Transcript
Speaker: So, I mean, as ah as a nurse practitioner that, you know, went through the whole program, I'm really curious. What kind of education in wound care did you get?
Speaker: You know, I've been a nurse practitioner for eight years and I was thinking, when did I learn wound care? Yeah. What came to my mind, I believe it was one chapter in one class and maybe a few questions on the exam. Hello, everyone. Welcome to Healing by Design. the podcast where we amplify the voices that matter most in wound care. I'm Jen Bierup and I am here with my co-host Therese Laub.
Speaker: We are so glad you found us and we can't wait to dig into today's conversation. Before we jump in, I do wanna take just a quick moment to cover a few things. Everything we talk about on this podcast is meant to educate and inform. It's not medical advice and it shouldn't be taken as a diagnosis or treatment recommendations. Your situation is unique and your healthcare care provider is always your best resource for decisions about your care.
Speaker: The opinions our guests share are their own. They don't speak for POSIC or our sponsors. And if any of our guests have professional or financial ties to products or companies we discuss, we'll always be upfront about that. One more thing, if you're ever dealing with a wound care emergency, please don't look to us for that. Go to a provider right away. Now that we have all of the disclaimers out of the way, let's dive right into our show.
Speaker: for joining us. Our next guest has spent over a decade proving that clinical care and great operations are really the same thing done well. Alicia Bobak, a family nurse practitioner and wound care certified clinician, and right now she's senior vice president of operations for a multi-state physical medicine and rehab organization, wound care and palliative care teams across Illinois, Wisconsin, and Alabama, building the systems that let great care scale.
Speaker: And at the heart, she's a mentor, someone who's just as focused on growing the next generation of clinicians as she is on building what they'll work in. Please welcome to Healing by Design, Alicia Bobak.
Speaker: Thank you guys so much. I am incredibly honored to be a part of this podcast. And thank to be a mentor to CNAs, nurses, nurse practitioners, clinicians for the wound care space, because I look to you too as mentors and I would not be where I am today without mentorship. So I'm very excited to get into the nitty gritty of wound care education and why People may not be looking for it or know where to look for it and really guide them to help finding that and touch upon some issues that we see in MoonCare every day so we can help improve our education, which in turn helps the patient and patient outcomes.
Speaker: So thank you. Awesome. We're so excited to have you. So, you know, Therese and I actually spent a long time yesterday kind of talking about this topic because we could probably spend like an entire day Yes. On this topic. So we were, we were like, what is the goal? Like, what are we hoping to get? Like, what's the actual end goal of what we're hoping to get out of this talk today? And I think it's just, um and Therese, remind me, what was our goal that we wanted to get accomplished today that we, it was the overall like,
Speaker: Well, we're we're talking about education, right? and And how there's so much of it. And that we want to um empower the people that are listening to, um you know, take it upon themselves to look at what's out there, to understand how um education can help them advance and help them understand their patient load better. Right.
Speaker: That was, I mean, I think that was probably is is is kind of ah call to action for the people in the audience to really understand how how to look at the education that's out there and to really find the education that fits in with what they're doing, right? And how it can help them in their field of work and what they're doing with their patient care.
Speaker: I think the most frustrating thing that we see is, is is there too much wound care education out there is there? Is it like such a deluge that you don't know what you're supposed to pay attention to? Nothing's standardized for anywhere across the board.
Speaker: That's, I think, key. We need to speak to the mountaintops, to the key stakeholders about standardizing wound care education across all health core organizations, post-acute, acute.
Speaker: Yes. Yeah. And that falls into the standardization of wound care, right? Because education falls right into that. And I think that's one of the things we're lacking in this industry is that there's not a standardized way of doing it in all spaces.
Speaker: I mean, we have this conversation every day in in some way, shape or form with everybody we talk to, Alicia. But there's no, it's really difficult for us to hold people accountable and to hold them accountable to a certain level of education if there's really actually no real standard of care.
Speaker: Right. Like anybody and their brother can hang a I'm a wound care person out on their shingle. Right. And they've never actually spent time educating themselves.
Speaker: Or doing wound care. Actually doing it. Yeah. That's what the Or even seeing wounds. You know, they just have templates out there. Stage two. Here's the template.
Speaker: Without even looking at the wounds. Yeah. and i think with ai that makes it even more difficult because people can look things up and they think that they that they know because it's all laid out in this form that looks really pretty but it's like you know it's not it's not the experience behind it to recognize when things go wrong where that might lead I didn't even think about the templates. Oh, good. And I think AI, you know, AI is a great tool, but I don't think it's quite there yet as far as wound care, because like Teres said, you can put in give me an intervention for stage two pressure injury.
Speaker: And they're giving you a blanket template, right? Right. A blanket intervention. Right. But they're not asking the questions about the patient and their underlying disease processes. How is their home environment?
