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Sharpening Your Tools for the Cutting Edge

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  • 1. Marketing the Gold Standard: Educating Others About WOCNCB Certification Mikel Gray, PhD, CCCN, FAANP, FAAN
  • 2. Objectives  Define (or redefine) specialty practice certification in nursing  Communicate the unique benefits of WOCNCB certification*  Identify key marketing points to justify & support your position as a certified nurse*  Discuss methods for marketing your value as a certified nurse* * Defined by WOCNCB
  • 3. Certification: What is it?  POP QUIZ: Which of the following reflects an accurate application of Laplace's Law to compression therapy for LEVD?  A. Adding layers to a compression bandage increases sub-bandage pressure  B. Increasing bandage width decreases sub- bandage pressures.  C. A larger leg circumference decreases sub- bandage pressure.  Increasing tension elevates sub-bandage pressure.
  • 4. Certification: What is it?
  • 5. Certification: What is it?  Slide 1 is about the anxiety provoking process of testing to earn the credential  Slide 2 is about the process of documenting evidence of professional growth and ongoing education to maintain the credential  Certification goes far beyond both of these processes….
  • 6. Certification  Online Dictionary: the state of being certified, a certificate that attests the truth of a statement or event1  Online Medical Dictionary: adherence to a set of standards defined by non- governmental society or association; certification is achieved on a voluntary basis, and it represents a professional status when achieved 1. Online Dictionary: http://dictionary.reference.com/browse/certification 2. Online Medical Dictionary: http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=certification
  • 7. Certification  Fulfills multiple purposes, but two are considered primary and essential1  Protect the public by setting standards for the individual’s knowledge/ experience/ skills against a benchmark of accepted standards  Meet needs of key stakeholders*: certified nurses, nurse colleagues and trans-disciplinary colleagues 1. Woods DK. Journal of Nursing Administration 2002; 32(7/8): 379.
  • 8. Certification: Additional Benefits  Recognition of specialty practice within facility, regionally and nationally1  Criterion for promoting via clinical ladder  Financial benefits (some facilities)  Fosters enlarged role of certified nurse; especially in the area of clinical leadership 1. ANCC online: http://www.nursecredentialing.org/cert/certfaqs.html
  • 9. Certification vs Licensure  Licensure provides legal basis for practice and defines scope of practice  Certification reflects achievement beyond that required for licensure; unique features:  It is voluntary  It is regulated by professional societies (not the government)  It is equated with a standard of practice above ‘minimum’ required for licensure
  • 10. Value of Certification: Consumer Perspective  Consumer perspective  Patients and their families increasingly want to know – are you qualified to perform care for me or my family member?1  1999 ANCC survey: 33% more confident when care for by certified nurse; 16% aware that nurses could be certified in a specialty area2  2002 Harris Poll: 75% wanted to receive care from certified nurse; 90% aware of specialty certification for nurses3 1. Mason DJ. American Journal of Nursing 2001; 110(1):7. 2. URL: http://www.nursingworld.org/pressrel/1999/pr0507.htm. 3. Hams Interactive Inc. AACN Survey. November 2002
  • 11. Value of Certification as Perceived by Certified Nurses (n=19,423) Recognized as expert by colleagues 39% Credential recognized or publicized 32% Recompense for associated costs 28% Advancement potential (adds to professional portfolio*) 21% Cary A. American Journal of Nursing 2001; 101(1): 44.
