My Specialty

Wound Care Nurse Manager, Nohemy Sam, San Antonio Regional Hospital

Addressing hard-to-treat or non-healing wounds

Please tell us about the trajectory of your nursing career.

The first nine years of my healthcare career were as a medical assistant and X-ray tech in a family practice clinic. I later obtained my LVN license and worked for six years in a plasmapheresis center. I was initially a staff nurse, but was later promoted to become the center’s trainer. I continued my nursing education and obtained my BSN from Loma Linda University, where I served nine years in a transplant unit that focused on kidney, pancreas and liver transplants.

Wanting to be closer to home, I found a new position at a nearby hospital and worked in the telemetry unit for two years. During this time, I concurrently served as a legal nurse consultant for a private Los Angeles law firm. Later on, I became part of the wound care department at my hospital and obtained certifications in wound, ostomy and continence specialties.

How did you become interested in wound care?

I always felt that I could do more for patients being admitted with different type of wounds and pressure injuries. As a floor nurse, I didn’t have specialized or advanced knowledge about wounds and wound care, so I became very interested in investigating wound therapies, dressings, etc.

When a position opened up after my two years in telemetry, I decided to go for it. Luckily for me, a very experienced wound care nurse took me under her wing and saw me through to my CWOCN [certified wound, ostomy and continence nursing] certification. Also, I’ve always had a director who has been very supportive of my role.

We have over 300 beds in our hospital. I was initially part of a three-person team in the wound care department, but after six months or so, I found myself the only one.

For three years, I was the only CWOCN to evaluate, treat and make recommendations related to wound, ostomy and continence care.  Eventually, one of the nurses from the telemetry unit began working towards his certification. Now, we’re the two certified nurses within the department.

What are your responsibilities as a wound care nurse manager?

Some of my duties include evaluating the quality of wound care delivered to patients; monitoring patients’ progress; implementing corrective action to improve patient care related to wounds and ostomies; developing, reviewing and implementing policy/protocol revisions based on current standards; and consulting with physicians and other healthcare professionals regarding the quality of wound and ostomy care.

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Do you also provide leadership in relation to wound care and education of the staff?

Yes, I provide leadership regarding standards of care for patients undergoing new wound or ostomy care therapies. I develop educational programs for new and current employees, provide quarterly wound and ostomy care classes, monitor local and national trends and make recommendations for practice changes. Our facility has “wound care champions” on each unit who serve as our eyes and ears when we’re not on hand. They’re like an extension of the wound care department. You could consider them “super- users” when it comes to wound care nursing. These champions are a resource for their peers.

What about committees and wound consult requests?

I am part of the skin care committee and represent the management of wounds and skin on hospital-wide committees and task forces.  I receive an average of 15 to 20 physician requests a day for wound consults. For each consult, I perform a complete assessment, take photographs and enter nursing orders for wound care. I also follow up with ostomy patients pre- and post-surgery, educate them and their families on how to care for their ostomy at home and provide the supplies they’ll need upon discharge.

What aspects of ostomies and continence fall under your jurisdiction?

We provide pre- and post-education for patients regarding ostomies, including addressing supplies and stoma care. We also educate staff because they aren’t exposed to these types of tasks every day.  Urinary diversions also fall within our purview, as do Foley catheter care, insertion techniques and infection control.

What are you seeing these days in terms of pressure ulcers?

We are noticing that constant education of the nursing staff is essential to reinforcing the understanding of proper pressure injury staging and treatment. Thorough skin assessments are important for ensuring that we can initiate appropriate treatment and intervention. Where pressure injuries are concerned, technology is very helpful. Specialty beds and pressure redistribution mattresses are major positive interventions.

What has changed in wound care in recent years?

More hospitals are hiring specialized wound care nurses to help with the flow of patients that have existing pressure injuries and difficult-to-treat or non-healing wounds. Specially trained and certified wound care nurses use evidence-based practices, therapies and modalities that can be helpful, especially for wounds that are difficult to heal. Insurance impacts and dictates what’s utilized for wounds, especially in the outpatient setting; in the hospital, we can always initiate excellent treatments.

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Sadly, some patients don’t continue their wound care after discharge because they can’t get their private insurance to pay for home-based nursing care or the right materials. Sometimes, patients are actually put in the position of having to choose whether to buy food or wound care supplies.  Medicare and Medicaid are realizing how important wound care is and that it’s more cost-effective to cover the products that will actually work for specific types of wounds.

However, it‘s most beneficial for the patient if the wound care follow-up is done by a provider who specializes in wound care. This avoids delays in care and can be more efficient and cost-effective.

Have MRSA and other antibiotic-resistant infections become more prevalent?

Antibiotic-resistant bacterial infections appear to be more prevalent now than in previous years. I’ve noticed that the number of patients on isolation precautions has increased, especially patients being transferred from nursing homes.   When we have a patient who is positive for MRSA, we run labs, isolate the patient and take appropriate precautions

What career strategies do you recommend for novice nurses interested in wound care?

Take every opportunity to get involved in the assessment and evaluation of patients’ wounds. Ask to shadow more experienced wound care nurses. You just can’t know for sure if you’ll like wound care until you do it for a while and get hands-on experience.

I recommend reading extensively about wound care; visiting the Wound, Ostomy and Continence Nursing Society website (wocn.org); and understanding the reality of what such a career move entails. Some employers will pay for you to attend conferences and trainings. Check with your current hospital and find out if they have tuition reimbursement for employees seeking to become certified in wound care.

While the certification for CWOCN is somewhat challenging to attain, there’s currently a shortage of certified wound care and ostomy nurses. Those who are certified are highly marketable. Recertification is required every five years.

What are your future career goals?

I plan to continue to develop the wound care resource program for my hospital and keep up with the evolution of wound care, including new therapies, dressings, policies and research.  I also have a goal of regularly attending more wound care conferences. It’s my responsibility to make sure we provide the best possible evidence-based care for our patients.


Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.


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