Speaker: Hopefully in the next couple of years, AI will prompt that those questions, right, to develop a proper intervention. But we're not there yet. We're not. Yeah. No. I mean, I think the problem with it is, is that we all know. and And one of the biggest things, Alicia, which is why we were so excited about having you on, is that you've been in personic. You've been like the boots on the ground, teaching the nurses and teaching the and NPs, especially during the heyday of the CTP situation. You were out there. You were seeing this.
Speaker: You were seeing this lack of education problem firsthand every single day. I still do, unfortunately, in the sniff space. Oh, yeah. yeah Yeah. what What do you think is the biggest problem in the sniff space when it comes to that?
Speaker: I think education on the wound care nurses time, right? They're just trying to get through all of the patients in one day because they have to document. Documentation's holding us down.
Speaker: But I do think that wound care often nurses and clinicians, well, just the wound nurse will handle it. The wound nurses got it, but they never put eyes on the wound, like the primary. I'm all for primary clinicians getting trained on wound cure.
Speaker: And I'll stand by that. That's where I found it as ah as a barrier in my knowledge when I was a new grad. I need to learn about wounds because that was the primary thing I was seeing in the home setting. That's what I was rounding in. But in the skilled nursing space, yes, you have your nurses doing assessments. They're there. There's someone always there to support, turn, et cetera.
Speaker: But if the clinicians or physicians are just putting in their notes, wound care team on consult, wound care following, well, that clinician is still liable. They are the ones giving the orders. yeah So they need to have at least a basic understanding of wounds.
Speaker: And that means like everybody. That's not just like one or two people. That's the team. that That's the whole team that's involved. yeah The whole team. You would be shocked. You know, me being having that wound care experience and me going to these skilled nursing facilities rounding, I see some of these reps on the legs and I just want to I just want to curl up in a ball.
Speaker: you know But I'm sure, you know, at what point am I overstepping going up to the wound nurse and saying, hey, hey. You know, did you do this? Did a nurse on night shift do this? ah How can we improve? Right. There's a very fine line. But as a clinician and ethically, like I have to say something because I am an expert in wound care, even though I'm not practicing, it still comes down to what's right for the patient.
Speaker: Yeah, absolutely.
Speaker: So now we have a patient that's in between and needs to make a decision about which direction, you know, they think they should go when they have no clue because they were never trained on wound care. Right. But, you know, you could see that that provider that may have said something that didn't understand maybe a part of what was going on. um and And that just puts like a wrench in the whole treatment, right? Because now we have to slow things down so everybody understands and now a big decision has to be made in which direction we go.
Speaker: Do you run into that? Have you seen that? Absolutely. You know, we always say interdisciplinary team or collaboration, but are we actually doing it? Do we have time to do it? yeah Do I have time to call the physician that ordered the wrong antibiotics based on the PCR? Yeah. That's going to be a 20 minute conversation with that physician. Do I really want to get yelled at today? Right. Sure. I'm advocating for the patient, right? So there's all of these factors that play into true collaboration.
Speaker: And we have to be confident in our skills and have the ability to call our colleagues and other specialties and really come up with a plan for the patient and the family and the caregiver.
Speaker: Versus, you know, I'm so busy, I'll call tomorrow. Or i hear this one all the time. They didn't answer. They're not calling me back. I tried calling them three days in a row. There's ways to get them. You better get their nurse manager, their nurse, their LPN, their assistant.
Speaker: you We have to be persistent in those cases. I think what's so frustrating though is that I felt so when I was doing consulting in home health and again, because let me, let's, let's, let's lay it all out here. Wound care is not a specialty.
Speaker: So the the one thing that I really noticed was um my husband has cancer and, and oncology is very specific, right? So when we went in and he had his, when he got his cancer staged and we went in and the oncologist pulled up a couple of these guidelines, right? And said, these are our options. And he said, sp and they were all these flow sheets.
Speaker: And he said, if I go off of these, it's considered malpractice. And i thought, oh my goodness. Wouldn't that be something that if we were able to say, you've been doing Dakin's for six months and the wound hasn't made any progress and you keep putting them on the wrong antibiotic and you haven't done vascular studies. And we keep asking that question.
Speaker: why is that not considered malpractice?
Speaker: and And where did the education piece go for that? Yeah, because there's no standard. but There's no standard for accountability. Yeah. Yeah. Yep. And then you get yelled at, right? Because they're like, well, I, i you know, I, this is what I'm doing. Right. And you're like.
Speaker: okay I think that's where the frustration is for most of us, right? In wound care. So, yeah but, you know, that goes back, we talked about this, Jen, too, about the education that is provided for nursing, for, you know, providers, for doctors, for NPs. I mean, just anybody in health care, really, um and how limited that is. So, I mean, as ah as a nurse practitioner that, you know, went through the whole program, I'm really curious, what kind of education in wound care did you get?
