Marketing the Gold Standard: Educating Others About WOCNCB Certification

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) Cary A. American Journal of Nursing 2001; 101(1): 44.

12. Realized Benefits of Certification (n=18,385)

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 1997; 30: 45.

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’ URL: http://www.wocncb.org/ updated 4/21/2008

28. COCN/ CWOCN vs Other ‘C’s’ URL: http://www.nursing2007.com/pt/pt-core/template-journal/nursing/media/cert.htm

29. CCCN/ CWOCN vs Other ‘C’s’ 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. WOCNCN Evaluation Form 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) 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