be clearly defined. Specific guidance documents or training classes may be necessary. It is helpful if several individuals are involved to identify specific responsibilities and explain who will manage each area. Example: Areas might be clinical services, reception, intake, billing, scheduling, marketing, quality improvement, purchasing, legal, accounting, and others as needed for your individual plan. Depending on how you are going to be using your business plan, you may want to include full resumes or curriculum vitae of individual team members in the Appendix of the plan.

You should also review the weaknesses of each team member. This is not a negative exercise. We all have areas in which we are less than perfect. Identifying those areas helps avoid putting people into situations in which they are sure to fail.

Financial Projections

It is critical in any business plan to formulate a pro forma budget that projects the expected revenues and expenses for 3 to 5 years or the length of the business/product and the break-even point. This helps you determine the validity of the business plan prior to starting the business/product and to evaluate progress over the ensuing years or life of the business/product.

Doing a pro forma is nothing more than creating an operating budget for the next 3 to 5 years. It should indicate at what point the business/product will break even and when it will start to show a profit. With businesses/products, the time frame may be in yearly quarters as opposed to entire years depending on the extent of the business/product.

  1. Financial fundamentals

    There are several fundamental principles that you must understand in order to do a pro forma budget. You will most likely need to employ the services of an accountant to actually do the budget; however, you will still need to understand the concepts and be able to provide certain information to the accountant (See Appendix S–III: A Business Financial Glossary).

    The first principle you need to understand is what a balance sheet and an income statement are used for and what information they contain.

    1. Balance sheet—a financial snapshot of a moment in time. A balance sheet profiles the overall financial condition of an organization. It can be likened to a complete physical assessment. It lets you know how things are at a given moment. The balance sheet specifically addresses a company's assets (or resources of value) and liabilities (or debts).
    2. Income statement—shows the results of operating activities. The income statement chronicles how a company got to the given moment in time that the balance sheet portrays. It can be likened to a record of how well or poorly a wound has healed over the past month. The income statement reports the total revenues (resources coming into the company), the expenses (resources going out of the company), and the net profit or net income (what's left over after expenses are paid). The income statement describes a period in time; it is usually done every month or every quarter.

    A pro forma budget is nothing more than an income statement that projects the next 3 to 5 years.

    It is not necessary to completely understand all the items on a balance sheet. Refer to an accountant for assistance. A sample balance sheet follows.

    Balance Sheet as of April 30, 2011
    Assets Liabilities
    Current assets Current liabilities
    Property/plant/equipment Long-term debt
    Investments Owners equity
    Intangibles  

    It is necessary to have some understanding of an income statement. However, it is not necessary to understand exactly how the numbers are calculated. Again, refer to an accountant for assistance. A sample of an income statement:

    Income Statement for Period Ending April 30, 2011
    Revenue and Gains
    Patient care revenues
    Contract fees
     
    Operating Expenses
    Salaries
    Supplies
    Administration
    Depreciation
    Utilities
    Occupancy
     
    Net Income
  2. Financial concepts

    There are also several financial concepts that you must understand in order to compile the information that the accountant will need to put together your pro forma budget.

    1. Contractual allowances are like discounts. First, you will decide what your charge will be for a particular service. However, instances will occur in which you will need to discount your charge. This frequently happens with managed care contracts. If your charge is $80 but your managed care contract is for $75, the $5 difference is a contractual allowance. This amount will show up on the income statement in a format such as the following:
      Revenue: $80
      Less contractual allowance: $ (5)
      Total revenue: $75

      You must state your actual charge as revenue and then show your contractual allowances. You cannot just show the difference (ie, $75). This is an accounting rule that only accountants understand!

    2. Charity and bad debt are similar to contractual allowances except that they are not planned for as in a contract. Charity is a discount that you determine you will give prior to providing the service. Example: You can decide to give a 10% charity write-off to a patient who has limited financial resources. The amount the patient would actually pay of the $80 charge would be $72.

      Bad debts are unplanned write-offs from what you had expected to receive for your services. Example: You billed a patient the $80 fee and he or she paid only $40 and never paid any more. After a period of time, you determine that this patient will never pay the remaining amount, and you write it off to bad debt.

      Bad debt and charity write-offs are expressed on the income statement:

      Revenue (2 visits): $160
      Less charity of 10% for 1 visit: $ (8)
      Less bad debt: $ (40)
      Total revenue: $132
    3. Depreciation is the financial representation of the normal wear and tear on a large piece of equipment or property determined by taking the total value of the equipment or property and dividing it over a given number of years. This is also referred to as amortizing. The number of years is determined in many ways; the best thing to do is ask the accountant how many years to depreciate each piece of equipment you will need. Most organizations choose a specific dollar amount over which they will depreciate an item. Example: Anything over $500 or sometimes $1000 will be depreciated.

      Example: You will need a biofeedback machine for your incontinence clinic that will cost $10,000. The accountant tells you that it will need to be depreciated over 5 years. The amount that will be “expensed” each year is $2000 ($10,000 divided by 5). The tricky part here is that the actual cash ($10,000) for the equipment will be spent when the equipment is purchased. However, the IRS will only let you recognize $2000 in expenses per year. In your pro forma budget, you will record an expense of $2000 each year for 5 years.

    4. When determining the costs that must be considered for your business/product, you will need to decide which are fixed and which are variable costs. Fixed costs are those costs that do not vary with the amount of services you provide. Example: Rent and depreciation on equipment are fixed. If your rent is $1000 per month, it does not matter whether you see 5 patients or 50 patients, the rent will not change. Variable costs are those costs that vary with the amount of services provided. Example: Patient care staff salaries and supplies will vary with the number of patients. You will use more supplies to see 50 patients than you will to see 5 patients.
    5. The importance of understanding fixed and variable costs is that you can control variable costs much more easily than you can control fixed costs. Frequently, you are more valuable to an organization as a variable cost than you are as a fixed cost. If you are a full-time employee with a set salary and benefits, you are a fixed cost. Whether you see 100 patients or 1000 patients, your salary and benefits will cost the organization the same. However, if you have a contract for a per unit fee, you are a variable cost. If your per unit fee is $75, the total amount the organization pays will vary with the number of units of service you provide. Therefore, if business is slow for your client (eg, a hospital), they can pay you for just the number of visits or amount of service that they need. When business is better, they are able to pay you for increased amounts of service.

The Budgeting Process

Now that you understand a few of the basic concepts, you are ready to begin collecting data for the pro forma budget. You must determine how much total revenue by source and total expenses by source you expect.

To determine the revenues and expenses, certain exercises are necessary:

  1. Statistical forecasting—trending

    This is how you can determine the expected revenues for your business/product. If it is an existing business/product, you can use past data to forecast the coming year(s). If it is a new business/product, you will use your situation and market analyses to project the future years. This part of forecasting is based on utilization only. Example: You will determine the number of patients, procedures, visits, hours, and so forth, that you will provide. The unit to use is based on the mechanism by which you are paid. Example: If you are paid for the service by hour, you should project in hours, and so forth.

  2. Expense forecasting

    Now, you will begin to think in dollar amounts. You will need to list all of your expenses and do the same type of trending that you did in the statistical forecasting.

    Expenses that you should consider are as follows:

    1. Salaries/benefits—of all personnel (including yourself) involved in the business/product. You will need to know how much time will be worked and the salaries and benefits of each individual.
    2. Taxes and other employee expenses—the accountant can provide this information.
    3. Rent.
    4. Supplies/equipment—this includes only the supplies and equipment that will not be depreciated. You can also include your brochures, business cards, and office supplies here. Repairs on equipment can be included here also.
    5. Depreciation∗—this is where the $2000 of depreciation for the biofeedback machine in the example would be noted.
    6. Professional fees—this would include your outside advisors such as accountants, attorneys, and so forth.
    7. Dues/membership—you can include any professional journal subscriptions or memberships to professional organizations in this category.
    8. Education—this would include any seminars or conferences that you plan on attending. Expenses in this category include flight, mileage, food, lodging, and so forth, related to the educational event.
    9. Travel—these are travel costs associated with providing the service.
    10. Postage and shipping.
    11. Utilities—this would include phone, electric, gas, and so forth.
    12. Marketing/advertising—include any media that you will be using. This could be online marketing, telephone book listings, advertising, and other expenses associated with marketing. If you did not include your business cards and/or brochures under supplies, you could put them here.
    13. Miscellaneous—anything that cannot be reasonably classed in the aforementioned categories could be included here.
  3. ∗To determine your depreciation amount, you will need to list the “capital equipment” you need. Capital equipment is equipment that is over the depreciable limit set by you or the organization (usually $500 or $1000). Remember to ask the accountant about how many years the equipment needs to be depreciated.

  4. Cost per unit
  5. Revenue forecast
    Forecasting revenue is more difficult than forecasting expenses. There is no set rule for what your charge should be. Consideration must be given to what is charged for similar services, what the competition is charging, and what the market will bear. Wound, Ostomy and Continence Nurses Society compiled a salary and productivity survey of members in 2008. This beneficial tool can help you determine your fee for service based on your geographical location or expertise (WOCN, 2008).
    Setting Number of Respondents Median Average 25th Percentile 75th Percentile
    Acute care 28 $67.50 $73.82 $56.88 $81.25
    Home care 34 $65 $66.91 $53.13 $80
    Subacute 14 $65 $61.25 $50 $78.75
    Long-term care 34 $65 $68.63 $50 $80
    Outpatient/wound care center 13 $55 $63.40 $52 $65
    Education 29 $77.50 $74.98 $50 $100
    Expert chart review 22 $162.50 $164.80 $125 $200
    Depositions 14 $250 $274.69 $200 $400
    Protocol development 16 $77.50 $81.53 $45 $100
    Workshop 20 $100 $129.47 $54.38 $150

    If you have the luxury of using your charge in all cases, use the average cost per unit that you just calculated and add on an appropriate profit. If you have contracted rates that are different than your charge, you must consider the difference between your charge and the contracted rate. You will, however, most likely be charging different prices for different types of services.

  6. Break-even analysis
  7. Pro forma income statement
    Believe it or not, this is the easiest part. Very simply put, the pro forma income statement indicates the revenue minus expenses—information you have already calculated. It finally shows you what your “bottom line” will be over the next 3 years.