Speaker: You know, I've been a nurse practitioner for eight years and I was thinking, when did I learn wound care? Yeah. What came to my mind, I believe it was one chapter in one class and maybe a few questions on the exam. You know, they're so they're focused on pharmacology, right? Diagnoses. How do we get to the diagnosis? What are the interventions for the diagnoses?
Speaker: But wounds, you know, Stage one, two, three, four, unstageable, those are the main ones that they go over. Your venous leg ulcers, your diabetic foot ulcers, they may have touched on it, but they're not going into great detail. So my education was actually after i graduated.
Speaker: You know, I chose to go to a specific organization to get training by myself because I wanted to be, i wouldn't have more knowledge and be an expert in it. And I don't feel like I had sufficient
Speaker: education on wounds, at least at the time when I went to nurse practitioner school. Now it can be different, but I'm assuming, right? We don't want to assume, but I'm assuming it's not that way because we see brand new clinicians or nurses that cannot even stage a wound. And that's a little scary to me.
Speaker: We at least need to assess and stage, right? And then we go to our clinicians or experts to get the intervention. Let's do it that way for now until we get something standardized. But I think you're correct. I believe it during initial training, medical school, NP school, PA school, nursing school, there should be curriculum.
Speaker: A whole semester, in my opinion, right? On one class for a semester on wound care. And that's not just evaluating staging.
Speaker: It's interventions and education. How do we address it with the patient's family? How do we address it with other clinicians and physicians too? But also clinical rotations. I don't remember seeing any wounds during my clinical rotation. You know, I saw the procedures. So peg tube, you know, all of that, trach, suctioning. Those were the big ones we had on our checklist. But did we have a wound vac dressing change?
Speaker: wow I don't believe so. So even during that clinical rotation, adding some exposure to complex wounds and the procedures, if the wound care nurse is coming on at 8 p.m. and rounding, hopefully that faculty can say, hey, can my nursing students follow you for the day? Yeah. What great exposure is that?
Speaker: Yeah. Yeah, right. We actually had. So, I mean, i always I always sing the praises of my original wound care center that we opened, but we did have ah the nurses um the nurses in nursing school around.
Speaker: They would each come for a day. That's amazing. That's awesome. I think it was like their second, like their med-surg second rotation, and they would come to the clinic for a day. And you know what?
Speaker: Some of those nurses I am still friends with after like 13, 14 years because they literally fell in love with wounds when they were there with us. And they were like, this is my life's goal. and And they loved it because they loved the critical thinking behind it. They loved the fact that it had almost nothing to do with the dressings.
Speaker: It was everything else around it. and And, you know, Therese I were saying we were watch we're we're on this ah Facebook group. And it's always amazing to me that the first thing everybody asks is, well, what do I put on this?
Speaker: Yes. All the time. First question. All the time. Here's a picture. what do I do with this? And you're like, yeah, I think I'm part of that same group and I see it constantly as well. While they have uncontrolled diabetes, the blood sugars are in the 400s. And the frustrating thing is like everybody's giving advice on what they should put on the wound. And it's like, you don't even know how much it's draining.
Speaker: No questions. It's just all of a sudden, try this, try that. Yeah, it's like, oh, hey, I mean, you know, we're looking at this wound and when I ever lot i look at it, I'm like, oh, we have a pibley, we have rolled edges. How long has this been? you know what? I mean, obviously we have um some friction and shearing problems. where Where are we at with bio burden? Like what's going on with this patient? And they're like, you know, go ahead and use sylvadine. I'm like, wait, what? And I'm like, no, that's yeah that's terrible. I sound really, you know, very like, I don't know, like snobby, but...
Speaker: No, but that's what has to go into it. You have to know those things, right? Yeah, it's like, it's it's crazy. So, you know, so I think we've established that there is, I mean, I can tell you, I mean, I mean, it's been how many years since I've been in nursing, like nursing, nursing school. And I don't know about you, Alicia, but like the one thing we had was these sterile, wet to dry dressing that we had to do for our competencies, you know, and I laugh now because what wound is sterile?
Speaker: Right. and And if they're and listen, in nursing schools, if you're still doing that. Stop it. Yeah, please rethink that. yeah That is.
Speaker: Evaluate your curriculum and standards. That is not best practice. No, that is not. And and i'm i'm in so I'm in school right now. And um so we had a great opportunity. We had this this project. And they um asked us to make sure we included evidence-based ah evidencebased ah research on BID dressing changes.
Speaker: What? and And I said, I can't. Because that doesn't exist. And I would love to know where your previous students have been pulling the evidence yeah before me for a BID. Because maybe Dakin's for two weeks BID? Yeah.
Speaker: I don't know. I don't know. But I mean, so we fundamentally have a school problem across the board, but it's not pulmonology. It's not oncology. It's not cardiology. There is no wound science.
