Comparing Wound Care Certifications: Clinicians Sound Off

     Within the wound care community there are currently three certifications offered:

     1) Certified Wound Care Nurse — CWCN— offered by the Wound Ostomy and Continence Nursing Certification Board (WOCNCB);
     2) Wound Care Certified —WCC— offered by the National Alliance of Wound Care (NAWC);
     3) Certified Wound Specialist — CWS — offered by the American Association of Wound Management (AAWM).

     Holding a certificate or a credential offers the clinician opportunities in employment and professional advancement. However, there are differences in costs and time commitment that make the choices less clear. Those who are best prepared to discuss the differences and to assist the applicant in choosing a program may be those who have attended two or three of the programs and/or have taken two or three of the tests.

     In November 2007, OWM published Rappl L, Fleck C, Hecker D, Wright K, Fredericks C, Mrdjenovich D. Wound care organizations, programs, and certifications: an overview.

This follow-up information elucidates clinician experience with the certification process. ****

     I have sat for the CWON test and the CWS test. I agree the CWS covers a broader scope; it is meant for physicians, PTs, and nurses. Each discipline focus is a bit different but the CWS test covers all areas — the same test for everyone.

     I thought the CWCN test covered more on treatment choices; the CWS test included more anatomy, physiology, testing/results, offloading, disease process/ etiology, and some treatment choices. Both are worthy tests. I used the Bryant chronic wound care book to review for the CWS and passed the first time with a good score. A few years ago, the CWS had only a 60% pass rate. I always wondered if physicians believed they could pass more easily (without adequate prep or focus) than a nurse with a BSN taking the same test or whether nurses focused on dressings, thinking this was a treatment-option exam. I believe the requirement for the CWS test is degree, 5-year experience, and three references; changes were being discussed recently, it may be different now.

     I do not know the pass rate on the CWOCN test. It would be interesting to see what the pass rate is for this credential as well. Anyone with a BSN meeting the criteria (education or CE and experience) can sign up to take a test; not everyone passes.

     I believe more hiring personnel understand what the CWOCN credentials bring and fewer are aware of what the CWS credentials bring. I personally believe the person, passion, and experience — not just the credentials — are what make the bigger difference in care.

     I also believe both are worthy tests, if very different. The WOCN is focused on areas of nursing (treatment options) with some limited cross-discipline reference (ie, arterial flow with ABI results or TPCO2, looking only at the result answer). The CWS seems to probe more into anatomy, ways to treat the arterial disease, other testing options (ie, arteriogram, vascular repair, mixed disease). I believe the AAWM – CWS – tested a strong science/theory base and the WOCN tested with a focus on clinical hands-on regarding the how and what to choose for treatment application.

     The WOCN refers to positive culture results and needing treatment. The CWS addresses what makes a positive result (ie, 105 before needing treatment with antibiotics).

     The WOCN refers to bx results and need for referral. The CWS ask best way to obtain the bx and how to treat bx results.

     The WOCN addresses knowing what to ask the physician for; the CWS requires you to think about the entire scope more like the physician.

     The WOCN tested with a focus on clinical hands on regarding the “how’s and what to choose for treatment application”. The AAWM – CWS tested a strong science/theory base.

     I was fortunate to work in a clinic paired one-on-one with a physician who helped me to develop this knowledge base and understanding. I used only the Ruth Bryant book to prepare for this test but I read it front to back.

Deanna Vargo, RN, BSN, CWS, FCCWS, DAPWCA, CWON, Barberton, OH ****

     The WCC test was not that hard to take, If you paid attention in class those 4 days and did the study guides they gave you, it wasn't that hard. I have really bad test anxiety and get myself really worked up when taking tests. I got 94 % on that test and my class was in Las Vegas where you can really play a lot and get off-track. I also liked that you took the test on the fifth day. I did not like the fact that there is no hands-on training. This course focus on all disciplines and how to treat the wound.

     I believe that the WOCN class prepares you more because of its intense class preparation. I had a more difficult time with these certification tests. I finished the program in March 2007 and had to wait until July–Sept to take the tests. I believe that when the information is fresh in your head, you do a better job. These programs should be able to schedule the tests when you finished the program. With this program, you also had clinical time with a preceptor and actual hands-on training. This program also focused on interdisciplinary treatment of the wounds.

     I believe I got quite a bit out of both courses, but I would say I got more out of the WOCN program.