Appendix

The Appendix of your business plan includes all the backup documents that support the data you have included in your business plan. Some of the documents you may want to include are as follows:

  1. External reports/information supporting your analyses.
  2. Charts and graphs from which you drew your projections.
  3. Product literature and lease agreements for capital requests.
  4. Marketing material you will use.
  5. Resumes of key members of the team.

Appendix S–I: Sample Business Plan for Always Wright Consulting Services

Introduction

  1. “He who fails to plan, plans to fail.” Proverb
    “Success in business is threatened if you can't see the forest for the trees.” Unknown
    “In the absence of clearly defined goals, we are forced to concentrate on activity and ultimately become enslaved by it.”—Chuck Conradt (Marquis & Huston, 2006)
  2. Planning requires time: It typically takes several weeks to complete a good business plan. Most of that time will be utilized in research and rethinking/reworking your ideas and assumptions. Make time to complete the task thoroughly.
    Be realistic and do not underestimate the time you will need to create a thorough and meaningful business plan or proposal. Whether you strive to improve clinical processes or you are requesting another wound, ostomy and continence (WOC) position to better meet current patient needs, planning will influence accomplishment. After the initial business plan is implemented, revising should be an ongoing process. You should collect information in your day-to-day activities and update the business plan 2 to 3 times a year. Minimally, you should revise your business plan with new goals and strategies at least once a year.
  3. Why develop a business plan?
    A business plan is essential because it allows you to:
    1. Lay out the master blueprint to show a logical progression of steps needed to reach the established goal. It is a powerful management tool that also helps you consider alternatives or possibly a better way of doing things.
    2. Communicate your business plan to your own team. This is important in order to keep everyone on the same track and to be able to measure progress.
    3. Communicate your business plan to others to gain their support. This may come in the form of resources, financing, reimbursement, “word of mouth” referrals, or just plain moral support.
  4. Keys to convincing others
    When others are looking at your business plan, their decision to support it depends heavily on the following areas:
    1. Your understanding of the current environment and your vision of the future: Your team's expertise—it is essential to identify the key attributes unique to a WOC nurse: the focused application of nursing science and practice to the care of persons of all ages with wounds, stomas, fistulae, drains, tubes, pressure ulcers, and incontinence (Wound, Ostomy and Continence Nurses, 2010). You or your team must demonstrate that you have a balance of expertise in planning, educating, organizing, review/control, and leadership skills to impact patient care across health care systems.
    2. Your business/product—culturally sensitive and age-appropriate care planning for patients across a variety of delivery systems is essential. Holistic care and guidance for psychosocial, sexual, and body image adaptation promotes optimal client outcomes. You should be able to describe how your business/product is different from others and how it will address current and future health care needs.
      Example: You may provide consultation in a remote service area without a formally educated or certified WOC nurse.
      Refer to http://www.wocn.org and http://www.wocncb.org for more information about the value of board-certified WOC nurses. There are many ways that our training and expertise can influence positive measurable outcomes.
    3. Your marketing plan—market research is vital to the success of your business/product. There are 2 types of market research: (1) primary (gathering your own data) and (2) secondary (published information). You should have a strategy in place to market your business/product that includes expected growth as a result of marketing strategies. Wound, ostomy and continence nursing is a dynamic specialty that has been influenced by societal and health care needs of communities.
    4. Your projected financial statements—you should be able to show that support of the business plan will result in an expected financial outcome. This will include forecasted positive financial growth for your business/product and/or cost-effective utilization of resources with improved patient outcomes.
  5. Before you start
  6. Building your business plan
    Your business plan should look professional but not glitzy. It should be bound with a cover, printed on quality paper, and be produced with a laser or letter quality printer.

The Cover

When you design the cover page of your business plan, keep the following in mind:

  1. Keep it simple.
  2. Clearly identify the business/product.
  3. Include address and phone numbers.
  4. Always date it.
  5. Indicate a contact person.
Business Plan For:

Always Wright Consulting Services

April 30, 2011
Contact person:
Kristy Wright, MBA, RN, CWOCN
1234 Maple Lane
Anywhere, PA 10023
555-123-4567

Table of Contents

A table of contents is imperative to facilitate the reader finding critical information with ease. The following is an ordered list of the usual contents of a business plan.

  1. Executive Summary
  2. Present Situation
  3. Objectives
  4. Business/Product Description
  5. Market Analysis/Strategy
  6. Operational Plan
  7. Financial Projections
  8. Appendix

Executive Summary

An executive summary is a critical but frequently overlooked portion of a business plan. It must be designed to capture the intended reader's interest by summarizing the key points and highlights of the business plan. It is a crystallization of the entire business plan in a brief overview format. Due to the nature of the executive summary, it is always located at the beginning of the business plan; however, it is one of the last portions that you will write.

A few things to remember when writing the executive summary are as follows:

  1. Keep it brief—1 page, if possible.
  2. Hit the high points—do not get bogged down in details.
  3. Make it interesting—you may want to change the summary for each intended reader and concentrate on the areas of most interest to that reader. Example: If presenting to physical therapist, explain how WOCN and rehab work together as a team.

Begin with a brief description of your business/product, how you developed it, and what your mission/purpose is. Next, describe the business/product that you will provide and how it will benefit the customer and/or the reader. (These topics should be stated succinctly in a few paragraphs.) One reference guide could be the information for Wound, Ostomy and Continence Nursing Certification Board “Are your Nurses Board Certified?” Do not assume that everyone is knowledgeable about the specific expertise and professional/clinical benefits provided by the WOC nurse.

Next, write a paragraph or two describing the background information including the market analysis, customer characteristics, competitive analysis, critical success factors, and assumptions.

Then spend sufficient time explaining your goals and strategies for obtaining them. This will lead easily into a summary of the financial picture and projections.

Close the executive summary with a 1-paragraph conclusion that highlights the points that you want this particular reader to remember.

Present Situation

Explain what factors and information have brought you to the decision to start this business/product. How does your business plan support the facility's mission statement and organizational goals?

  1. External analysis
    The following factors are important when analyzing the external environment (remember to do your homework and research these areas below):
    1. Demographics of the anticipated target patient population.
    2. Technology requirements.
    3. Regulatory/political.
    4. Economic/reimbursement.

    What does the average person in your market area demographically look like? (You can usually find this information in the census bureau report; local, state, and federal reports; and other documents located in your local library or online.)

  2. Competitive analysis
    There are many types of competitors. Some of the most difficult competitors are the least obvious. The following are the 3 most common types:
    1. Input or resource—competes for the same resources as you.
    2. Process—provides a business/product that is different than yours but has many of the same results (ie, physical therapist, case managers).
    3. Output—does the exact same thing as you do.
  3. Internal analysis
    The following areas are the most common areas reviewed in an internal analysis.
    1. Past performance—can only be done when there is an existing business/product that has data from the past to analyze.
      1. Cost/profitability—reviews how profitable the business/product has been in the past. Profitability might be measured in actual revenue or net profit but could also be measured in other forms of benefits brought to an organization. Example: The business/product has been within budgeted expenses for the last 3 years and has had a net profit of “X” each year, or the business/product has stayed within the break-even projection and as a direct result of the business/product's activities, visits to the outpatient clinic have increased by 20%.
      2. Utilization—can be expressed in whatever units of measurement you prefer. It might be measured in any or all of the following: number of visits, hours, and patients. This is a representation of “volume” of service.
      3. Quality (customer perceived and technical)—technical quality is expressed as measurable outcomes and proven benefits. Perceived quality is from the customer's point of view. Sometimes what makes a customer satisfied is not necessarily technical quality. Example: Many patients have a high degree of satisfaction with a health care provider who is friendly and caring, even though his/her clinical skills may be less than adequate.
    2. Strengths and weaknesses—you must take a close look at what strengths and weaknesses you have. This can include an evaluation of your skills, your team's skills, financial strength, your support systems, your competitors, and any other factor that will impact your business/product.

Goals and Objectives

Formulate a vision of where you want to be in 1 and 2 to 5 years and how you are going to get there. It is fine to be enthusiastic, but you should also be realistic. It is easiest to first set long-term goals and then establish a few objectives for each time period describing how you will achieve the goals. Do not get locked into a yearly time period; monthly time periods are very appropriate, especially for businesses/products.

Business/Product Description

Develop a clear explanation of what the business/product does and how it benefits your customers. To get support or financing for a business/product and to attract customers, you must show that you have researched and identified the need for the business/product. Moreover, you must be able to clearly describe the business/product and the benefits that it provides.

In a large organization, you cannot assume that others know what you do as a WOC specialty nurse. What is your vision? One of greatest contributions of leaders is having a driving purpose, a vision. This purpose is exhibited through your knowledge, passion, and experiences, and is reflective and empowers the group or culture (Grossman & Valiga, 2005).

The following are specific areas you need to consider:

  1. Service portfolio—WOC services, direct care, education, research, and standards.
  2. Unique features—these are specific to your business/product.
  3. Value-added benefits—program development expertise, disease management.
  4. Pricing strategy—this is unique to your situation and should reflect the economic environment, health care reform, and regulatory or market demands.

Market Analysis and Strategy

Through market analysis, you can clearly identify your customers, your competitors, and your business/product's position in the market. This is the first and most important step in marketing. It is what will drive your marketing strategy and your promotional efforts. It helps you understand the needs of your customers, who your competition is, and where pitfalls lie. Give yourself adequate time to research and analyze this information. Market information can be obtained through analysis of past customer data, written or verbal surveys, and demographic information.

You can define your market in one way by the type of customer. The 3 types of customers are as follows:

  1. Decision maker—this is the customer who actually makes the decision to obtain your business/product. It may be the patient but also could easily be the physician or managed-care case manager, for example.
  2. Influencer—this customer influences the decision maker. It could be the patient's family, another nurse, and so forth.
  3. End user—this customer is the one who actually uses the business/product. The end user may also be the decision maker, but in health care the patient is frequently only the end user.