Speaker: Right. I think there is now. I think we see more of that coming out in the conferences that we're seeing the science behind, you know, what we're doing, what we're using, um which is very encouraging. But we haven't seen that bridge, at least I haven't yet, into the field, right, to what people are actually doing at the bedside or even the education that makes it understandable to somebody that's just starting in wound care.
Speaker: Yeah. And that goes to the, so we, Tres and I were talking about, there is so much education out there. I mean, there is webinars, there is free stuff. If you want it, it's there.
Speaker: And so the question is, is we were like, you know, we were, I was in the cereal aisle not that long ago and we were laughing about how many boxes of cheer, like how many kinds of Cheerios there are. There's like, I don't know, 700 kinds of it like, why do we have 700 kinds of Cheerios? And so the question I have for you you, Alicia, is do we have too much? Like, is it not specified? Like, does it, is it overwhelming? And and what stops clinicians at all levels from saying, i want to educate more you know myself? Is it only up to their ah employer to educate them? Or should we expect more? i don't know. I don't have an answer.
Speaker: I believe as a clinician, especially in the primary field, if you're a primary care provider, you should be an expert in wounds. And I think that's some self-guiding education.
Speaker: by With time, i mean, there's a time constraint, let's be honest, on CEUs. When can I listen to a podcast? When can I go to a class? I love to do in-person classes, but who can get off a whole day, you know, and take off PTO and be away from their family and not be home for multiple hours?
Speaker: It is so hard, especially if you're seeing as a nurse practitioner, 20, 30 patients a day that priority list of more education, that's the last on the list. yeah I'll be honest. because right um So time constraint, I think is a huge one, right? For seeking additional education. But I do think as clinicians, we are responsible for being the best we can.
Speaker: and that's learning. We are always learning and we have to, we have to keep learning. But to your point, wound care products and options and techniques are evolving so quickly that I don't even know all that's out there, to be honest. And the reps calling, you know, our products the best. Here's the evidence. Here's the white papers. But there's no one comparing these products to each other.
Speaker: What I would love as a new nurse or clinician, show me show me a graph. of different products, you know, by exudate level if you want, right?
Speaker: And show me the evidence. What is Premier? What is not? But a lot of our choices are based on what's covered. So insurance, we have to talk about it, right? yeah Especially in, at least in the home setting,
Speaker: We're getting the generic products. We can't get some of these amazing technologies for these patients. They're ridiculously expensive. In post-acute, it's a little different. In the skilled nursing facility hospital setting, you have what you have, and it's great because they typically have a bunch, and you just scan it to the patient's chart, right?
Speaker: Even though we're billing the patient for that, we can grab whatever we want. But I believe time constraint is number one. Number two, there's too many products out there and there's no evidence comparing each one of them. and number three is insurance.
Speaker: they're They're tying our hands here on what we can choose for our patients and how often we can utilize products. Right. Yeah, absolutely. i mean,
Speaker: Yeah, absolutely. It's interesting how so many times it comes back to the reimbursement piece. It really does. I mean, you get all excited about something and then you realize half your patients won't qualify for it. You know, and it's frustrating. And then what you What do you do? yeah That's the yeah only product that you believe will work for this wound.
Speaker: Mm-hmm. Now what do we right Who do we go to for guidance? You know, yeah who's calling us and telling us that the product is not covered? When do we have time to call orders? But I think case management, that is key, especially in wound care.
Speaker: There's a lot of things that get delayed or rushed off because the clinician or nurse has so many things to do that calling to make an appointment at the local wound care clinic or calling the home health to substitute, again, last on the list, unfortunately.
Speaker: Right. Or calling the payer and working with them directly and saying, we have this, we have that. Can we do a carve out? Can we do this? Can we do that? um You guys don't have time for that.
Speaker: No. You really don't. So wouldn't it be cool, you know, if you had somebody to help with that to allow the field staff to concentrate on the education they need that's pertinent to what they're actually doing at the bedside with that patient, right? you know, the dressings, understanding the assessments and what they need to do, you know, what are the the key things for Venus Legos, right? Instead of taking all of that time,
Speaker: to do what you just had, right? Because I think with the education, like you said, there's so much that's going on ancillary to what they're actually doing at the bedside, you know, that it's it's an overwhelming mode is what it is for a lot of these people out there.
Speaker: It is. And you have to know your local community too, right? You can have a case manager that's virtual. That's great, right? There's some help there, but they're not going to know the community and the resources for that community.
Speaker: So a local case manager, regional case manager, specifically for wound care, Would be a game changer. And healthcare organizations, we've they've done a good job at getting case managers or clinical directors or social workers, right?