Julie Schmitz BSN, RN, WCC, CWON ****

     When I think what each represents I can sum it up with: CWS = Validation CWOCN = Ability.

     I received my CWS first and found it encompassed the prior 10 years of my nursing career and more. The test is based on all aspects of the healthcare continuum, which left me to study what the other members of the team would consider for wound care, such as diagnostics, nutrition, the therapies and hospice/palliative nursing, to name a few. Passing this test validated I had the knowledge for wound care. I work in a rural, nurse-run (I am my own department) wound ostomy clinic and I need the total picture to refer to others as needed.

     The expert teaching from The Cleveland Clinic School of ET Nursing’s Barbara Hocevar and Paula Erwin Toth provided me the ability and confidence to put it all together. This course prepares a nurse to assess the whole picture, starting with anatomy and physiology of the body systems most frequently involved with wounds. Knowledge and clinical internship at Cleveland Clinic gave me the tools to be the best I can be.

Janet Cooper, RN BSN ET CWOCN CWS ***

     In August 2004, I attended the Skin and Wound Management Course presented by the National Alliance of Wound Care and the Wound Care Education Institute. After having successfully completed the course and passed the written exam, I was awarded the certification of Wound Care Certified (WCC).

     In March 2006 through May 2006, I attended the R. B. Turnbull, Jr. School of Enterostomal Therapy Nursing at the Cleveland Clinic Foundation. Once I successfully completed the schooling and passed the written exam, I was awarded the title of Wound Ostomy Continence Nurse (WOC Nurse). I passed the written exams presented by the Wound, Ostomy and Continence Nursing Certification board in March, 2007, and became a board-certified Certified Wound Ostomy Continence Nurse (CWOCN).

     The WCC class was 1-week long and consisted of four 8-hour days of lecture dealing with all aspects of wound management. The course was all-encompassing and included such areas as AHRQ guidelines, A&P, principles of wound healing, acute versus chronic wounds, product selection, nutritional management, and interdisciplinary wound care concepts (among many others), to name a few. The fifth day consisted of a 100-question test covering all of the previous four days of didactic instruction. I felt the instructors covered the material well, were knowledgeable about their subject, and prepared the students adequately for the examination. The passing rate at the time was in the high-90% range. I felt that the test was relatively easy, as the questions were based more on recall than on critical thinking. The class was open to anyone in the medical profession with previous experience of (I believe) at least 2 years in providing wound care in a clinical setting. The vast majority of my class consisted of nurses, both RNs and LPNs, with a Nurse Practitioner and a DME provider as well.

     Some pros to the WCC were the short class, the extensive material covered, the offer of post-graduation support, and the possibility of a separate 1-day debridement course and certification. Some cons were the lack of clinical experience offered, minimal hands-on, and a simplified final examination.

     The WOCN school consisted of 4 weeks of didactic instruction, divided equally into wounds, continence, ostomy, and professional practice. This was followed by 4 weeks of clinical rotation consisting of acute care; working with excellent WOC Nurse preceptors; outpatient settings, such as wound clinics; urodynamic testing; and ostomy clinics. These two settings provided at least 120 hours of clinical and 120 hours of lecture.

     The wound management portion consisted of a week of didactic instruction provided by WOC Nursing staff and the program leader, with supplemental lectures from vascular surgeons, podiatrists, and wound clinic WOC Nurses. The lecture portion thoroughly covered all aspects of wound care, from extensive A&P to alternative therapies. This part also provided hands-on activities such as performing ABIs, four-layer compression dressing application, and a debridement lab. The clinical portion primarily involved working with acute-care WOC Nurses, with optional outpatient wound clinics and home care visits with a WOC Nurse.

     The final written exam for the wound portion consisted of (I believe) 100 questions covering all aspects of wound care, including professional practice. The questions, on the average, were more difficult than the WCC questions, as they were based more on critical thinking. The wound portion of the CWOCN certification exam was thorough and covered most aspects of wound care. There is a large bank of test questions and which areas are covered on the exam depends on which questions one receives. The questions were a mixture of recall and critical thinking with an emphasis on applying advanced wound care knowledge in a clinical situation. Personally, I feel that the WOCN schooling provides a more rounded wound care education than the Wound Care Education Institute; furthermore, the addition of numerous clinical hours is of tremendous benefit to the student. This is the primary reason why I chose to devote 8 weeks of my life to WOCN school despite having completed the Wound Care Education Institute training. Having said that, I also feel the WCC offers a solid wound care education. The graduate would benefit greatly from the assistance of a good preceptor following the course after which he or she would function capably in the capacity of a “wound specialist.” Finally, I believe that a wound care provider can achieve all the certification titles available but still be a lousy clinician. Likewise, someone with a little less training can easily provide excellence in wound care with good patient outcomes. It is all about the individual clinician, not the title.