  • 12. Realized Benefits of Certification (n=18,385) ↑ Satisfaction as a professional nurse 67% More effective resource to staff 39% Serve as consultant within facility 22% ↑ Competence in specialty skills 65% ↑ Satisfaction/ Confidence in decision- making 56% ↑ Perception as a credible specialty provider 56%
  • 13. Value of Certification: Administrator’s Perspective  AONE commissioned study found that certification associated with job satisfaction & retention1  ANCC commissioned study supports greater skill competency and risk of iatrogenic error↓ and harm among certified nurses2  2 studies comparing certified and non-certified nurses in skill-related knowledge3 and skill performance4 favored certified nurses 1. Woods DK. Journal of Nursing Administration 2002; 32(7/8): 379. 2. Critical Care Nurse Focus Study Group. TNS Market Development, 2000. 3. Practice Guidelines for Pulmonary Artery Catheterization. 2003. 4. Redd ML, Alexander JW. Nursing Management
  • 14. Strategies for Marketing Yourself as a WOCNCB Certified Nurse  Identify and communicate the unique value of WOCNCB certification  Evaluate your competitors  Identify your market – who are your Customers and who are your Clients?  Determine patient needs and measure satisfaction with your services  Document your contributions to your facility Liguori R. Journal of Pediatric Health Care 2005; 19: 407.
  • 15. Marketing Yourself as WOCNCB Certified  Communicate your credential and scope of practice: CWOCN  Wound Care Assessment • Identify etiologic and contributing factors and their effect on healing • Apply TIME or DIME conceptual frameworks • Evaluate and manage wound pain • Assess impact of factors on wound healing (eg: bacterial bioburden, systemic disorders, depression) • Differential diagnosis  Resource utilization: specialty dressings, specialty beds, pressure redistribution devices, negative pressure wound therapies
  • 16. Marketing Yourself as WOCNCB Certified  Communicate your credential and scope of practice: CWOCN  Wound Care: Prevention & Management of the most difficult to heal & costly wounds • Pressure ulcers (resource for CMS changes) • Lower Extremity Ulcers • Non-healing surgical wounds • Catastrophic traumatic wounds • Neoplastic wounds • Atypical wounds
  • 17. Marketing Yourself as WOCNCB Certified  Communicate your credential and scope of practice: CWOCN  Ostomy Care • Historic heart of WOC specialty practice • Stoma site marking (WOCN-ASCRS position, WOCN-AUA to follow) • Pre- and postsurgical counseling, customized to patient readiness and facility • Discharge teaching and patient hand-off • New and existing ostomy management
  • 18. Marketing Yourself as WOCNCB Certified  Communicate your credential and scope of practice: CWOCN  Ostomy Management • Urinary and fecal continent diversions • Fecal and urinary orthotopic diversions (IPAA, orthotopic neobladders) • Management of abdominal fistulae; good example of interrelationships among principles of WOC nursing  Resource utilization: ostomy supplies, supplies for managing abdominal fistulae
  • 19. Marketing Yourself as WOCNCB Certified  Communicate your credential and scope of practice: CWOCN  Continence Management: 2 levels not yet entirely articulated; strengths unevenly recognized by CWOCN • Comprehensive management involves UI, FI and IAD (another interrelationship) • UI, FI containment (pads, wrap-around briefs, underpads for beds) • Temporary urinary diversion via indwelling catheter (resource for CMS policy changes and balance between IDC and PU prevention)
  • 20. Marketing Yourself as WOCNCB Certified  Communicate your credential and scope of practice: CWOCN  Continence Management • Temporary diversion of stool via bowel or fecal management systems • Counseling about options for long-term management and identification of appropriate referral sources
  • 21. Marketing Yourself as WOCNCB Certified  Communicate your credential and scope of practice: CWCN  Wound Care Assessment  Resource Utilization  Prevention & Management  Emphasize your particular expertise as well • Conservative sharp wound debridement • Negative pressure wound therapy techniques • Draining wounds and fistulae • Non-healing or indolent wounds • Atypical and complex wounds
  • 22. Marketing Yourself as WOCNCB Certified  Communicate your credential and scope of practice: COCN  Stoma site marking, counseling, counseling  Continent urinary and fecal diversions  IPAA and other orthotopic bowel procedures, orthotopic neobladders  Resource utilization  Emphasize in-depth knowledge, including role in managing short- and long-term stomal and peristoma complications, associated diseases (colorectal cancer, bladder cancer, etc).