Speaker: But it's a generalized role. It's not specific to healthcare. Well, you're singing my, you' you're strumming my song here, Alicia. You know that, right? Like, you know, you're, you're, you know, because that's been our passion for, I mean, since we first met each other a couple of years ago is, is, you know, I wanted, we were all excited about having you out there with the patient.
Speaker: Being the nurse practitioner and then handing it off to us to say, we'll deal with the insurance stuff. We'll deal with the, you know, if you're running into a roadblock, we got you. We just want you to be with your patient. We want you to educate. We want you to get on to your next patient. Like we will do all of those case management pieces underneath you. And yes, it's it's very true. I mean, you can have virtual case managers, but you're 100% correct. I'm a big advocate that every post-acute space needs to have case managers involved that are localized, that case manage their specific providers, um that know what's going on with that patient and know what's going on in the community. um And yes, does that mean that that that case manager, you know they can take care of a lot of patients if they have the right tools and the right technology. And they can, you know in many more, it's getting better and better with AI. But um yeah, you're absolutely right. it's and And even in the acute space, because what I'm seeing is is that the patients are being discharged from the hospital and that's a mess.
Speaker: Right. see it every day. Unfortunately, i you know, i I did a small stint in the skilled nursing space and I actually got out of it because I thought it wasn't where I thought it should be.
Speaker: I'm back in it now, but I'm, it's better. I'll say it's better, but we still the same issues across all healthcare organizations, right?
Speaker: Rule is a, is a prime example. They're at this sophisticated rehab. Nurses twenty four seven wound is improving.
Speaker: They live two hours away. They live with their spouse on a ranch. They're 90 years old. They're going to have home health and maybe one CNA. Wouldn't it be amazing if that wound care nurse educated that patient family so they were comfortable on what could happen with the wound when they're at home versus giving them maybe extra supplies and a printout and saying, if this happens, do this. If you get a fever, go to the hospital. Your home health nurse will be out there within 24 to 48 hours.
Speaker: Pushing it on the home health agency. And then does the home health agency have enough time to educate the family on the wound, right? So we see it. I see it. Unfortunately,
Speaker: Those wounds regress when they're back out in the community and they end up right back in that ER. r They do because there's no, and I'll tell you, you know, with the home health situation is that, you know what the problem is? It goes back to education. was just going to say that. Yeah.
Speaker: Those nurses in home health, unfortunately, and I'm going to be real blunt, they have not been trained. but go on it But they want it. Oh, I know. Yeah. They want training. They do. you and i I educate home health locally. and And they're like, thank you.
Speaker: Thank you so much. I can put this into my practice today. And it will benefit a patient and a family today. Yes. Turnover is another huge issue, I think, in health care, specifically in home health.
Speaker: A lot of agency, a lot of PRN, it's so difficult to provide education when you're not full time. Right. And it's when it's not consistent. I think a lot of agencies don't want to invest. but I've been told that before because they said, ah you know, these people come and go and I don't want to spend all this money if they're going to go take this education to another institution.
Speaker: But, you know, ah going back to what we started with, and it's very interesting, is that, and it's true because I've seen this, all these nurses want this and they're thankful for it. And they utilize it It's not just like they sit through it. They actually utilize what they're being taught.
Speaker: There's so much of it available. So much of it. And it's, a lot of it is free. you know, that they can do. So I think that goes back to what your initial question was, Jen, is like, why are, what's our point here, right? But why aren't the, why aren't people engaging with this free education? And I think that's one of the things that we talk to our audience is maybe think about that. You know, if you're in wound care, if you're in healthcare, care not just wound care, but you're taking care of patients, you
Speaker: You're taking care of patients with diagnoses that more than likely can end or have a wound, right? So it's important for everybody to understand how to prevent that, understanding that disease process where that patient may want end up with a wound.
Speaker: So it's that education that, you know, needs to really be utilized, right?
Speaker: But I think to your point, though, Therese, and I think to Alicia's point, is that they don't have time. So if the agencies, the facilities, if all of them said, you know what, we're going to actively train our nurses and wounds when they're onboarded, we're going to actively continue to train them regardless of if they might go, because it benefits us as an agency, it benefits us as a facility, and it stops us hemorrhaging cash on the back end because that's what happens with the wound care patients. So my question is, is I'm going to put this out there. I'm going to be very real. Facilities, home healths.
Speaker: Why are you not actively training your staff as a part of their actual employment? I'm going to be real blunt because your patients aren't doing well, just like Alicia said. They're not doing okay. And you're actually losing money.
Speaker: So, and we see it every single day, right? And and these patients go back to the hospital. and And the closer we get to value-based care, the more this is going to be super painful. And so I'm going to implore the employers right now out here to educate your staff, regardless of if they're PRN, regardless on if you think they might leave.
Speaker: Because it is the right thing to do. And your outcomes will benefit regardless. And I will say that in in our previous lifetime, we educated home health. And do you know, Alicia, that they had a 30% less turnover when the agency said, I'm going to invest in education for you?