Dean Price RN, WCC, CWOCN ****

     Exploring or entering a new field is never easy. As clinicians, we usually enter a specific specialty one of two ways; clinical immersion or formal training. Most of us would prefer advanced training before entering a specially. In the specialty of wound care, we have several options for training. How do we determine what program is right for us?

     I chose to explore several options to ensure I was prepared to handle most scenarios. I had worked in wound care before exploring advanced training so I had a base-line knowledge of wound care products, wound etiologies, and typical treatment modalities.

     My first educational experience included participating in a 4-day course with an exam at the end. The class demographics were broad and consisted of LPNs, RNs, Advance Practice Nurses, and a Physician. The course content included an introduction to wound care, wound types, treatments, and the like.

     My second wound care educational experience was with a Wound, Ostomy, and Continence Nurse Education Program. This was a graduate level course with nurses who were baccalaureate-prepared and also advance practice nurses with graduate degrees. The education was set up in semesters and included professional practice modules as well. This course was rigorous and required papers, presentations, projects, and clinical practicum.

     The week-long course was basic information and was more focused on rote memorization for the exam on day 5. There was a lack of development of critical thinking about wound management. The course did not include different learning modalities or a preceptored experience. This course would best suite treatment nurses or anyone who may be involved with wound care but are not the primary decision makers. I have sent several colleagues and employees to this program and I have seen similar outcomes from each person. They have a basic understanding; however, they require significant mentorship and continuing education. The course was taught to prepare you for taking the certification exam on the last day.

     The graduate course in wound care provided a more in-depth educational experience in wound management. It covered most topics from theoretical aspects and research to psychomotor skills in practice. The graduates of this type of program are taught to develop wound programs and manage all aspects of wound management. This type of education of different than most wound care programs because the breath and depth of information that is covered. There a practicum experience that helps to apply most aspects of the didactic in the clinical setting. This course was very rigorous with multiple methods of evaluation prior to becoming eligible to take the board certification.

     In my experiences in wound care and wound education, there is a significant difference between the two types of education and certification. The week-long courses prepare clinicians with information to improve their practice in the area of wound care. It was not meant to prepare expert clinicians and scientists. The graduate program in wound care develops clinicians and prepares them to lead practice and research and to develop wound care initiatives.

     There is a program for everyone, no matter what your goals when exploring options for wound education. My recommendations as a clinician and someone who has experienced both programs is that if you are looking for a basic understanding and maybe you are a treatment nurse, work in sales, or you just want to increase your basic knowledge in the field of wounds, the 1-week course is a great starting point. If you are looking to eventually become an expert, implement evidence-based practice, or develop wound programs, a graduate program in wound care is the type of education you should pursue.

Kevin R. Emmons, MSN, RN, CWCN, WCC, Philadelphia, PA ****

     My career as a nurse started more than 23 years ago. After 6 years in long-term care and acute care I realized the specialty of wound care was for me. I have two certifications in the specialty of wound care: the CWCN (WOCN) and CWS (AAWM). As my skills and experience grew, I discovered options for specific education and certification in this specialty that wound give me a competitive edge for employment opportunities.

     Since I already possessed a bachelor’s of science degree (nursing), the WOCN program for education and certification was an option. In fact, at that time it was the only option. I chose the distance-learning version to better fit family and work obligations. The WOCN program provides a supportive structured learning process for the nurse with no prior wound care experience. After completing the theory component of the program, I was ready for the clinical experience and put the concepts to work. With the help of my supervisor (at that time) in selecting clinical sites, I was able to seek experiences outside of my local employment area.

     Traveling to the various clinical sites had its challenging moments: up early, long days, and unknown institutions. The payoff was a very wide set of experiences focusing on chronic wound care. Because my interest focused on wounds, I limited the experience (and theory portion) of the learning and certification process to wound care only — an unusual limitation: but it made sense to me.