Once you have analyzed your market and your customers, you can begin to plan a marketing and promotional strategy. Based on the individual characteristics of each customer group, you can plan a strategy that will appeal to each. Keep in mind that 1 strategy does not usually apply to all 3 groups. Example: A case manager wants to hear how you will save money and achieve the expected outcomes. A patient, however, wants to know specifically what you will do and how available you are for phone calls.

When you plan your strategy, remember your Unique Service Advantage that you identified earlier. Focus strategies to highlight your uniqueness and benefits you bring to customers.

You will also need to decide what media you will use to market your business/product. If it is a business/product within an organization, a well-written, professional-looking business plan is the perfect medium. However, if it is an independent business/product, you will probably want to consider at least business cards, stationery, and perhaps brochures. Other techniques include the Internet, telephone books, human interest stories in the newspaper, speaking engagements, and face-to-face meetings. The key is to not get carried away and blow your budget on advertising and promotion. Start small, see what works, and then expand if you need to. Frequently, the most effective means of marketing a business/product is through word of mouth and networking. Go to where your customers are and talk to them!

Critical Success Factors and Key Assumptions

Critical success factors are the conditions that must be met to achieve the success of your business/product. They may be resource related or situation related. Example: Your continence clinic will succeed only if there is adequate dedicated space available in the current outpatient setting, or your independent practice will succeed only if you obtain a contract with the local 400-bed hospital.

Assumptions are similar to critical success factors; however, they differ in that the success of the business/product is not dependent on them. Assumptions may also be resource or situation related. Frequently, assumptions are financial or utilization (volume of business—number of patients, hours, visits, etc) related. Example: Available space in the outpatient clinic becomes an assumption if there are several other space options available. Example: You assume that you will get a contract with the local 400-bed hospital and have based your financial analysis on that assumption. This is not a critical success factor if there are other contract options available.

Qualifications

The success of your business/product depends on the skills that you and your team possess. In addition, gaining support from others for your business/product will also depend on your ability to demonstrate that qualified individuals will be involved. Therefore, as you write your business plan, describe who will be in charge of the different aspects of the business/product and what other expertise you will use. Example: If you are the sole proprietor of an independent practice, you will want to describe your abilities, and the outside advisors that you have chosen (ie, attorney, accountant, etc).

For a business/product, it is likely that you will have several members of a team. The skills and responsibilities of each team member need to be clearly defined. Specific guidance documents or training classes may be necessary. It is helpful if several individuals are involved to identify specific responsibilities and explain who will manage each area. Example: Areas might be clinical services, reception, intake, billing, scheduling, marketing, quality improvement, purchasing, legal, accounting, and others as needed for your individual plan. Depending on how you are going to be using your business plan, you may want to include full resumes or curriculum vitae of individual team members in the Appendix of the plan.

You should also review the weaknesses of each team member. This is not a negative exercise. We all have areas in which we are less than perfect. Identifying those areas helps avoid putting people into situations in which they are sure to fail.

Financial Projections

It is critical in any business plan to formulate a pro forma budget that projects the expected revenues and expenses for 3 to 5 years or the length of the business/product and the break-even point. This helps you determine the validity of the business plan prior to starting the business/product and to evaluate progress over the ensuing years or life of the business/product.

Doing a pro forma is nothing more than creating an operating budget for the next 3 to 5 years. It should indicate at what point the business/product will break even and when it will start to show a profit. With businesses/products, the time frame may be in yearly quarters as opposed to entire years depending on the extent of the business/product.

  1. Financial fundamentals
    There are several fundamental principles that you must understand in order to do a pro forma budget. You will most likely need to employ the services of an accountant to actually do the budget; however, you will still need to understand the concepts and be able to provide certain information to the accountant (See Appendix S–III. A Business Financial Glossary).
    The first principle you need to understand is what a balance sheet and an income statement are used for and what information they contain.
    1. Balance sheet—a financial snapshot of a moment in time. A balance sheet profiles the overall financial condition of an organization. It can be likened to a complete physical assessment. It lets you know how things are at a given moment. The balance sheet specifically addresses a company's assets (or resources of value) and liabilities (or debts).
    2. Income statement—shows the results of operating activities. The income statement chronicles how a company got to the given moment in time that the balance sheet portrays. It can be likened to a record of how well or poorly a wound has healed over the past month. The income statement reports the total revenues (resources coming into the company), the expenses (resources going out of the company), and the net profit or net income (what's left over after expenses are paid). The income statement describes a period in time; it is usually done every month or every quarter.
      A pro forma budget is nothing more than an income statement that projects the next 3 to 5 years.
      It is not necessary to completely understand all the items on a balance sheet. Refer to an accountant for assistance. A sample balance sheet follows.
      Balance Sheet as of April 30, 2011
      Assets Liabilities
      Current assets Current liabilities
      Property/plant/equipment Long-term debt
      Investments Owners equity
      Intangibles  

      It is necessary to have some understanding of an income statement. However, it is not necessary to understand exactly how the numbers are calculated. Again, refer to an accountant for assistance. A sample of an income statement:

      Income Statement for Period Ending April 30, 2011
      Revenue and Gains
      Patient care revenues
      Contract fees
      Operating Expenses
      Salaries
      Supplies
      Administration
      Depreciation
      Utilities
      Occupancy
      Net Income
  2. Financial concepts
    There are also several financial concepts that you must understand in order to compile the information that the accountant will need to put together your pro forma budget.
    1. Contractual allowances are like discounts. First, you will decide what your charge will be for a particular service. However, instances will occur in which you will need to discount your charge. This frequently happens with managed care contracts. If your charge is $80 but your managed care contract is for $75, the $5 difference is a contractual allowance. This amount will show up on the income statement in a format such as the following:
      Revenue: $80
      Less contractual allowance: $ (5)
      Total revenue: $75

      You must state your actual charge as revenue and then show your contractual allowances. You cannot just show the difference (ie, $75). This is an accounting rule that only accountants understand!

    2. Charity and bad debt are similar to contractual allowances except that they are not planned for as in a contract. Charity is a discount that you determine you will give prior to providing the service. Example: You can decide to give a 10% charity write-off to a patient who has limited financial resources. The amount the patient would actually pay of the $80 charge would be $72.
      Bad debts are unplanned write-offs from what you had expected to receive for your services. Example: You billed a patient the $80 fee and he or she paid only $40 and never paid any more. After a period of time, you determine that this patient will never pay the remaining amount, and you write it off to bad debt.
      Bad debt and charity write-offs are expressed on the income statement:
      Revenue (2 visits): $160
      Less charity of 10% for 1 visit: $ (8)
      Less bad debt: $ (40)
      Total revenue: $132
    3. Depreciation is the financial representation of the normal wear and tear on a large piece of equipment or property determined by taking the total value of the equipment or property and dividing it over a given number of years. This is also referred to as amortizing. The number of years is determined in many ways; the best thing to do is ask the accountant how many years to depreciate each piece of equipment you will need. Most organizations choose a specific dollar amount over which they will depreciate an item. Example: Anything over $500 or sometimes $1000 will be depreciated.
      Example: You will need a biofeedback machine for your incontinence clinic that will cost $10,000. The accountant tells you that it will need to be depreciated over 5 years. The amount that will be “expensed” each year is $2000 ($10,000 divided by 5). The tricky part here is that the actual cash ($10,000) for the equipment will be spent when the equipment is purchased. However, the IRS will only let you recognize $2000 in expenses per year. In your pro forma budget, you will record an expense of $2000 each year for 5 years.
    4. When determining the costs that must be considered for your business/product, you will need to decide which are fixed and which are variable costs. Fixed costs are those costs that do not vary with the amount of services you provide. Example: Rent and depreciation on equipment are fixed. If your rent is $1000 per month, it does not matter whether you see 5 patients or 50 patients, the rent will not change. Variable costs are those costs that vary with the amount of services provided. Example: Patient care staff salaries and supplies will vary with the number of patients. You will use more supplies to see 50 patients than you will to see 5 patients.
    5. The importance of understanding fixed and variable costs is that you can control variable costs much more easily than you can control fixed costs. Frequently, you are more valuable to an organization as a variable cost than you are as a fixed cost. If you are a full-time employee with a set salary and benefits, you are a fixed cost. Whether you see 100 patients or 1000 patients, your salary and benefits will cost the organization the same. However, if you have a contract for a per unit fee, you are a variable cost. If your per unit fee is $75, the total amount the organization pays will vary with the number of units of service you provide. Therefore, if business is slow for your client (eg, a hospital), they can pay you for just the number of visits or amount of service that they need. When business is better, they are able to pay you for increased amounts of service.

The Budgeting Process

Now that you understand a few of the basic concepts, you are ready to begin collecting data for the pro forma budget. You must determine how much total revenue by source and total expenses by source you expect.

To determine the revenues and expenses, certain exercises are necessary:

  1. Statistical forecasting—trending
    This is how you can determine the expected revenues for your business/product. If it is an existing business/product, you can use past data to forecast the coming year(s). If it is a new business/product, you will use your situation and market analyses to project the future years. This part of forecasting is based on utilization only. Example: You will determine the number of patients, procedures, visits, hours, and so forth, that you will provide. The unit to use is based on the mechanism by which you are paid. Example: If you are paid for the service by hour, you should project in hours, and so forth.
  2. Expense forecasting
    Now, you will begin to think in dollar amounts. You will need to list all of your expenses and do the same type of trending that you did in the statistical forecasting.
    Expenses that you should consider are as follows:
    1. Salaries/benefits—of all personnel (including yourself) involved in the business/product. You will need to know how much time will be worked and the salaries and benefits of each individual.
    2. Taxes and other employee expenses—the accountant can provide this information.
    3. Rent.
    4. Supplies/equipment—this includes only the supplies and equipment that will not be depreciated. You can also include your brochures, business cards, and office supplies here. Repairs on equipment can be included here also.
    5. Depreciation∗—this is where the $2000 of depreciation for the biofeedback machine in the example would be noted.
    6. Professional fees—this would include your outside advisors such as accountants, attorneys, and so forth.
    7. Dues/membership—you can include any professional journal subscriptions or memberships to professional organizations in this category.
    8. Education—this would include any seminars or conferences that you plan on attending. Expenses in this category include flight, mileage, food, lodging, and so forth, related to the educational event.
    9. Travel—these are travel costs associated with providing the service.
    10. Postage and shipping.
    11. Utilities—this would include phone, electric, gas, and so forth.
    12. Marketing/advertising—include any media that you will be using. This could be online marketing, telephone book listings, advertising, and other expenses associated with marketing. If you did not include your business cards and/or brochures under supplies, you could put them here.
    13. Miscellaneous—anything that cannot be reasonably classed in the aforementioned categories could be included here.
  3. ______________________________________________________________________________________________________________________

    ∗To determine your depreciation amount, you will need to list the “capital equipment” you need. Capital equipment is equipment that is over the depreciable limit set by you or the organization (usually $500 or $1000). Remember to ask the accountant about how many years the equipment needs to be depreciated.