  • 23. Marketing Yourself as WOCNCB Certified  Communicate your credential and scope of practice: CCCN • Comprehensive management of UI, FI and IAD • Containment • Temporary urinary diversion (IDC, B/F MS) • Assessment of chronic/ established UI/ FI • Behavioral and lifestyle interventions • Toileting schedule manipulation including habit training/ retraining • Pelvic floor muscle training
  • 24. Marketing Yourself as WOCNCB Certified  Communicate your credential and scope of practice: CFCN  Holistic health assessment focusing in foot health  Physical examination including vascular, temperature, sensations of foot  Evaluate risk profile and assess adequacy of footwear  Skin and nail care  Education and referral  Excellent adjunctive certification for CWCN, as well as CDE
  • 25. Marketing Yourself as WOCNCB Certified  WOC and Advanced Practice Nursing  AP credentials (NP, CNS) provide value added benefits to W/O/C certification  Consider adding AP portfolio to your certification when AP nursing education completed  Emphasize potential for reimbursement (esp NP), enhanced autonomy in outpatient & inpatient consultations, prescriptive authority, potential as source of independent patient referrals
  • 26. Communicate the unique quality of your WOCNCB Certification  3 standard elements  Credential earned through combination of didactic knowledge and focused skill acquisition (preceptor supervised plus independent experience)  Maintain and update knowledge & skills through formal re-certification process  Credential legally defensible; testing psychometrically sound, re-certification process transparent and fair
  • 27. CWCN/ CWOCN vs Other ‘C’s’ WOCNCB NAWC AAWM (CWS)  Accredited by NCCA, ABNS  No external accreditation  Accredited by NCCA  240 didactic hrs,120 precepted Active in wound care + 5 day seminar  BS or higher, 3 yrs in wound care  Reexamination or PGP Reexamination, CE, Community outreach, fee plus course Self-assessment examination every 10 yrs URL: http://www.wocncb.org/ updated 4/21/2008
  • 28. COCN/ CWOCN vs Other ‘C’s’ WOCNCB All Others  Accredited by NCCA, ABNS  240 didactic hrs,120 precepted   Reexamination or PGP  URL: http://www.nursing2007.com/pt/pt-core/template-journal/nursing/media/cert.htm
  • 29. CCCN/ CWOCN vs Other ‘C’s’ WOCNCB All Others  Accredited by NCCA, ABNS  240 didactic hrs,120 precepted   Reexamination or PGP  URL: http://www.nursing2007.com/pt/pt-core/template-journal/nursing/media/cert.htm
  • 30. Communicate the quality of your WOCNCB Certification: WOCNCB Brochures  Marketing Brochure for Facility/ Administrators  Brief description of WOCNCB  Why certification matters  2 studies supporting overall value of certification  1 study suggesting risk of↓ malpractice filing  1 study providing evidence that certified nurse achieve better wound outcomes than non-certified nurse
  • 31. Communicate the quality of your WOCNCB Certification: Use the WOCNCB Brochures  Marketing Brochure for Facility/ Administrators  Certified nurses associated with better retention than non-certified nurses  WOCNCB certification is psychometrically sound and legally defensible (based on criteria established by NCCA and ABNS)
  • 32. Communicate Key Research Findings  “Rules” of the game  Focus is on identifying key points  Look for bulleted points to bolster your argument  Use only verifiable, published data  Less emphasis on weaknesses of research methods than systematic or highly academic reviews
  • 33. Communicate Key Research Findings  WOCNCB Certified Nurses have better clinical outcomes that non-certified nurses  Retrospective (“real world”) review of 519 patients admitted to 5 home health agencies revealed that 78.5% of wounds managed by WOCNCB certified nurses healed as compared to 36.3% of non- certified nurses Arnold M, Weir D. Journal of Wound, Ostomy and Continence Nursing 1994; 21(4): 126.
  • 34. Communicate Key Research Findings  WOCNCB Certified Nurses act as resources for non-certified nurses to improve patient outcomes  WOCNCB Certified nurses achieved faster wound healing and reduced home visits by 50% using a telemedicine system Kobza L, Scheurich A. Ostomy Wound Management 2000;45(10):48.
