I am a Wound Ostomy and Continence (WOC) nurse-once known as an enterostomal nurse. I work for a home healthcare agency in South Jersey. The many responsibilities of this role include management of wounds and ostomies, and supply and formulary management. My day actually begins in the late afternoon the day before, when I set up visit times with patients. I try to plan a route that will be efficient. One of the downsides of working in home care is traveling 40 to 60 miles a day and spending 2 to 3 hours a day in the car!

Patients are referred to me by primary care physicians (PCPs), our agency nurses/case managers as well as area hospitals and rehabilitation facilities. Patients who should be referred to a WOC nurse include: every new ostomy patient, patients with daily wound care, wounds that show no improvement after 2 to 3 weeks, wound vacuum-assisted closure (VAC) patients as well as chronic Foley catheter patients with problems.

Today I began my visits in Camden, one of our impoverished but recovering communities. I made a visit to assess an older woman recently discharged with dementia and multiple superficial Stage 3 pressure injuries. The case manager made the referral because the current treatment was not effective due to incontinence. The patient's daughter is very conscientious and is doing her best with what she has. After initial assessment and discussion with the PCP, we discontinued the current dressings and ordered a thick barrier cream to be applied after each incontinent episode. Unfortunately, the patient was cachectic and daughter could not afford oral supplements so I instructed on high-protein foods she could purchase. The case manager had already consulted the social worker who is assisting with resources.

My next patient was a 19-year-old with severe Crohn disease, now dealing with an ileostomy, mucous fistula and an abdominal wound, who was eager to return to college life. I have been seeing him twice a week in an attempt to find a pouching system that is easier for him to manage. He made tremendous gains once he was placed in a smaller pouching system and a stoma cap for his mucous fistula. As I prepared him for discharge and instructed on ordering his monthly supplies, his main concern was how he will manage his ileostomy when he goes to the Philadelphia Eagles parade! We discussed what he will need to take with him, where he should go to watch the parade because he will need easy access to a bathroom, how he will keep hydrated, and what snacks to take and eat throughout day to keep stool thick.

Lunch is usually spent in my car in a parking lot of a convenience store. I check my email, text messages, voicemails, and Quick soft. I would prefer the old fashion phone call but, as my daughters tell me, I need to get with the program.

I traveled next to a patient with a Stage 4 pressure injury and met the patient's nurse/case manager to apply a wound VAC and instruct her on how to apply a new bridge dressing. The bridge dressing will be easier for the daughter as she will not have to worry about the tubing when she turns and positions her mother.

My last patient was a man recently diagnosed with lymphoma who was hospitalized for a bowel perforation requiring a high-output ileostomy. The ileostomy and pouching system was not so much of an issue because he had a great family support, but monitoring his fluid balance and preventing dehydration and rehospitalization have been the challenge. Much time is spent educating on signs and symptoms of dehydration, creating charts to monitor input and output, and instructing on diet and hydration. The most difficult aspect of my job is caring for the large volume of cancer patients with ostomies. Although many have great prognoses, others are at advanced stages and are dealing with so much.

At the end of the day, I go back to office and complete my documentation. Then I begin to prepare for the next day, and the journey continues...