Appendix S–II: Sample Business Plan: Always Wright Consulting Services

Always Wright Consulting Services

April 30, 2011

Contact person:
Kristy Wright, MBA, RN, CWOCN
1234 Maple Lane
Anywhere, PA 10023
(555) 123-4567

Table of Contents
Executive Summary
Present Situation
Goals and Objectives

Business/Product Description
Critical Success Factors and Key Assumptions
Always Wright Consulting Services Staffing Structure
Proposed 2012 Budget
Contractual Agreement
Appendices (Note: Sample items are not included here but would be included in an actual proposal.)

Executive Summary

Always Wright Consulting Services (AWCS) is a professional nursing and organizational development firm that will provide clinical wound, ostomy and continence (WOC) services and assist with development of programs, clinics, protocols, outcome data, and regulatory compliance. AWCS is also expert in reimbursement issues.

In the proposed service area, the 5 diseases causing the highest incidences of mortality and morbidity are directly related to the service capability of AWCS. They include diabetes, cancer, circulatory disorders, and accidents. One city in the area has a particularly high incidence of bladder cancer with resultant cystectomy. In addition, due to the concentration of the elderly, there is a relatively high incidence of untreated incontinence. The long-term care facilities in the area feel that it is their greatest concern followed closely by pressure ulcers. AWCS will address the most costly physical manifestations of the aforementioned diseases that would express themselves in wounds, chronic peripheral vascular ulcers, incontinence, and ostomies.

In the current competitive managed care environment, health care organizations need to provide quality services in a cost-effective and efficient manner. The obvious benefit of utilizing AWCS is an improvement in the quality of life for patients. AWCS ensures this through individualized patient education, continuity of care across all settings, family involvement, decreased complications, and a more rapid return to normal activities. AWCS will benefit the contracting customer (organization) through cost savings by managing resources, ensuring that services and supplies are reimbursable, treating the patient in the most effective setting, reducing length of stay, and decreasing complications and readmissions. In addition, AWCS will assist with regulatory compliance through staff education, protocol development, outcome data collection, and quality measurement. These benefits will give the customers a competitive advantage and put them in a solid position to work with managed care organizations and negotiate for capitated contracts.

AWCS will serve a variety of customers and consumers, each with different characteristics and needs. Service delivery will remain flexible in order to target the needs of each customer group. A specific plan has been developed for each customer segment that includes customer characteristics, the “message” that needs to be conveyed to each customer, and strategies for improving customer relations.

The long-range goal is to financially break even by the end of the second year of business. In order to achieve this, the following goals have been established:

  1. Achieve a 10% to 15% growth over each of the next 5 years.
  2. Pay off start-up debt in 5 years.
  3. Realize a profit in 2 years.
  4. Ensure quality services with measured outcomes.
  5. Employ qualified team members.

The success of AWCS is reliant on certain critical success factors. AWCS must acquire certain resources in order to achieve a successful and profitable business within the time frame stated in AWCS goals. Resources needed include personnel, equipment and supplies, and start-up capital. AWCS must also secure at least 2 hospital contracts prior to beginning business.

The current environment is exciting and promising for AWCS to begin business. Once established, the firm has plans to grow and expand in size, available services, and geographic area. The current partners are certified in WOC nursing. Plans are in place to hire additional professional staff as the business grows.

Present Situation

The current environment for this new business is very exciting. Managed care is increasing penetration into all health care settings in western Pennsylvania. Many of the smaller hospitals and alternative settings are merging or affiliating to form larger networks. The challenge is to reduce costs, maintain quality, and learn how to work cooperatively with managed care organizations.

External Analysis

The population in the area has an average age of 73 years, and the fastest growing age group is older than 80 years. Although the average income is relatively low ($25,000/y), the elderly population creates many opportunities for services by AWCS.

The 5 diseases causing the highest incidences of mortality and morbidity are directly related to the service capability of AWCS. They include diabetes, cancer, circulatory disorders, and accidents. One city in the service area has a particularly high incidence of bladder cancer with resultant cystectomy. In addition, due to the concentration of elderly in the area, there is a relatively high incidence of untreated incontinence. The long-term care facilities in the area feel that it is their greatest concern followed closely by pressure ulcers. AWCS will address the most costly physical manifestations of the aforementioned diseases, which would express themselves in wounds, chronic peripheral vascular ulcers, incontinence, and ostomies.

Competitive Analysis

There is moderate competition in the service area. Two other WOC nurses are in practice; however, both work full-time for acute facilities. Physical therapists and 1 physician's group also provide wound care on an inpatient and outpatient basis.

The primary competitive concern is that physical therapists and the physician group receive direct Medicare reimbursement for their services. It is unlikely that Medicare will revise payment regulations to include WOC nursing. Therefore, AWCS will need to present their services to customers from a cost-savings perspective.

AWCS has an edge over competitors by offering a comprehensive service that includes not only clinical care but also organizational development. This allows AWCS to provide protocol development, business development (including outpatient clinics), marketing to managed care, and assistance with reimbursement.

Internal Analysis

AWCS has the ability to provide expert WOC care in all settings. The staff possesses a variety of clinical skills and certifications including special expertise in delivering care in the patient's home. In order to fully meet the demands of potential customers, the company will need to collect outcomes data to present to organizational customers (including managed care). In addition to clinical expertise, AWCS has a unique strength in other related business skills, including organizational development, reimbursement issues, financial analysis, marketing, and medical equipment management. In order to work within the managed care environment, knowledge and skill with capitation will need to be developed.

Financially, the company has obtained a small business loan, has $5000 in start-up cash, and has 2 guaranteed contracts. Although total income is uncertain, the AWCS could remain financially solvent through the first 2 years.

Goals and Objectives

AWCS planned on beginning business on September 1, 2011, as a partnership. The long-range goal was to financially break even by the end of the second year of business and then to add other staff. In order to achieve this long-range plan, the following goals have been established:

  1. Achieve a 10% to 15% growth over each of the next 5 years.
  2. Pay off start-up debt in 5 years.
  3. Realize a profit in 2 years.
  4. Ensure quality services with measured outcomes.
  5. Employ qualified team members.

The following objectives have been developed to meet AWCS's goals:

Goal 1: Achieve a 10% to 15% growth over each of the next 5 years.

Steps to Achieve Resources Needed Completion Date
Get contract with 2 hospitals None additional December 2012
Get contract with 3 home care organizations Possibly half-time WOC nurse funding, staffing, van, equipment March 2013
Establish outpatient clinic Funding, staffing, space December 2015
Establish mobile clinic Funding, staffing van, equipment December 2016

Goal 2: Pay off start-up debt in 5 years.

Steps to Achieve Resources Needed Completion Date
Put 5% of revenue toward loans each quarter Adequate revenue Each quarter, ending in 2016

Goal 3: Realize a profit in 2 years.

Steps to Achieve Resources Needed Completion Date
Get contract with 2 hospitals None additional December 2012
Get contract with 3 home care organizations Possibly half-time WOC nurse funding, staffing, van, equipment March 2013

Goal 4: Ensure quality services with measured outcomes.

Steps to Achieve Resources Needed Completion Date
Develop clinical guidelines for practice Wound, Ostomy and Continence Nurses guidelines December 2012
Set up database to collect outcome data Education for secretary on database management March 2013
Analyze and report data Time!!! September 2013

Goal 5: Employ qualified team members.

Steps to Achieve Resources Needed Completion Date
WOC nurses to attend Wound, Ostomy and Continence Nurses conferences Funding and patient coverage Annually
WOC nurses to be certified Funding Every 5 years
Database management education for secretary Funding and time March 2013

Business/Product Description

AWCS will provide comprehensive clinical, business, and development services that include the following:

The obvious benefit of utilizing AWCS is an improvement in the quality of life for patients. AWCS ensures this through individualized patient education, continuity of care across all settings, family involvement, decreased complications, and a more rapid return to normal activities. AWCS will benefit the contracting customer (organization) through cost savings by managing resources, ensuring that services and supplies are reimbursable, treating the patient in the most effective setting, reducing length of stay, and decreasing complications and readmissions. In addition, AWCS will assist with regulatory compliance through staff education, protocol development, outcome data collection, and quality measurement. These benefits will give the customers a competitive advantage and put them in a solid position to work with managed care organizations and negotiate for capitated contracts.

Most importantly, in the current economic environment of health care, contracting for services is a variable rather than fixed cost. This allows the customer to have “just in time” service without the overhead costs associated with employee downtime and fluctuations in productivity.

“Quick Referral” System
AWCS has developed a “Quick Referral” system to streamline access to services. Referral forms will be provided to each customer on disk and in hard copy. Written referrals may be faxed 24 hours a day or e-mailed to [email protected]. In addition, referrals can be called directly to the office from 8 am to 5 pm or to the 24-hour answering service. AWCS also has 24-hour on call staffing for emergencies.

Service Area

Critical Success Factors and Key Assumptions

AWCS will require certain resources to be in place in order to achieve a successful and profitable business within the time frame discussed in the AWCS goals. Resources needed include the following:

Personnel

Equipment

Capital

Always Wright Consulting Services
Contractual Agreement

Contractual Agreement Between ABC Agency and Sarah Smith, BSN, RN, CWOCN
(Note: Usually begins with introductory paragraph explaining the purpose of the contract.)

