Going It Alone: Educating Staff as an Independent

Education is a never-ending process of acquiring knowledge and skills and developing powers of reason and judgment. In an independent wound clinic, educational responsibilities are handled in-house. The following discussion offers insights into the way one independent wound clinic, the Archbold Center for Wound Management, Thomasville, Ga, addresses staff educational and training needs.

Background. Our wound care program consists of an outpatient clinic where patients are seen both for MD appointments as well as regularly scheduled wound care. We also consult on acute care patients with complex wounds and provide any advanced wound care required during the hospitalization. Additionally, we oversee the wound management practices and round on complex cases at our four affiliate hospitals and four nursing homes.

Orient new staff. To work successfully in the clinic, each clinician must have a good base of knowledge and skills. Knowing that staff members come to the clinic from a variety of backgrounds and experiences, we utilize the required competencies necessary for each description as a template for orientation.

The orientation is accomplished with preceptorships and readings (texts and journals). The timeframe for orientation is determined individually for each staff member. Because this method of education is predominantly informal and only loosely structured, knowledge is not usually gained in a logical sequence; to compensate, each new staff member is sent to a 1- to 2-day basic wound management course within 4 to 6 months of hiring. This practice has allowed individuals to reinforce new knowledge and skills in an organized sequence.

Most of our orientation has been provided because we have added rather than replaced staff. We started 8 years ago with one PT and one RN; we now have three PTs and five RNs.
Attend conferences. All licensed staff are expected to attend at least one national or advanced conference annually. The clinic will support attendance at additional conferences if the employee takes the initiative to submit an abstract, join a committee or task force, or present or help with a course. Although closing the clinic and allowing all of the staff to attend a conference together is no longer feasible, several people may attend a conference at one time. In addition to the camaraderie and team-building benefits of conference attendance, new ideas seem to be embraced more readily when opportunities are seized for brainstorming and sharing at the time the idea is presented. It is also easier to follow through with new ideas when multiple people are engaged. We all have had the experience of going to an energizing lecture or conference and returning to work enthusiastic and ready to try something new, only to get caught up in the daily grind. Shared endeavors have a better chance of implementation.

Tap vendors. Staff members are encouraged to explore new products and equipment. We periodically have product-focused inservices presented by industry reps. Because vendors are a biased source of information, staff are encouraged to challenge product claims and request evidence. Most of today’s wound care companies have clinical personnel on staff or retainer who offer a wide range of services, from answering case-specific questions regarding the use of their product to presenting 1- or 2-day courses. Vendors can be a valuable resource for product information.

Teach (and learn from) students. One of the most effective education methods is bedside instruction. We routinely have LPN and RN students, paired with one of the staff members, spend a day in the wound clinic as a part of their curriculum. For the experienced clinician, explaining the what and why of the your everyday activities reinforces your own knowledge base. For some nursing programs, students are required to complete questionnaires on wound types, product categories, and phases of healing. In helping students with their assignments, it is not uncommon for clinician teachers to seek texts and journals for details they no longer have on the tips of their tongues. For novice clinicians, having a “shadow” is an opportunity to realize just how much specialized knowledge they have gained.
Facilitate a cooperative environment. We have discovered that a steady knowledge exchange occurs among clinical staff sharing work space. At our wound center, we have the luxury of treating patients in individual rooms with four walls and a door. This structure enhances patient privacy but it also impedes the free exchange of ideas and expertise. However, the shared office space promotes informal discussion of treatment approaches and challenges. One nurse kept finding herself out-of-the-loop on small changes in practice; she was the only clinic nurse whose charting desk was in a different room. By rearranging seating so all licensed staff in the clinic shared one office, we eliminated the “how come I didn’t know that” factor.

Provide classroom opportunities. Developing a new service or skill requires a structured approach. When we identified the need to provide total contact casting in our clinic and knew we had to train both licensed and support staff, it was more economical and feasible to bring in an expert speaker. We closed the clinic early one Friday, turned the waiting room into a laboratory-style classroom, and spent the weekend in a didactic class and skills lab tailored to our needs. On Monday, pre-selected patients were scheduled to allow us to begin casting with the expert’s oversight. Expert speakers are brought in as needed.

Promote clinical discussions. Licensed clinic staff meet over lunch every other Wednesday. This provides a venue to brainstorm on pertinent issues. The discussion may revolve around operational concerns such as how to accommodate requests for late appointments or clinical matters such as how to promote better patient cooperation with offloading or how to know when to use a specific dressing.

Encourage networking. Staff are encouraged to participate in local networking groups such as the Wound Care Wine Club and to join national organizations like Association for the Advancement of Wound Care (www.aawconline.org). These become avenues for staying in touch with industry issues and trends and providing links to clinicians who have faced and triumphed over similar challenges — an opportunity to learn from the experiences of others in similar situations.

Champion learning. In our clinic, we believe that in order to provide the best patient care possible, you must stay abreast of current thoughts and be knowledgeable about what products and tools are currently available. The goal is to provide a culture that supports and encourages education. There must be flexibility in the way information is offered to accommodate different learning styles and schedules along with an attitude that there is always something to learn and various ways to acquire knowledge. No matter how long you have been in the field, everyone has something to learn and everyone has something to teach.

Tere Sigler is Director, Archbold Center for Wound Management, Thomasville, Ga.