     Upon completing the WOCN course requirements, I was eligible to sit for the certification exam (and passed!). I felt very well prepared through the rigorous course work, projects, and the test preparation materials available for review.

     Approximately 5 years later, I had my own outpatient wound care clinic up and running with six surgeons as part of the team. The Medical Director and two of the other surgeons had inquired about certification options for the physicians. The CWS (AAWM) option is available for nurses, physicians, physical therapists and other health professions who have work experience in the chronic wound care field and the appropriate educational background.

     We chose the exam date well in advance to allow for preparation. Once the applications were accepted, a study group schedule was developed. Each participant was responsible for a portion of the exam outline (per CWS examination manual) to be presented at the scheduled group meetings. The sections were chosen based on personal interest or pre-existing knowledge.

     This style of study and test preparation worked quite well. One of the surgeons focused on the cellular portion, one on the medical/surgical treatment options, and I presented details on topical wound product selection. By the date of the test, we each had a three-ring binder complete with an outline, study notes, and text references. Yes, we all passed!

     Frequently, I get calls from nurses in the local area asking about certification options. I review with them using my personal experiences. There are more options available today than in the 90s when I began my journey but I believe the choices I made stand far and above any other in communicating to the public and to other healthcare providers the quality of wound care offered in our clinic can be validated through our certifications. The rigor of the WOCN program for nurses set the stage to blend classroom and clinical practice. Program focus is on the nurses’ role in caring for the patient with the chronic wound. The AAWM’s program for certification takes the playing field to a higher level. The test preparation program is less structured than the WOCN program (there is no formal certification test preparation study program) and the scope of the information in the study outline required me as a nurse to think beyond the nursing focus and delve into ideas of medical management options and learn concepts from a multidisciplinary focus.

     Imagine the confidence inspired in the patients and primary care physicians when their community offers a wound care clinic with nurses and physicians certified in this specialty.

Catherine Rogers, APRN, BC, CWCN, CWS, FACCWS, SwedishAmerican Health System, Rockford, IL ***

     I am a Clinical Nurse Specialist in Adult Nursing and am currently directing a 32-bed hospital unit. I also facilitate the wound and skin nurse program that has just started.

     I initially completed the CWS exam after 2 years of full-time experience in a wound care center. Functioning as a midlevel practitioner (MS, ARNP), I wanted to take an exam that was also administered to physicians and other healthcare providers such as physical therapists.

     A few years later, my scope of practice increased to include ostomy patients. At that time, I decided to complete graduate nursing ostomy and continence courses and certify in wound, ostomy and continence nursing. The addition of ostomy and continence knowledge also helped when I cared for wounds as well. I have gained much from my association with the Wound, Ostomy and Continence Nursing group as educational and networking opportunities are available on-line.

     I found the two tests were similar. I feel that the background of the practitioner would influence which test would be most appropriate to take. I do not feel the test would produce a different practitioner but that the background of the practitioner could influence which test would be more appropriate to take. I think a midlevel practitioner should take the CWS exam and a nurse should take the CWCN exam. That is why I did both.

Dawn Julian, MS, ARNP, CWS, CWOCN, Director of Medical, Oncology and Pediatrics, Mercy Regional Health Center, Manhattan, KS ****

     For the past 20 years I have practiced nursing as a community health nurse working for home care agencies, both certified and licensed. I have worked with a diverse population of patients with a variety of disorders. As years passed, I began to see an increase in the aging population and increase in the number of chronic wounds. There was an increase in facility-acquired wound care patients, diabetes, vascular and arterial ulcers, and especially pressure ulcers. I learned through reading and local conferences how to better care for these patients, but it wasn’t enough for me. I looked into becoming certified in wound care, which would help me learn more and be able to share more with my colleagues.

     I learned that certification for wound care is available through three organizations.

     One was a class and certification that I could take and complete in 5 days. I registered for the Wound Care Education Institute (WCEI) class, which would certify me as a WCC after successful completion of the program and passing the exam. The certification was affiliated with the National Alliance of Wound Care (NAWC). I am a baccalaureate-prepared RN so this program seemed perfect.