Purpose

Whereas ABC Agency (hereinafter referred to as “Agency”) desires to assure the provision of outcomes-oriented and cost-effective care to its patients with compromised skin integrity, chronic wounds, ostomies, or incontinence, and Sarah Smith, BSN, RN, CWOCN (hereinafter referred to as WOC nurse), desires to provide these services on a contractual basis, these parties hereby enter into this contractual agreement.

May include general background information regarding scope of practice and qualifications.

Background

The WOC nurse is minimally a baccalaureate-prepared RN who has graduated from a nationally accredited program in wound, ostomy and continence (WOC) nursing. The designation CWOCN reflects National Board Certification by the Wound, Ostomy and Continence Nursing Certification Board and is a nationally recognized measure of current knowledge and competence in the field of WOC nursing.

The WOC nurse scope of practice includes the following:

The contract should include specific responsibilities of each party. See the following example:

Specific Responsibilities of WOC Nurse:

  1. WOC nurse agrees to provide the following patient care services upon consultation:
    Wound Care:

    Ostomy Care:

    Continence Care:

  2. WOC nurse agrees to respond to consult within 24 working hours unless alternate arrangements are made.
  3. WOC nurse agrees to obtain MD orders for all care provided and to communicate all care recommendations to staff and MD via written documentation on the progress notes and the plan of care and verbal communication to the staff.
  4. WOC nurse agrees to provide in-services to staff within areas of expertise upon request and within mutually agreed upon parameters regarding length, content, materials to be provided, program dates, and compensation.
  5. WOC nurse agrees to maintain current registration as RN within state of __________ and current board certification as WOC nurse, with documentation provided to Agency upon request.
  6. WOC nurse agrees to maintain own professional liability insurance with minimum of $1 million per incident and $3 million aggregate coverage and to make documentation of coverage available to Agency upon request.
  7. WOC nurse agrees to provide documentation of acceptable health status to Agency (to included negative PPD updated every 6 months; immunity to measles, mumps, and chicken pox documented by titers or by immunizations × 2; immunity to hepatitis B documented by titers or by evidence of HeptaVax × 3, or signed statement of declination and acceptance of responsibility).
  8. WOC nurse agrees to submit monthly invoice to Agency for services provided; invoice for each month of services will be submitted by the 15th of the following month along with itemized statement delineating services provided.
  9. WOC nurse agrees to pay own federal, state, and social security taxes.

Specific Responsibilities of Agency:

  1. Agency agrees to provide WOC nurse with staff privileges and to orient WOC nurse to agency.
  2. Agency agrees to appoint a contract person and supervisor for the WOC nurse.
  3. Agency agrees to notify the medical staff and nursing staff in writing of the appointment of the WOC nurse to the Agency's consultant staff; such notification shall be accompanied by the following:
  4. Agency agrees to notify WOC nurse by beeper (beeper #) of patients to be seen and reason for consult.
  5. Agency agrees to handle all patient billing.
  6. Agency agrees to remit payment for services provided within 4 weeks following receipt of invoice. Payment shall be made according to the attached fee schedule. Would need to attach a fee schedule; see fact sheet on contractual agreements for tips.
  7. Agency agrees to provide institutional liability coverage for WOC nurse services.
  8. Agency agrees to provide free parking to WOC nurse.
  9. Agency agrees to provide all patient care supplies required for WOC care.

Joint Responsibilities:

  1. Both parties agree to hold an evaluation conference annually to review the services being provided and to resolve any issues or problems. In addition, each party agrees to meet at any time upon the second party's request to discuss and resolve any issues.
  2. This agreement may be terminated at any time by mutual consent or by either party with written notification of the second party; such notification must be made 60 days prior to the termination date.
  3. This agreement is effective________________________________
    ________________________  ________________________
    Agency representative         Provider

Appendix S–III: A Business Financial Glossary

Account payable—A liability representing an amount owed to a creditor, usually arising from purchase of merchandise or materials and supplies. Normally a current liability.
Account receivable—A claim against a debtor usually arising from sales or service rendered. Normally a current asset.
Accrual basis of accounting—The method of recognizing revenues as goods that are sold or services that are rendered, independent of the time when cash is received. Expenses are recognized in the period when the related revenue is recognized, independent of the time when cash is paid out.
Asset—A resource with exchange or economic value.
Bad debt—An uncollectible account receivable.
Balance sheet—A financial report that profiles the economic condition of an organization as of a moment in time.
Budget—A financial plan used to estimate results of future revenues and expenditures.
Capital budget—Plan of proposed outlays for acquiring long-term assets and the means of financing the acquisition.
Cash—Currency and coins, negotiable checks, and balances in bank accounts.
Current assets—Cash and other assets that are expected to be turned into cash, sold, or exchanged within the normal operating cycle of the firm, usually 1 year. Current assets include cash, receivables, and inventory.
Depreciation—An expense that represents the normal wear or deterioration experienced by an asset.
Direct costs—Costs that can be identified with and that result from the production of a specific good or delivery of a specific service.
Expense—Use of assets in producing revenue or carrying out other activities that are part of operations.
Fixed cost—An expense that does not vary with volume of goods or services produced.
GAAP—Generally accepted accounting principles.
Income—Excess of revenues over expenses. Also referred to as net income.
Income statement—Financial statement of revenues, expenses, and net income.
Indirect costs—Costs of production not easily associated with the production of specific goods or services. Also referred to as overhead.
Liability—Financial responsibilities and debts resulting from current operations and investment in fixed assets.
Long-term debt—Debt or liability that will typically be repaid over a period greater than 1 year. This debt is usually acquired in obtaining fixed assets.
Net income—See income.
Overhead—Any cost not associated directly with the production of goods or services. Also referred to as indirect costs.
Pro forma—Hypothetical financial statements as they would appear if some event such as a merger, increased production, or addition of a new service had occurred. Frequently done in the form of a pro forma budget.
Revenue—The monetary measure of a service rendered or goods sold.
 Variable costs—Expenses that vary with the volume of goods produced or services rendered.

References

Grossman, S., & Valiga, T. (2005). The new leadership challenge: Creating the future of nursing (2nd ed.). Philadelphia, PA: F. A. Davis Company.

Marquis, B., & Huston, C. (2006) Leadership roles and management functions in nursing: Theory and application (5th ed.) Philadelphia, PA: Lippincott Williams & Wilkins.

Wound, Ostomy and Continence Nurses Society (2008). WOCN salary and productivity survey. Retrieved November 19, 2010, from http://www.wocn.org

Wound, Ostomy and Continence Nurses Society (2010). Wound, ostomy and continence nursing scope & standards of practice. Mt. Laurel, NJ: Author.

Appendix T: Sample WOCN Society Member's Research Grant Proposal∗

Note: The following is an example of a research grant proposal provided by the Center for Clinical Investigation (CCI) of the Wound, Ostomy and Continence Nurses Society Foundation. This document was developed by the CCI and is available at the WOCN Web site (http://www.wocn.org/ResearchFunding). The document is provided here only as an example and is subject to change. Please contact CCI or check the Web site to verify current funding opportunities and the proposal process.

Funding Priorities:

WOCN Society Member's Research Grant—$10,000:

Any topic of WOC nursing practice that promotes the science or practice of the WOC nursing specialty.

This grant proposal is divided into 4 sections:

  1. Grant Submission Instructions
  2. Title Page
  3. Proposal Guide
  4. Checklist
  1. GRANT SUBMISSION INSTRUCTIONS
    1. Notice of interest
      • Please submit a Notice of Interest e-mail to Linda Dahle, Program Associate ([email protected]) when you are considering applying for a Member's Research Grant. This is not a commitment, and you can notify CCI later if you change your mind. This will enable CCI to send you any updates or resources to assist you. Please include the following information in the Notice of Interest e-mail:
        • Principal investigator's (PI) name
        • Topic you are considering studying and the title of proposal
        • A statement of the purpose of the study
        • E-mail address
        • Telephone number
    2. The title page to be completed includes the following information:
      • Title of research grant
      • Principal investigator's name
      • Academic degrees
      • Current professional certification
      • Home address
      • Current employer
      • Employer address
      • Preferred mailing address
      • Work/home telephone numbers
      • Fax number
      • E-mail
      • Registered nurse/license number/state of PI and Co-PI
      • WOCN Society Co-I Member Number of PI and Co-PI

      If you have team members as part of your study, please fill out,“Other Team Members Contact Information” (please copy table on separate pages for as many team members as you have).

    3. The following sections are included in the Proposal Guide, and need to be completed in order to be considered for funding:

      A) Title Page

      B) Abstract (summary of proposal)

      C) Scientific Plan (statement of problem including fit with grant and relevance to WOC nursing, research questions/aims, review of literature, references, methods)

      D) Bio-sketch of Principal Investigator (PI)

      E) Co-Investigator(s) Bio-sketch

      F) Statement of Team Qualifications/Strengths

      G) Project Budget

      H) Budget Justification

      I) Human Subjects/Ethical Considerations

      J) Timeline

      K) Scientific and Funding Overlap—Duplicative funding will not be accepted (ie, funding for same project by more than 1 grant). Please see the “K. Scientific and Funding Overlap” section for more detail.

