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business case, hospital-acquired pressure injury, nurse staffing, outcomes, wound ostomy continence nurses



  1. Gallagher, Mary Anne DNP, RN, Ped-BC
  2. Chraplyvy, Natalia MBA, RN


OBJECTIVE: To describe how one organization built a business case for a wound, ostomy, and continence (WOC) nurse team expansion.


SETTING: The organization is part of a multihospital system; it is an 862-bed, urban, academic medical center with a gastrointestinal surgery program.


METHODS: The director of nursing and the WOC nurse staff worked collaboratively to build a staffing proposal. Finding a lack of published staffing guidelines for WOC nurses, researchers assessed workload and volume growth, benchmarked internal and external staffing, and conducted a market comparison. The proposal demonstrated impact on care outcomes related to a reduction in WOC nurses.


RESULTS: Based on the case presented, the Off Budget Investment Team committee was satisfied that additional WOC nurse resources would bring both quality and financial value to the organization by reducing hospital-acquired pressure injury (HAPI) incidence and increasing ostomy consults. Approval of additional full-time equivalents was contingent upon a commitment to reduce year-over-year HAPI incidence and to assess the additional costs of treating a HAPI, specific to this organization.


CONCLUSIONS: Wound ostomy continence nurses bring value to clinical outcomes that impact patient experience, direct and indirect expenses, rankings, reputation, liability, and pay for performance.