Speaker: i believe that. Yep.
Speaker: Yeah, they have a ah tangible support, right, hu that a lot of them aren't getting. Yeah, yeah. I don't think we've ever met a nurse that says, hey, I love walking into a house and having nobody to talk to and having no idea what to do about this wound.
Speaker: Yeah. I don't even know what I'm looking at. yeah it's And I can't educate. Talk about time. You know, time is a huge constraint, but I think in the eyes, if you know, if I had to think of another reason as to why they're not doing that is where, where do they start? Where do they go? Like we said, there's so much information out there. Who's going to help guide them with that curriculum? Who's going to help guide them in that onboarding with the best practice? You know, there's so many things out there. can Google, you can AI, but they need a true wound care expert in the field to help guide them.
Speaker: And that's where that mentorship comes in, Torres. I was just talking about that. She's saying it. She's saying it. And it's like, but it's the right mentor because like what we don't want is somebody who really, you know, because I have said, and maybe you'll agree with me, Alicia, that wound care is like the biggest Dunning-Kruger effect. If you kind of know about wounds and you kind of know about dressings, you think you know everything.
Speaker: We've always done it this way. or that's Yeah, that's another All wounds need antibiotics. That one is... Oh, oh, that's not, oh, yeah, no, like everything, single yeah, no, and, or we need to change this daily, absolutely has to happen. yeah So, I mean, how do we get mentors out there like like you? How do we get mentors into these facilities, into all the post-acute spaces, and even the acute space? How do we do this? How do we, and make sure that those mentors know the standard of care?
Speaker: Yeah, that goes back to that Facebook group, right? Where everybody thinks they're a mentor and all this wrong information. and It's like, wait a minute. Yeah, but cast I would say to first start, you know, definitely if you're listening, you're local experts, right?
Speaker: You can go to organizations like A&P find different things, CEUs and such and things like that. But I think reaching out to a local reputable organization.
Speaker: wound care expert by asking around. Everyone knows everyone, right? In healthcare. care and So see who's rounding in the home setting, in the skilled space and go to them.
Speaker: They have experience in interventions and, you know, the bigger groups I would say is okay. There's smaller groups out there, smaller organizations that are trying to do wound care too. you know, individual nurse practitioners or PA, which is fine.
Speaker: But I would say those larger organizations that are rounding either in the home setting or facility or hospital setting, or even in the clinics to call your local wound care clinic. Hey, who's your doc?
Speaker: Who's your medical director? Research them. We have an amazing platform, LinkedIn. You find someone in two minutes, right? That is reputable. Look at their connections. Look at what they're involved in. That's where would start. That's That's true. I agree. Yeah.
Speaker: No, that's really – I will say this. So on ah on a side note, POSIC, because this is a POSIC podcast, so I will put a little shout out for POSIC and for Therese because they are putting together um a consulting situation that And what they do want to have is a ah basically a list of reputable mentors, reputable consultants.
Speaker: So you can get right on the POSIC website and say, oh, who can I call? Who's available? um and and I'm super excited about that because it falls right into what we're talking about today because we really just don't have a true north for that right now, I don't think.
Speaker: That's incredible. And once that's alive, we should scream it to the rooftops. Yep. Because that's such a great resource for all organizations, all organizations and home health, specifically home health. I know, the home health.
Speaker: It's the master guide, as I say. We're always looking for a master guide. Right. And yeah could as a resource, that could be our master guide. and And I love it. And there's some other things that POSIC is doing too, that they're really just trying to organize and have a central place to go for all these post-acute spaces to say, this is what we really have to do. And, you know, again, that's why I just love being a part of POSIC because of of the paradigm shifts that they're trying to accomplish. And we know it's like, you know, it's, it's, we're basically trying to turn a giant ship very slowly.
Speaker: here because of all the behavior that we have to change. But um i'm I'm really hopeful that the future will bring mentors, education.
Speaker: um and it has to. I mean, let's be fair, guys. Like, it has to change. yeah we We can't keep doing the status quo.
Speaker: We can't keep being like, hey, we're not going to educate our staff. We're not going to try to all adhere to the same standard of care. And, you know, and ah and and and that's including surgeons.
Speaker: That's including PCPs. We have to because we're failing. it's It's what? almost ah It could be up to $95 billion dollars yeah of a problem. usuallyly And outcomes worse than cancer.
Speaker: Scary. And we have a population, this huge population, that's been entering you know this whole realm. So we have to get it together.
Speaker: We really do. yeah and And the only way we're going to do that is if we start with good mentorship and we start with a true north education. And i again, it goes right back to it's got to be in the nursing schools.
Speaker: Nurse practitioners need a whole class. um it needs to be in basic nursing school. and and And that's where it has to begin, I think. Would you agree?