      L) Receipt of Funds

      M) Appendix (Letters from research mentor; permission of holder of any records to be used, administrative approval to conduct study in an agency, etc, are required)

      Research proposal preparation

      • The Scientific Plan of the research proposal is a maximum of 10 typed pages in length single space (see Section C), but does not include the abstract, references, biographical sketches, budget, human subjects/ethical considerations, timeline, and other appendix materials.
      • Submission content must be:
        • Typed single space—maximum 10 pages (references should also be single spaced)
        • Leave 1-inch margins on all sides
        • Use a 12-point font Arial
        • Number every page
        • Do not use proportional spacing or justified margins
        • One Microsoft Word document that includes ALL the sections of the proposal will be accepted—no PDFs will be accepted.
      • The institutional review board (IRB) approval is not required at the time of submission, but an IRB application must be submitted within 30 days of award.
    4. References
      • The authors are responsible for the accuracy of the References. References should use an established format such as in the AMA Manual of Style, 9th ed (p. 43), or Publication Manual of the American Psychological Association (6th ed).
    5. Submission of a grant proposal:
      • E-mail the completed grant proposal by _________Date__________ to:
        Linda Dahle, Program Associate: [email protected]
    6. Questions?
      If you have questions about your proposal submission, please contact Linda Dahle at [email protected] or 612.625.8159. If you have any scientific questions, please contact Dr Donna Bliss, Director of the Center for Clinical Investigation, at [email protected].
  2. TITLE PAGE
    1. WOCN Society Member's Research Grant—$10,000: Funding priorities: Any topic of WOC nursing practice or that promotes WOC nursing specialty practice.
      ▪ Title of Research Project:  
      ▪ Principal Investigator's Name:  
      ▪ Academic Degrees:  
      ▪ Current Professional Certification:  
      ▪ Home Address:  
      ▪ Current Employer:  
      ▪ Employer Address:  
      ▪ Preferred Mailing Address:  
      ▪ Home Number:  
      ▪ Fax Number:  
      ▪ PI's Registered Nurse License Number/State:  
      ▪ Co-PI's Registered Nurse License Number/State (if applicable):  
      ▪ PI's WOCN Member Number:  
      ▪ Co-PI's WOCN Society Member Number (if applicable):  
    2. OTHER TEAM MEMBERS' CONTACT INFORMATION
      (Please copy table on separate pages for as many team members as you have.)
      Role Name Credentials Work Affiliation Responsibilities/Contributions to Study Address Telephone/E-mail Address
      Co-Investigator(s)            
      Research Mentor            
      Statistician            
      Consultant            
      Other            
  3. PROPOSAL GUIDE
    1. COMPLETE TITLE PAGE
    2. ABSTRACT (250-300 words maximum). The abstract is a summary of the entire proposal written in lay language. The abstract needs to include significance, purpose, research questions, aims, design, sample and summary of main procedures, planned statistical analyses, and expected outcomes.
    3. SCIENTIFIC PLAN—No more than 10 pages single space in length maximum, and include the following 4 areas:
      1. Statement of the Problem: includes significance, innovation of study, and how you meet priority of the grant (approximately 1–2 pages). Opening sentences should communicate what the study is about. Be succinct, clear, and direct.
        a) Significance:
        • What is this study about?
        • Why is the topic important?
        • What new knowledge will your study offer?
        • Is it timely?
        • What is its relevance to WOC nursing?
        • What is the clinical or scientific problem and need for your study?
          • Support with statistics, epidemiology.
          • Expert opinion.
          • Formal position/white papers of societies.

        b) Innovation of Study:

        • Explain what is unique or new about the study.
        • Are you bringing 2 ideas together in an innovative way?
        • Are you proposing a new way of thinking?
        • Are you proposing a new solution to an existing problem?
        • Are you proposing a novel approach of studying problem?

        c) Priority areas of grant:

        • How do your priority areas fit with the priority areas of the grant?
      2. Research Questions/Aims:
        • 1/2 page in length
        • Questions you will answer (2–3 questions is usually enough).
        • Statements of what you intend to do and accomplish.
          • Make known your main variables, sample, study design.
          • Must be measurable outcomes.
            • Be clear.
            • Not too broad—must be measurable.
            • Not too narrow—must be relevant.
            • Not too complicated—must be understandable.
            • Not too simplistic—must be important.
            • Should be specific, not general or ambiguous.
      3. Review of Literature
        • 2 to 3 pages in length
        • Critique quality of key individual studies.
          • Do not just describe—why is your study better/needed than what is published?
        • Evaluate state of science/evidence base.
          • Across all studies.
        • Interpret conflicting information.
        • Demonstrate knowledge about the problem and area of science
        • Identify the GAPS in knowledge that your study will address:
          • What information is missing that is important to know?
          • What new contribution to knowledge will your findings make?
          • Has practice or technology changed so that new information from your study is needed?
        • Include only most relevant studies.
          • Include most current articles and only pivotal historical ones.
      4. Methods (4-5 pages in length)
        a)Design
        • Specifically identify the design
        • Determined by the research question
        • Provides logical link among aims/questions, procedures, and analysis
          Question—Design—Methods—Analysis
        • Consult a statistician, experienced researcher about best approach

        b) Procedures

        • How will the proposed research be conducted?
        • Address the following:
          • Sample—the number and characteristics of subjects to be studied.
          • Sampling—strategies for recruiting subjects from where they will be recruited.
          • Explain procedures in good detail what you plan to do.
          • Describe groups you will form, including any control/placebo groups.
          • If doing random assignment, describe how it will be done.
          • Indicate points of interaction and data collection with subjects.
          • If you will do an intervention, explain what the intervention is, how you will implement it, and the data collection points. Include explanation of any placebo.
          • What are the expected outcomes of the study and how will they will measured, what instruments will be used, etc.?
          • How will you obtain data? Describe instruments, surveys, etc., that will be used to collect data.
            • Address their validity and reliability.
          • Potential problems and how you plan to address/avoid them.
      5. c) Analysis

        • Describe statistical testing or qualitative analysis as appropriate (frequencies, correlations, chi-square, t tests).
        • Appropriate statistical tests or analyses (for research question, type of data, frequencies, correlations, chi-square, t tests).
        • Organize by research aim/question.
        • Consult a statistician whenever possible.
    4. THE FOLLOWING ARE NOT INCLUDED IN THE 10-PAGE LIMIT:

    5. BIO-SKETCH OF PRINCIPAL INVESTIGATOR (PI) and Co-PI (2–4 pages)
      1. An example of a National Institutes of Health biosketch that you can follow is available at: http://grants.nih.gov/grants/funding/2590/biosketchsample.pdf
      2. A biosketch includes:
        • Name and credentials
        • Education (post–high school through present; institution, location, dates of attendance, degree, date degree was awarded)
        • Professional employment (title of position(s), address of employer, inclusive dates, certifications, and dates)
        • Publications
        • Any previous research experience (including funded research where you were the investigator, years, funder, and monetary amount of grant; role on other projects or other experience that would support your role as a PI; briefly describe type and level of experience/participation)
    6. COINVESTIGATOR(S) BIOSKETCH (2–4 pages maximum for each person). List any coinvestigators and attach a biosketch for each that contains information as described for a PI in D. above.
    7. STATEMENT OF TEAM QUALIFICATIONS/STRENGTHS. (Approximately ½-1 page in length)
      Include a statement about the role of each team member on the study, the qualifications and strengths of the research team, whether you have worked effectively together before, and what the consultants (if any) will add, etc.
    8. PROJECT BUDGET:
      In preparing your budget, please address the following categories of items: Supplies, Equipment, Photocopying, Services, Postage, Consultants, Technical Support Staff, Computer-related, Other Costs, and Indirect Institutional Administrative Costs, followed by a Total Amount of Budget Requested (see below).
      A few items to note:
      1. Funds cannot be used as salary support of the PI, Co-PI, or any Co-I or mentor, but can be used to support technical staff, such as statistician or data collector, etc.
      2. Up to 10% of the total budget can be used for indirect institutional administrative costs.
      3. Up to $500 may be used to purchase any type of computer.
      4. Principal investigators are expected to use software available at the agency at which they are conducting the study (eg, workplace or school has SPSS license that PI can use).
      5. Include travel costs for ONE PI to attend the WOCN Society's annual conference to present findings. The total amount of grant budget should include the travel cost. Estimate $1200 to $1500.
      6. $500 will be withheld from your grant until an abstract reporting the study findings is submitted to the WOCN Society annual conference, and a manuscript of final results is submitted to CCI as a final report and to JWOCN for review for publication.
    9. Budget Line Items

      1. Supplies
      (eg, camera, tape recorder)
      $
      2. Photocopying
      (eg, survey data forms, consent forms, etc.)
      $
      3. Services
      (eg, poster printing, data entry, etc.)
      $
      4. Postage
      (eg, to mail a survey)
      $
      5. Consultants $
      6. Research & Technical Support Staff
      (statisticians, data entry)
      $
      7. Computer-related
      (eg, special software, laptop)
      $
      8. Travel/Mileage
      (to present findings, mileage to/from subject's homes)
      $
      9. Other Costs $
      10. Indirect Institutional Administrative Costs
      (no greater than 10% of total)
      $
      TOTAL AMOUNT OF BUDGET REQUESTED: $
    10. BUDGET JUSTIFICATION. Please include a brief explanation of what each item is, why it costs, what it does, and indicate how each item relates to the research plan. The information should be sufficiently detailed to address cost and need.
    11. HUMAN SUBJECTS. If human subjects will be involved or medical record information of human subjects will be used, briefly explain the risks related to the study and how you will protect the safety and confidentiality of human subjects or their information. Indicate whether informed consent will be needed. If multiple institutions are data collection sites, address IRB approval at the various sites.
      NOTE: Final approval of the study by an institutional review board/ethics committee is required after an award is made and before funds will be released.
    12. TIMELINE. Provide a timeline starting from submission of IRB proposal through data collection and analysis to submission of findings to WOCN Society annual conference and final report.
    13. SCIENTIFIC AND FUNDING OVERLAP. Explain if there is any overlap of the proposed project with other funds/grants received or pending by the principal investigator or study team:
      1. If your proposed study is contingent upon receiving a grant from another funding source, PI must explain which portion CCI will fund and which portion will be funded by the other funding source. CCI will take into consideration the ability to complete CCI portion of the grant independently from the other grant.
      2. If there is a majority or entire overlap of the grant submitted to CCI and another funding source and you are awarded funding by both, you must choose which grant you will accept.
    14. RECEIPT OF FUNDS. Please check below if the principal investigator or the employment institution will be accepting the funds:
      • □ Principal investigator (If you choose this option, you will be required to include this as income on your income tax.)
      • □ Employment institution
    15. Name and complete mailing address of person/institution to whom funds will be sent:

    16. APPENDIX. The following materials are required or recommended in an Appendix:
      • Letter of agreement to participate in study from institution in which the study will be conducted, or letter of agreement from Director of the clinical practice from which subjects will be recruited (required);
      • Letter of agreement from consultants (required);
      • Letter of support from a research mentor on the project, if applicable (required);
      • Data collection instruments that are not readily accessible in the public domain/literature (recommended);
      • If the study has already been approved by an IRB, please include in the Appendix.

