Response

I appreciate Ms Siegel's response, and in fact I agree with her on many of her points, and certainly with her goal of evidence-based wound care for all patients. It is clear that we agree on the need for wound-related education for all wound care providers, and we also agree on the need for clear definitions of roles in the area of wound care. We disagree in that I believe we can best achieve this by clearly defining and articulating the scope of practice for a Certified Wound Care Nurse (CWCN) (who is prepared to implement and manage a comprehensive wound management program for individual patients and for an agency, to provide in-depth assessment, to debride necrotic wounds, etc.), and a Certified Wound Care Associate/Assistant (who is prepared to provide evidence-based wound care under the guidance and overall supervision of a CWCN or Wound Care Physician). I do not want to see CWOCN positions filled by individuals with less preparation, but I think the way to prevent that is to clearly articulate the scope of practice for each provider (and each level of certification).

I believe there is a lot of precedent in health care to support this approach. For example, there is a separate certification for an Occupational Therapist and for an Occupational Therapy Assistant. We have certified nurse practitioners, who have clearly proven their ability to provide excellent care to selected patient populations under the overall direction of a physician (despite initial dire predictions about the negative impact of having anyone less than an MD provide this care). We all recognize that wound care is typically directed by a CWOCN but actually provided by staff nurses at the bedside; I believe that these nurses should have the option to pursue certification for their level of practice, and I also believe that patients would benefit from the higher levels of knowledge associated with certification as opposed to just education.

Having said this, I acknowledge that this is a very complex issue and that there are no simple answers. I also acknowledge that any decision we make will have far-reaching consequences, and I believe we are obligated as professionals to actively consider both the pros and cons of any proposed solution, and to vigorously argue and debate all points of view until we can come to some degree of consensus. I applaud Ms Siegel for initiating this process, and I hope to see many more letters to the editor in regards to this debate.

Dorothy B. Doughty, MN, RN, CWOCN, FAAN