Speaker: i would agree. And I would even say in your CNA school. You know, I was 18 taking the CNA course that was offered through my high school. And that's basic, you know, looking at urine and being a Foley, et cetera.
Speaker: Why not? Looking at a wound. assisting the nurse in the dressing change. What is Coban? What is a Mepilex? Very basic knowledge, but I think they would grab onto it and then they have more exposure so that they're comfortable when they enter that role. And if you don't have exposure to wounds, how do you know that someone who's really great at that specialty, going to call a specialty, even though it's not,
Speaker: We don't even know they're out there. You know, if I wasn't exposed to wounds in my early days as a nurse at a hospital setting, i probably wouldn't have gone into wound care, to be honest.
Speaker: So the more exposure we have to entry level health care positions or CNAs, LPNs, RNs, NPs, the better we'll become.
Speaker: Mm hmm. I think, Jen, you said it. I mean, when you have a program that exposes new grads or people in school, it opens up a whole new area that they probably they never would have known.
Speaker: You know, we talked, I know, yesterday a little bit. So I'm an LPN, right? And I'm older. So going back way to the days when I started, all of the education back then really came from the reps. Because if you remember, they would have like tons of samples. They would just stock you up with samples and then they would spend time under helping you understand what the dressing did and how it worked. So it wasn't like the best, the best, but at least it was a hands on experience where you had somebody there that was a mentor for obviously the product, but at least you were getting an education of of this dressing and how it worked. And that's how I got started really in wound care because I remember going into a patient's home and they had ah and a calcium algae. Nobody told me what this was. And they had us cut it up into these little tiny pieces for all these little wounds. And it was almost like a puzzle. I was there for like an hour and a half just putting these calcium. I had no idea what it was. Right.
Speaker: So then I started learning and it's just like then you started seeing the result of what the products were doing. So then i took the deeper dive into what was behind that. Why was that working or why wasn't it working for somebody else? You know, there was that curiosity. And that's how I got my start back then, because I had almost like hands on in a mentorship, so to speak.
Speaker: that isn't there in that, in that way today, you know? So that's why I think mentorship and being, you know, having somebody to talk to, to ask questions, to give feedback, you know, that is, is so critical with the education piece. So I, I, I'm totally on board with the mentorship.
Speaker: Yeah, you're saying I mean, I had the same thing. I mean, I can give a, I'm going to give a shout out to a huge rep mentor and he is no longer with us. And his name was Ted Purdy. And I bet that if we have some listeners listening in, I bet you they will go, ah, Ted.
Speaker: ah He was original cystogenics way back in the day. um yeah ah Prisma, Promeran, all that kind of stuff. And I mean, i think half the world knew him, but what an amazing man he was and what an amazing mentor. And you could call him with any science question. And if he didn't know, he would find somebody for you.
Speaker: ah And like, and you could just always lean on Ted. And, um, and like I said, he's no longer with us. That's why I feel like I can do that. But, um, yeah, we don't necessarily have that, those types of reps or maybe we do Alicia. What do you think?
Speaker: You know, we do i do. I, in my experience, we do. um You know, being part of a larger wound care organization, we had reps locally, regionally, nationally, with some of the larger organizations out there. And they they collaborated with us.
Speaker: They invited us to free events. There was one with the cadaver lab, right? With the pristine surgeon and all of our nurse practitioners were able to attend for free. um So I think there is opportunity for wound care organizations to reach out to these reps because the reps want us to not only partner with them, but they provide education and they can be a mentor to us. So they're out there. It's just a matter of
Speaker: who, where, and then contacting them, right? Takes one phone call, one one message on LinkedIn, and you have a partner for life. Oh, yeah.
Speaker: Yeah, absolutely. That is very true. I mean, have some reps that have become personal friends of mine over the past 20 years. And even if they jump ship to a different company, they are still like, hey, Jen, you want to know about this? So, I mean, like these, because we're such a small little community in Wounds, but you're absolutely right. I mean, I mean, like, so what I'm hearing is, is we literally have millions of ways For us to try to find a mentor, for us to try to find education.
Speaker: But it seems to ultimately come down to desire, time, ability. And then the first um taking that first step, doing that outreach.
Speaker: Just take the first step. Do it. What's holding you back? Right. I mean, go randomly call your home health care agency and say, hey, can I come in for an hour and teach and teach your nurses? I mean, really, seriously, I do that.
Speaker: Yeah. Like, don't pay me anything because I really just want your nurses out there to take care of patients. Like, that's just where I'm at, you know, because they love it. They absolutely love it. And wouldn't it be an amazing thing Anyone in the wound care space, if they're not certified, that their employer would pay for their wound care certification.
Speaker: i was at a previous organization. They did do that. And it it is incredible. You have that for life. That knowledge is so tangible, not only to the patient, but to the outcomes.