    NOTE:

  4. CHECKLIST

□  II. A. Title Page

□  II. B. Other Team Members Contact Information

□  III. B.  Abstract

□  III. C.  Scientific Plan

□  III. D.  Biosketch of Principal Investigator/Co-PI

□  III. E.  Coinvestigator(s) Bio-sketch

□  III. F.  Statement of Team Qualifications/Strengths

□  III. G.  Project Budget

□  III. H.  Budget Justification

□  III. I. Human Subjects

□  III. J. Timeline

□  III. K.  Scientific and Funding Overlap

□  III. L.  Receipt of Funds

□  III. M. Appendix

□  I have reviewed the “Research Grant Terms of Agreement” and agree to its terms if funded.

Questions?

If you have questions about your proposal submission, please contact Linda Dahle at [email protected] or 612.625.8159. If you have any scientific questions, please contact Dr. Donna Bliss, Director of the Center for Clinical Investigation, at: [email protected].

Appendix U: Web Sites for Evidence-Based Resources

ACP Journal Club
http://acpjc.acponline.org

Agency for Healthcare Research and Quality
http://www.ahcpr.gov/clinic/epcix.htm

Agency for Health Care Research and Quality (AHRQ): Quality and Patient Safety
http://www.ahrq.gov/qual/index.html

AHRQ Research Funding Opportunities
http://www.ahrq.gov/fund

American Academy of Nutrition and Dietetics
http://www.eatright.org

American Diabetes Association
http://www.diabetes.org

American Podiatric Medical Association
http://www.apma.org

American Society of Pain Educators
http://www.paineducators.org

Campbell Collaboration
http://www.campbellcollaboration.org
∗Site requires registration or a subscription through OVID or a similar service.

Canadian Centre for Health Evidence
http://www.cche.net

Centre for Evidence Based Medicine
http://www.cebm.net

Center for Gerontology and Healthcare Research
http://www.chcr.brown.edu

Centre for Reviews and Dissemination
http://www.york.ac.uk/inst/crd

Essential Evidence Plus
http://www.essentialevidenceplus.com

Implementing Best Practice Gateway
http://www.nursingsociety.org/Education/Pages/NewIBPKnowledgeGateway.aspx

Institute for Health Care Improvement (IHI)
http://www.ihi.org

Institute for Health Care Research and Policy (Georgetown Public Policy Institute)
http://ihcrp.georgetown.edu

Joanna Briggs Institute
http://www.joannabriggs.edu.au/Home

National Association for Continence
http://www.nafc.org

National Guidelines Clearinghouse
http://www.guideline.gov

National Institute for Clinical Excellence
http://www.nice.org.uk

National Pressure Ulcer Advisory Panel
http://www.npuap.org

Registered Nurse Association of Ontario
http://www.rnao.ca/bpg

Sigma Theta Tau International
http://www.nursingsociety.org/default.aspx

Society of Urological Nurses and Associates
http://www.suna.org

The Urology Care Foundation
http://www.urologyhealth.org

United Ostomy Associations of America, Inc
http://www.ostomy.org

University of Texas Health Sciences School of Nursing Academic Center for Evidence Based Practice
http://www.acestar.uthscsa.edu/index.asp

US Preventive Services Task Force
http://www.uspreventiveservicestaskforce.org/uspstf09/epbnursep/epbnursep.htm

Virginia Henderson International Nursing Library
http://www.nursinglibrary.org/vhl

WOCN Society
http://www.wocn.org/?page=research_funding

Searchable Databases

Cochrane Collaboration
http://www.cochrane.org

Cumulative Index of Nursing and Allied Health Literature
http://www.ebscohost.com/academic/cinahl-plus-with-full-text

EMBASE
http://www.embase.com

MEDLINE
http://www.ncbi.nlm.nih.gov/pubmed

PsycINFO
http://www.apa.org/index.aspx

PubMed
http://www.pubmedcentral.nih.gov

Government Resources

Centers for Disease Control and Prevention
http://www.cdc.gov

National Institutes of Health
http://www.nih.gov

US Department of Health and Human Services
http://www.hrsa.gov

Appendix V: Wound, Ostomy and Continence Nurses Society™ Advocacy and Grassroots Toolkit

Influencing Public Policy: Strengthening the Voice of the Wound, Ostomy and Continence Nursing Community

Originated By:
Wound, Ostomy and Continence Nurses Society (WOCN) National Public Policy/Advocacy Committee

Date Completed:
February 15, 2012

Table of Contents

Introduction

The future growth and vitality of wound, ostomy and continence (WOC) nursing is largely dependent on the ability of our professionals to influence key decisions made in our state and nation's capitols. These policy decisions are essential to preserving the future of our practices, our health care facilities, and the patient populations that we serve. To protect our field of nursing, we must develop and deliver effective messages from credible messengers to our elected officials about the quality of our patient care and its importance to the community. This is the essence of advocacy, which can be implemented on many levels and take many different forms.

This toolkit will present a variety of options for incorporating advocacy efforts into your operations, from simply establishing regular communications with your elected officials to the more advanced efforts entailed in developing a grasstops or grassroots program to strengthen your influence in Washington, District of Columbia, or in your state capitol. The WOCN Society has prepared this toolkit as a resource for its members to enhance their own, individual efforts at public policy/advocacy. The WOCN Society continues to conduct direct lobbying on Capitol Hill, provide advocacy support and training, and coordinate all of the Society's government relations activities.

WOCN Society Grassroots Toolkit for State Advocacy

It is important for WOCN Society members to recognize that to be an effective advocate for our profession, we need to become involved in every level of government, including state and local policy. While the bulk of this toolkit focuses on federal activities, state legislatures across the country are playing a bigger role in health care policy than ever before. Since the enactment of the “Affordable Care Act” in 2010, states have been given broader authority and responsibilities with regard to health care policy decisions. Going forward, states will be largely responsible for the expansion of Medicaid authority, granted in the Affordable Care Act, and the establishment of their state Health Insurance Exchanges. State legislators will be more involved in coverage and reimbursement decisions than in past years.

WOCN Society members must be engaged at a state level because we are the eyes and ears of our profession and our patients. Policy decisions often happen quickly at the state level and can be made without the input of all stakeholders if those stakeholders are not engaged in the process. So, how do you become engaged in the process at the state level? There are some simple steps that can be taken:

  1. Stay Alert. Try to read about the activities of your state legislature in the newspaper or on health policy blogs that might be available in your state.
  2. Engage Other Stakeholders. Reach out to patient group leaders in your state as well as the public policy representatives you might have at your institution and ask that you be kept involved and considered a resource on health policy decisions.
  3. Research. Two great resources are listed later that can help you become well informed about state policy and your state legislatures. The National Conference of State Legislatures (NCSL) has a wealth of information about state policy and state legislators and has a dedicated Health Policy section. In addition, Project Vote Smart can help you identify who your state legislators are and how to contact them.
  4. Reach Out. The WOCN Society encourages all of its members to reach out to their state representatives, just as they would with their federal representatives. Being engaged is the best way to protect both your profession and your patients.

The Basics: Communicating Directly With Your Legislator

Legislators are greatly influenced by what they know and what they hear—especially from the people they represent. By communicating with a state legislator or a member of Congress, you can have a profound impact on the government policies that most affect your practice and the field of wound, ostomy and continence nursing.

Your elected officials need to hear from you. They hear from constituents and special interest groups about many diverse issues ranging from education to transportation to foreign policy. They need to hear from the nursing community as well. Do not assume that they know all the facts about the important role that wound, ostomy and continence specialty nurses play in delivering patient care in your community. It is incumbent upon you to provide them with the information they need to fully understand and appreciate the vital role of WOC specialty nurses.

Remember that you also should communicate with legislators from around your state and not just the elected representative from the district in which your facility or institution is located. Legislators from neighboring districts need to know that your WOC specialty nursing practice is essential and impacts their constituents.

Suggested Steps

Send an introductory packet to your congressional delegation, especially new legislators.

The beginning of a new Congress is an ideal time to introduce (or reintroduce) wound, ostomy and continence nursing.

Provide information, such as the WOCN Society's position statements, to educate or update legislators in your state about the important role WOC specialty nursing plays in your community.

Use this first mailing to develop or strengthen your relationship with the office.

Maintain regular contact with a legislator's office.

Keep your legislators informed about your practice and facility.

Communicate clearly about relevant legislation—do not assume that they know where you stand.

Depending on the urgency of the situation, use one of the following methods of communications:

Writing a Letter

Constituent letters are a common way of communicating with a legislator and an effective advocacy tool.

Your letter should be simple and direct.

Letters should be addressed as follows:

To a Senator

The Honorable (Full Name)
United States Senate
(Room Number; Building Name) Senate Office Building
Washington, DC 20510

Dear Senator (Last Name):

To a Representative

The Honorable (Full Name)
House of Representatives
(Room Number; Building Name) House Office Building
Washington, DC 20515

Dear Representative (Last Name):

Sending an E-mail

E-mail is an easy way to communicate with a legislator or staff member.

State key information in the subject line.

Keep your message brief and to the point.

Finding your legislator's Web site and e-mail.

Telephone Calls to an Office

Phone calls are effective in delivering information quickly and directly, especially on days of key votes.

Calling the District Office.

Calling the Washington, DC, Office.

Sample Phone Script. Reference the legislator's Web site for the Washington and District Office phone numbers. You can locate his or her Web site by going to www.house.gov for House members and www.senate.gov for Senators. You also can call the Capitol operator at (202) 224-3121 and they will direct you to your legislator's office.

Sample Letter to a Legislator on a Key Issue. Constituent letters are an extremely effective advocacy tool. Your letter should be simple and direct. Ideally, it should not be more than 1 page since short letters tend to have the greatest impact. It should address only 1 issue and you want to be very clear about your position and request. Print your letter on personal stationery, if possible.

