I first became aware of our Society's interest in continence care when WOC nurses were certified and practiced as Certified Enterostomal Therapy Nurses (CETN). At the time, CETN practice largely focused on ostomy care, but they were learning to cope with an increasing number of consultations for management of hospital-acquired wounds such as pressure injuries and acute-onset urinary and fecal incontinence in persons with an intact urinary system. Thanks in large part to the vision of Dr Debra Broadwell-Jackson (among a select group of other leaders such as Kristy Wright and Dorothy Doughty), enterostomal therapy practice evolved into full-scope WOC nursing and the CETN credential evolved into Certified Wound Ostomy and Continence Nurse. Debra's invitation to teach continence nursing at the WOCNEP at Emory University led to my ongoing love affair with WOC specialty practice nursing and the tremendous contributions you make to the care of patients with wound, ostomy, incontinence, and foot care needs of patients in all care settings.

My introduction to the role of continence care in full-scope WOC nursing came from a chance interaction with Kristy Wright, who was serving a legendary term as WOCN Society President. She and I were asked to testify before the Agency for Health Care Policy and Research around as they released practice guidelines for pressure injury prevention and management and urinary incontinence. Kristy's testimony addressed WOC nursing practice in the area of continence and pressure injury prevention and care, while I addressed continence care as President of the Society of Urologic Nurses and Associates. I was more than a bit surprised and deeply honored when Kristy asked me to participate in a Strategic Planning Session (SPS) for the newly renamed WOCN Society as part of a group of 3 nurses with extensive experience in the management of urinary or fecal incontinence. During the SPS, I was intrigued by the process used to address a variety of issues relevant to WOC clinical and professional practice. I was further intrigued by the openness of WOC nurses, by their desire to integrate continence into WOC practice, and their desire to partner with nurses practicing in a traditional continence role. To this day I remember Kristy asking the 3 continence nurses to explain our vision of continence care, our vision for WOC nurses as partners in continence care, and any related concerns. One colleague expressed concerns over WOC nurses encroaching on traditional nursing, but I concurred with another colleague that WOC nurses bring unique knowledge and expertise to continence management that is no less valuable than the behavioral and rehabilitative approach adapted by nurses practicing in a traditional continence adviser role. I also stated, and continued to state that WOC-centric continence care is more than "mopping and sopping," and remind you that the care you provide in this area touches substantially more lives than the select few patients seeking care from continence nurse advisers.

While the scope of nurse practice in the area of continence care has grown considerably over the intervening 30 plus years, my advocacy for a "WOC-centric" role for continence care, existing as a unique and essential role within a larger framework of continence nursing specialty practice, has not substantially altered. However, I also assert that confusion between these concepts has led to a dangerous erosion of full-scope WOC nurse certification and practice, and the persistence of a destructive myth of WOC-centric versus traditional continence care that has plagued our vision of ostomy or wound care to this day. I take partial responsibility for sowing the seeds of this confusion. When I was first asked to speak to WOC nurses at our annual meetings, I presented the traditional role for continence nursing I was exposed to-comprehensive assessment within the scope of practice of a nurse practitioner, complex evaluation including multichannel urodynamic and anorectal manometry testing, and care based on behavioral interventions, habit training, pelvic floor muscle training with computer-based biofeedback, neuromodulation, pharmacotherapy, and surgery. While I distinctively remember acknowledging the importance and value of WOC-centric continence care, I lacked the knowledge and evidence to clearly articulate the nature of such care, and its integration into full-scope WOC nurse practice. As Editor-in-Chief of the Journal of Wound, Ostomy and Continence Nursing, I saw the inevitable consequences of this lack of clarity in continence practice; "real" continence nursing increasingly focused on advanced practice techniques not immediately accessible to full-scope WOC nurses, complex urodynamic or anorectal manometry testing, biofeedback as a tool for teaching pelvic floor muscle exercises, pharmacodynamics, and adverse side effects of antimuscarinics and other drugs used to alter bladder and bowel function. At the same time we lost our focus on the critical concepts of WOC-centric continence practice, screening for presence of incontinence and underlying bowel of bladder dysfunction, absorption of urine or stool via body-worn absorbent products or products placed on a bed or seating surface, containment of urine or stool via growing variety of external collection devices, and (in selected cases) transient or long-term diversion of urine or stool via indwelling urinary or bowel devices.

I am happy to report that the Society's revised statement of the Role of the Wound, Ostomy and Continence Nurse in Continence Care in this issue of the Journal of Wound, Ostomy and Continence Nursing perfectly articulates WOC-centric continence practice, while preserving a collaborative place for traditional continence nurse specialty practice as a first-line or advanced practice nurse. Acting on your behalf, Chris Berke, Mary Jo Conley, Dr Dem Netsch, Lynette Franklin, Cindy Shephard, Eric Goodman, and Donna Thompson cogently define WOC-centric continence nursing that places containment, diversion, and absorption in their proper place as the most prevalent forms of continence management used by more than 90% of all incontinent patients worldwide.1 They also summarize essential resources and advances in research and care in the area of incontinence-associated dermatitis, microclimate and the relationships between moisture and pressure injury, the science of absorbent product selection, evaluation and use, and revolutionary advances in containment and diversion interventions at the heart of WOC-centric practice. At the same time, this landmark document acknowledges the evolving role of the continence nurse specialist, and the leading role the WOCN Society takes in supporting this role on a global basis. Tangent examples of our ongoing support for this role include publication of the International Continence Society's development and validation of the role of the Nurse Continence Specialist2 and the WOCNCB credentials Certified Continence Care Nurse (CCCN) and advanced practice continence nurse specialist CCCN-AP, the only certifying body to offer both levels in the world.

In preparation for release of this revolutionary statement, colleagues within the WOCN Society have been busy at work establishing the evidence base essential for WOC-centric continence nurse practice. This includes consensus conference and practice guidelines for prevention and management of incontinence-associated dermatitis, external collection devices, and body-worn absorbent products. Look for additional guidance regarding selection and use of body-worn absorbent products at the 2019 WOCNext in Nashville and additional insights into the role of intermittent catheterization by the end of 2019. As I have stated before, whenever you prevent a pressure injury, institute a structured skin care regimen for incontinence-associated dermatitis, or provide a well-fitted and effective absorbent product that effectively contains urine of stool while preserving personal dignity and privacy, "You Are a Continence Nurse" and I, along with your patient, are your biggest cheerleaders!

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