     The classes were 8 hours a day for 4 days, followed by the certification exam on the fifth day. The class consisted of many levels of clinicians, some of whom wanted to learn more about wound care, others with several years of experience. The class work was detailed and very well organized. It focused on the basics of wound identification and management. It was presented to prepare the bedside caregiver to make an assessment and recommendations for treatment or further follow-up and depended on the prior experience of the provider. The instructors provided “must know” information for the exam. Following each day, they gave you a practice exam based on that day’s work to complete and return the following day. For me, with several years of wound care experience, I found the class to fill in the gaps and prepare me well for the exam. The exam questions were not all straightforward; sometimes there could have been more than one right answer and you needed to choose the best answer, like many other exams. There was minimal anatomy and physiology on the WCC exam. At the time that I took the class and certification, it was right for me.

     After practicing as a WCC for several years, I often felt that this certification was not accepted by those who held more advanced certifications by accredited organizations. I wanted additional opportunities to advance my skills and learned that the other two certifications were both accredited by National Commission for Certifying Agencies (NCCA) and required a BSN and many hours of hands on wound care and CE hours. I realized I met the requirements for both of these certifications.

     I have worked with many physicians, nurses, and PTs who hold the CWS certification and are highly regarded by their colleagues.

     The exam was self-prep. The AAWM website reported that the exam would be about 40% anatomy and physiology, understanding about wound formation and repair. This was the part I needed to better understand. I prepared for the exam by taking a 17-hour review class that helped me understand what to expect. I also read different textbooks to expand my knowledge in the anatomy and physiology of wound repair, and in wound care overall. In contrast to the WCC exam, this exam made you think about the occurrence of a wound, what happens within the body through all phases of wound repair, and how to assist the body through those phases. The CWS prepared one to be the primary decision-maker for assessment and treatment of wounds. I passed the exam and have experienced personal growth and earned respect as a wound care clinician.

     I was determined to complete the last certification and the most highly recognized by nursing — ie, the Certified Wound Care Nurse (CWCN). I qualified to sit for the experiential tract of the CWCN certification. I studied diligently using the 17-hour CWS course material in addition to reading from textbooks. The CWCN exam incorporated a large part of bedside care as well as addressing the pathophysiology processes in wound formation and healing, as well as physiological and psychosocial needs of the patients. I found if one could pass the CWS exam and was proficient at bedside wound care as a nurse, the CWCN preparation was just a review.

     I found the CWS exam to be the most difficult of the three.

     All of these certifications have enabled me to advance my knowledge and skill in wound management and gain respect from my colleagues. Although each of these certifications holds value in wound management, there are considerable differences in preparation for the certification exams.

     The WCC is a great place to start; the CWS and the CWCN build on the basic information and experience. Before taking the WCC, you need to know the basics. In anything you do, it’s important to know the basics — you must crawl before you walk. Again, the CWS exam was the most difficult of them all. The prep class was awesome. The CWS certified practitioners are definitely more prepared. All three all hold the “wound care specialist” or “certified practitioner” to a standard of care.

Sharon L. Cohen, RN, BSN, CWCN, CWS, WCC, Director of Wound Care Prevention & Management, Prime Care Medical Supplies, Inc. **** CWS

     This assessment of skills test was the most difficult test I've taken. It truly measures a candidate's interdisciplinary wound management knowledge.

     Preparation included attendance to the Scarborough, Weir, Patterson prep course, intimately understanding the principles of Wound Bed Preparation (TIME), understanding the biochemistry of wound healing in all phases of wound healing (acute and chronic wound healing model) and factors that affect wound healing outcomes, and 3 to 5 years in a clinical capacity fulfilling the role of wound care leader or manager (recommending or prescribing treatment plans for wounds). The books mentioned on the AAWM website were invaluable and I still refer to them quite often. After preparing and successfully passing the test, I truly understood wound management from a multidisciplinary standpoint, as well as wound etiologies, differential diagnosis, and appropriate screening and testing. Most importantly, I came away with a better understanding of other disciplines and what they bring to the 'wound management table'. This certification truly positions you to fill the role of Wound Team Coordinator. WCC      

Since I was a CWS, I was not required to take the week-long course. The testing required no preparation and I learned no additional information that enhanced my current clinical practice. This certification would be a good start for a beginner in wound management. CWCN

     After I receive my RN licensure, I’m really debating if I’ll take it because it’s so nursing-focused. I don’t want to end up in a wound care silo. This testing appears to be more focused on topical dressings and not so much the biomechanics of wound healing. On the other hand, having this certification does lower perceived competitive barriers within the wound care community.

Ellen L. Williams, RN, BS, CWS, FACCWS, WCC

This article was not subject to the Ostomy Wound Management peer-review process.