The Honorable (First Name; Last Name)
US House of Representatives/Senate
Washington, DC 20515 (for House)/20510 (for Senate)

Sent via facsimile: (202) (fax number)

Dear Representative/Senator (Last Name):

Sincerely,

Tips for Writing a Letter to a Legislator

  1. Fax Your Letter
  2. Opening Paragraph
  3. State the Facts
  4. Explain Consequences
  5. Ask for a Response
  6. Close the Letter

Common titles and job functions in a congressional office. Members of Congress rely on their staff to assist him or her during a term in office, so knowing and understanding the titles and roles of these staff members are critical to communicating effectively with Congress. These are some of the common staff members in a congressional office:

Administrative Assistant (AA) or Chief of Staff (CoS). The AA or CoS is usually a person in charge of overseeing office operations and supervising key staff, but most importantly, this person reports directly to the Member of Congress. The AA/CoS typically has responsibility for evaluating the political outcomes of various legislative proposals in the member's district or state and constituent requests.

Legislative Director. The Legislative Director is typically the staff member who monitors the legislative schedule according to the interests and committee assignments of the member, supervises legislative assistants, and makes recommendations to the CoS or the member based on the likely or expected outcomes of particular issues.

Legislative Assistant. A legislative assistant is usually a staff person with specific interest and expertise on a particular issue or a number of issues. There are typically several legislative assistants in a given member's office and they will usually vary based on the interests of the member and his or her constituency.

Press Secretary (Press Secy.) or Communications Director (Comm. Dir.). The responsibility of the Communications Director is to establish clear and open lines of communication between the member, their constituency, the media, and the public at large. This staff member must be able to effectively promote the views and positions of their member on specific issues to these parties as clearly and briefly as possible.

Personal Secretary. This secretary or scheduler is responsible for appropriating the member's time to accommodate the many demands on his or her time including congressional and constituent requests and staff requirements. These responsibilities may involve making travel arrangements, scheduling speaking engagements or visits to the district, or making appointments with the member.

Caseworker or Legislative Correspondent. This staff member typically deals with constituents' requests, addressed to the member or to a federal agency, and prepares replies to those requests for the member's signature. These staff people will also address or resolve constituents' concerns over the phone. There are usually several of these correspondents in any given congressional office.

Increasing Your Voice: Building a Relationship With Your Legislator

Over time, you will have a much greater impact on public policy by developing and sustaining relationships with your elected officials and their staff. As a starting point, it is important for legislators to be aware of your practice and the community that it serves. However, for you to affect their decision making, they must come to know you, your hospital and clinics, the people you serve, and the other community leaders who form the backbone of your support.

Keep in mind that you also want to develop relationships with legislators from around your state, not just your elected representative. Legislators from neighboring districts need to know that wound, ostomy and continence nurses are providing essential nursing care to their constituents—even if the actual practice is not located in their district.

People respond to people, and it is important to build personal relationships. These can be with legislators or with their key legislative staff. Building a relationship will take time and hard work, but if done well, it has the potential to yield significant results for the WOCN Society and our practice. Ideally, you will be able to involve your stakeholders and build upon their existing relationships with legislators. Here are just a few ideas to get you started.

Suggested Steps

Get to know the district staff.

Building relationships with the district office can prove to be very useful.

Use the first meeting to cultivate a relationship.

Arrange for a visit to your medical or research facility by your legislator.

A first-hand tour of your facility is the most effective way to educate an elected official.

Prepare for the visit with clear goals.

Encourage a tour of the entire facility, including clinics.

Visit your elected officials in Washington, District of Columbia Ultimately, you will want to schedule a personal visit to your members of Congress in Washington, District of Columbia. Elected officials will take notice of your visit. Taking the time out of your schedule to travel to Washington, District of Columbia, sends a very clear message to your legislators about the importance you place on public policy matters. Plan your visit carefully by being clear about what you seek to accomplish and whom you want to meet.

Prepare for the meeting. Be prepared to state your specific request. Develop 2 to 3 well-documented talking points reinforcing your message.

Follow up to the meeting.

Invite a legislator to one of your meetings.

Inviting an elected official to speak at a special facility, practice or hospital meeting is an opportune way to enhance the relationship. Take advantage of relationships that any of your leadership or board members may have with the legislator in arranging for the visit.

Thank legislators and staff for their interest and support.

Take the time to thank legislators and staff whether it is for a meeting or support of legislation.

Sample Meeting Request Letter to a Legislator

Meeting face-to-face with a legislator is an effective way to develop a relationship and to impress upon an elected official the importance that you place on particular issues. Your letter should be simple and direct about your request for a meeting. If you are proposing to meet in Washington, District of Columbia, or in the legislator's district, be clear as to the specific date and time you will be available to meet.

The Honorable (First Name; Last Name)
U.S. House of Representatives/Senate
Washington, DC 20515 (for House)/20510 (for Senate)

Sent via facsimile: (202) (fax number)

Dear Representative/Senator (Last Name):

On behalf of (your facility's name) in (your city), I am writing to request a brief meeting with you on (day and date) anytime between (specific hours of availability). Representatives from our community, including (reference types of stakeholders; eg, “nurses”) will be in Washington, District of Columbia, that day and would welcome the opportunity to talk to you about the essential role that wound, ostomy and continence specialty nurses play in the local community.

As you may know (your practice/facility's name) is a vital part of our community's health care delivery system. We provide quality, accessible health care to all segments of our community. (Insert information about your facility, including the number of patients you serve, the number of people you employ, and your areas of expertise in medicine.)

Thank you for considering our request for a meeting on (date). We would very much appreciate it if your scheduler would contact me (or name of your government relations director if signed by someone else) at (phone number) to schedule an appointment.

Sincerely,

Tips for Writing a Meeting Request Letter to a Legislator

  1. Fax your letter
  2. Open the letter
  3. Provide facts on your practice
  4. Specify follow-up steps
  5. Close the letter

Do's and Don'ts: Tips for Meeting Your Representatives

Meeting with your elected officials is often the most effective way of educating them on a public policy issue. A face-to-face meeting provides an excellent opportunity to convey and receive information and to develop relationships that will benefit your cause. You can simplify the process by following the tips and guidelines outlined later.

Before the meeting
During the meeting
After the meeting

About Congress: Resources to Help You Navigate the Legislative Process

This section contains background information on the US Congress and the legislative process. Included are links to a variety of Web sites that will be useful to you in tracking the status of legislation and planning your advocacy activities in Washington, District of Columbia

For specific information about the WOCN Society's advocacy efforts and federal legislation affecting the field of nursing, visit the WOCN Society's Web site at: http://www.wocn.org and click on “About Us” and then click “Advocacy and Policy.”

Congressional Calendar

The US House of Representatives and the US Senate maintain their own calendars of legislative activity. To obtain the most current calendar produced by each legislative body, you can visit their respective Web sites:

Status of Legislation

You can track the status of a piece of legislation through an online service offered by the Library of Congress. This Web site offers you the option of searching by a bill number, if known, or by a word or phrase. You can also monitor committee action and floor votes by visiting:

Contacting Your Members of Congress

To obtain contact information for your Senator or Representative (ie, phone number, fax number, or e-mail address), you should access their Web site. The easiest way to get to a member's individual Web site is through the House or Senate sites:

Congressional Committees

Each House and Senate committee has its own Web site with more detailed information on committee action and the status of legislation under its jurisdiction. Among the committees you may want to monitor are the following:

House jurisdiction relating to health care.

Senate jurisdiction relating to health care.

House of Representatives

Appropriations
www.house.gov/appropriations
(202) 225-2771
H-218 Capitol Building

Labor, Health and Human Services, Education, and Related Agencies Subcommittee
(202) 225-3508
2358 Rayburn House Office Building

Energy and Commerce
http://energycommerce.house.gov
(202) 225-2927
2125 Rayburn House Office Building

Health Subcommittee
(202) 225-2927
2125 Rayburn House Office Building

Ways and Means
http://waysandmeans.house.gov
(202) 225-3625
1102 Longworth House Office Building

Health Subcommittee
(202) 225-3943
1136 Longworth House Office Building

Senate

Appropriations
http://appropriations.senate.gov
(202) 224-7363
S-128 Capitol Building

Labor, Health and Human Services, and Education Subcommittee
(202) 224-7216
184 Dirksen Senate Office Building

Finance
http://finance.senate.gov
(202) 224-4515
219 Dirksen Senate Office Building

Health Care Subcommittee
(202) 224-4515
219 Dirksen Senate Office Building

Health, Education, Labor and Pensions
http://help.senate.gov
(202) 224-5375
428 Dirksen Senate Office Building

How a Bill Becomes a Law

For a quick review of the federal legislative process, visit the Web site below. This site will step you through the process beginning with the introduction of legislation by a member of Congress, the role of committees, floor action, and eventually the President's signature.

www.vote-smart.org/resource_govt101_02.php

Glossary of Legislative Terms

The vote-smart Web site also includes a brief glossary of basic legislative terms. For a more comprehensive listing, visit the following Web site: www.thecapitol.net/glossary

Relevant US Government Agencies

To fully follow the development of policy in our nation's capital, you may also want to contact or access the Web sites of several executive offices, including Cabinet departments and federal agencies. These offices play a role in developing legislative proposals, which the administration submits to Congress for consideration. Depending on the issue and the legislation being proposed, you may want to contact officials in these offices to discuss any concerns or recommendations.

The White House
www.whitehouse.gov
(202) 456-1414
1600 Pennsylvania Avenue, NW
Washington, DC 20500

US Department of Health and Human Services
www.dhhs.gov
(202) 690-7000
200 Independence Avenue, SW
Washington, DC 20201

Centers for Medicare & Medicaid Services
www.cms.hhs.gov
(410) 786-3000
4700 Silver Hill Road
Suitland, MD 20746

Food and Drug Administration
www.fda.gov
(301) 827-2410
5600 Fishers Lane
Rockville, MD 20857

National Institutes of Health
www.nih.gov
(301) 496-4000
9000 Rockville Pike
Bethesda, MD 20892

Office of Management and Budget
www.omb.gov
(202) 395-3080
725 17th Street, NW
Washington, DC 20503

Date Approved by the WOCN Society Board of Directors: March 20, 2012

Appendix W: Structure of Medicare and Medicaid in Relationship to the Rest of the Government Branches

How Medicare Policy Is Established

Appendix X: How Medicare Policy Is Implemented