My Career Chose Me

It’s choice — not chance — that determines your destiny. - Jean Nidetch (Weight Watchers® founder)

  Nursing is a vocation that reveals inner strength and courageousness that some men and women never knew they possessed. Wound/ostomy nursing in particular facilitates personal discovery and professional achievement. For Rosemary Kates, RN, MSN, CRNP, CWOCN, the nursing journey began in 1974 as a cardiovascular staff nurse specializing in critical care and cardiac rehab. After 15 years of working with postop open heart surgery patients, Rosemary wanted a change and eventually became a nurse educator at Our Lady of Lourdes Medical Center (OLLMC), Camden, NJ. One of her primary duties was to work with staff on patients’ skin issues and pressure ulcer prevention. Because Rosemary and the nursing staff lacked skin care knowledge, she paid close attention to WOCN consultant Nancy Tomaselli’s work. Nancy soon became Rosemary’s professional mentor, guiding and encouraging Rosemary on wound care issues.    Rosemary received her WOCN certification in 2003 through LaSalle University (Philadelphia, Pa) and continued to work in the nursing education department at OLLMC as an educator and wound care provider. Over time, her efforts evolved into a full-time position as a WOCN. Because the facility previously had no full-time WOCN, Rosemary could develop and customize the position. She provided oversight to staff on wound care education and placed major emphasis on pressure ulcer prevention and treatment because of the facility’s high nosocomial wound prevalence rate as well as Joint Commission and New Jersey State regulations. Standards of care were reviewed and updated; eventually, a skin care team comprised of nurses from the hospital’s clinical units was initiated. Team members were provided information on prevention, skin products, and standards of care. After an educational “kick off” day, the team met on a monthly basis for education updates, to review standards of care, and to evaluate products. Rosemary noticed that as a team the group was able to provide constant education on wound and ostomy care to staff at the bedside and in classroom settings. 

   Rosemary earned her Master’s degree in nursing from LaSalle in 2006. While attending the graduate program, she conducted research to compare the effectiveness of usual wound care treatment and prevention practices versus implementing an interdisciplinary skin care team in an acute care facility. The study led to the creation of an interdisciplinary team at OLLMC. After developing and implementing evidence-based prevention measures, prevalence of hospital-acquired pressure ulcers decreased from 12% to 4%. Rosemary credits the project’s success to the support and contributions of nursing administration. The presence of the CWOCN in this facility played a vital role in the heightened awareness of the entire multidisciplinary team regarding wound-related concerns, resulting in increased collaboration and standardization of the care provided to patients.

   After becoming a certified Nurse Practitioner in 2007, Rosemary was offered a position at Thomas Jefferson University’s (Philadelphia, Pa) wound/ostomy care department. Today, Rosemary provides patient consultations and runs an outpatient wound care clinic 2 days a week. She sees all types of wounds, including pressure ulcers and lower extremity, trauma, and surgical wounds. The outpatient clinic treats a large number of arterial and neuropathic wounds and venous ulcers that require compression.

   For Rosemary, the most fulfilling aspects of working as a Nurse Practitioner are the ability to be a participating member of an interdisciplinary dermal defense team, providing education to nursing and medical staff, and conducting prevalence studies. If you had asked Rosemary back in 1974 if she would have ever predicted her career would take this route, she would have answered, “No!” This career — this calling— definitely chose her. As she explains, “I fell into wound care.” Her career “choice” affords her the opportunity to speak at several regional and national conferences, create poster presentations, and network with fellow wound and ostomy professionals.

   Rosemary has observed that physicians are not provided with the level of education in wound care that WOCN nurses attain throughout their careers; there is a co-dependent relationship between physicians and nurses. At Jefferson, nursing students, med students, and interns shadow WOCN nurses to learn all they can about wound care. Rosemary admits she is very “hands on” — for her, total wound care consists of being able to consult at the bedside, perform clinical work, and teach in the classroom setting. In the future, Rosemary would like to do even more teaching and consulting work. Because wound care is such a vast and growing arena, Rosemary is open to increasing her expertise and continually expanding her scope of practice.