  • 35. Communicate Key Research Findings  Other key points  Nurse managers recognize that hiring certified nurses seen as exerting positive impact on patient care and safety1  Hospitals who hire more board certified nurses tend to have reduced malpractice suits, resulting in rebates on insurance rates2 1. Stromborg MF et al. Nursing Management 2005; 36(5): 36. 2. Trossman S. American Journal of Nursing 2002; 102(5): 71.
  • 36. Communicate Key Research Findings  Canadian based certified WOC (ET) nurses achieved faster and more cost effective wound healing than non-certified nurses  The greatest differences were seen when the ET nurse was directly involved in delivering wound care  Statistically significant and clinically relevant differences were seen even when ET nurses were indirectly involved in patient management Harris C, Shannon R. Journal of Wound, Ostomy and Continence Nursing 2008; 35(2): 169.
  • 37. Evaluate competitors  Assess formal competitors within your facility, within other facilities, and from different settings  Identify informal competitors; those offering WOC services without certifications or formal credentials  Can competitors become allies? Partners in delivering care? Supplements to your practice or can you function to supplement their practice?
  • 38. Identify your Market  Customers vs Clients  Your clients are your patients – those who require and benefit from our direct services  Your customers are those who provide you with clients, for the WOCNCB certified nurse, they are often surgeons, other physicians, AP and influential staff nurses
  • 39. Evaluate and Meet Patient (client) Needs  Routinely measure patient/ client satisfaction  Encourage patients to communicate with key decision makers whenever possible  Establish and nurture key client relationships within bounds of professionalism when indicated
  • 40. Provide Family & Patients with WOCNCB Expert Care Brochure  Defines what board certification mens in broad term  Traces origins of WOCNCB to 1978  Lists possible certification credentials  Speaks directly to patient & family as consumers
  • 41. Provide Family & Patients with WOCNCB Expert Care Brochure  Nice description of WOCNCB certified nurses as:  Clinical experts  Treatment specialists  Health educators  Experienced and knowledgeable care providers  Summarizes research bullet points noted on general marketing brochure ∀ ↑ clinical expertise • Better clinical outcomes ∀ ↓ likelihood of medical errors
  • 42. Please check which of the following services I provided to you:  Wound Care  Ostomy Care  Continence Care  Foot Care Please check which customer type best describes you:  Physician  Nurse  Insurance Company  DMERC  Other (specify) WOCNCN Evaluation Form URL: http://www.wocncb.org/pdf/satisfaction_profsurvey.pdf
  • 43. WOCNCB Evaluation Form On a scale of 1 to 5, with 1 being the lowest and 5 being the highest, please evaluate my performance on the following. Please circle the appropriate number. Knowledgeable 1 2 3 4 5 N/A Assess needs appropriately 1 2 3 4 5 N/A Performs patient care appropriately 1 2 3 4 5 N/A Maintains caring attitude toward patients 1 2 3 4 5 N/A Innovative problem solver 1 2 3 4 5 N/A Professional 1 2 3 4 5 N/A Communicates well 1 2 3 4 5 N/A Responds in a timely manner 1 2 3 4 5 N/A Completes documents accurately 1 2 3 4 5 N/A Overall performance rating 1 2 3 4 5 N/A
  • 44. Document Your Contributions to Facility  Differentiate being busy from productive  Measure only highly select indicators of productivity  Maintain productivity database (even if you do not keep a clinical or research database)  Learn and use language that non-clinical (business) administrators can relate to… even if you are not allowed to bill directly for these services
  • 45. Conclusions  Board certification is more than passing an examination; it is a combination of education, skill acquisition and ongoing vigilance  WOCNCB certification is a rigorous & legally defensible board certification accurately recognized as the gold standard for WOC nursing  Every acute care facility, every long-term care facility, every home-care facility, every major university department needs one or more of these key players