Speaker: is Call to action to all employers out there. Yes. If you do wound care and your clinicians and nurses are not wound care certified, they should be. Please offer it to them. They want it.
Speaker: I have a feeling it'll be mandatory in the next, in the upcoming years, right? With the value-based model. But offer it to them. Give them the chance to learn and get certified and be experts in it. And I'll even take a step further.
Speaker: Primary care. Yes. Primary care docs and PAs, pas please take a course. But a wound care certification on top of that would be absolutely incredible. And you would be doing your patient population justice.
Speaker: Yes. That's true. Amen. And actually, we had it on our list. We were like, what do we, Alicia, what do you think about certification programs? You just answered our question. That was actually on our list. So like, I'm really happy and that we got into that because I completely and totally agree with you. I completely and totally ah agree with you. And again, I think we're looking at, you know, employers being so afraid to spend that money or you know i'm going to lose that, I'm going to lose that clinician. But I'm going to say this as a whole.
Speaker: We are loyal to employers that invest in us.
Speaker: And so I just, i'm I'm just going to put that little tidbit you know, out there. There's things that the legal department can put in contracts. Like, let's be honest, right? There's a lot of healthcare organizations out there that, you know, if we give you this, you have to stay with us one, two, three years, et cetera.
Speaker: Put that in your clause, you know, talk to your legal team. Why not? We'll offer you wound care certification, but you have to stay with us for one year. I'm sure there's ways around it. However, um we're giving something to them It's professional and respectful to stay at minimum for that return. Yeah, because that takes, I mean, you're wound care certified for life. I mean, at that point, as long as you keep it up. I mean, right you know. Right, right. yeah Yeah, right. Exactly. So, no. So, i'm I'm happy to say, I think you're in a I think you are aligned with Therese and I as we were, you know, thinking, gosh, wouldn't it be fantastic if, because at least we know in in the couple of of national certifications that we have, that training is uniform. Right.
Speaker: Yes. So that everybody would have the same base knowledge about wounds. um And we're excited about the professional, you know, case manager education as well that will be coming out, that everybody will be speaking the same language in that as well, which is different really from a wound care certification because now we're talking more regulations and payers and things like that. But um yes, it would be great if we were all speaking the same language wouldn't it and not just clinicians and nurses what about the other pieces of the puzzle dietitians your nutritionists social workers your therapists how many patients are on therapy that have wounds you know could you imagine a world where everyone has basic wound knowledge and we all we all talk the same language and
Speaker: You know, they can call us, hey, I was with your patient, Miss Smith, today. I see her wound is draining through the the dressing. You know, it's it's purulent.
Speaker: Can you imagine a physical therapist calling you and you getting that information, what it can do for that patient? Incredible. Or your CNA, even your CNA to say, hey, I don't know, I gave this, I gave so-and-so a shower and there was some really ah ah thick tan ah drainage coming from that dressing. and And I just wanted to make sure that you knew that, that that was important for you to know. Amazing.
Speaker: Think of the hospitalizations, right? That would be prevented. The ER visits. Yeah. I mean, it's like, how do we... see We have all of this, right? How do we go out there? how How do the three of us go out there and change the world? Because I feel like... I mean, I feel like we have an entire army behind us that agree with us, but... you know It's like, how do we how do we change it? It's a huge paradigm shift, but how do we change it? And I think one of the biggest things is is that wounds affect wounds are acute man chronic wounds are a cutaneous manifestation of a disease process. We have to think about it as an expression of a disease process more than just a whole. And when you start thinking about it like that, then you realize it touches everything.
Speaker: Everything. Hypertension, diabetes, obesity, autoimmune diseases. You have to address all of those things. So it becomes everybody's problem.
Speaker: Absolutely. Everybody's issue.
Speaker: I just, like, I ask myself, do endo, because I don't, because I don't know. Do endocrinologists get training on diabetic foot ulcers? Probably not. don't know. Do they send them to podiatry?
Speaker: Do they have a partner that collaborates them with them? You know, that standard of practice, you know, specifically for those specialties, endocrinology, diabetic foot ulcers, you got your vascular surgeons, they deal with BLUs all the time, but every specialty should be trained on a minimum what affects their specific disease process that they're educating their patients on every day.
Speaker: Absolutely. um I don't think they do. it makes sense I think they get if they get anything, it's super basic, but I don't think that they do, um based on my experience and actually talking to one here recently.
Speaker: I think it's very, very limited. um I've seen two where you know you send them to a specialist for something that's going on, and there's a wound involved, and the specialist will put it back to the nurse or to the home health agency or to the facility. Because they they think or they they want them to take care of that part. And and this is where the silos come in, right? Because we're not understanding the connection. And I think that goes the other way too, is you know the nurses in the facility or the home health agency aren't really understanding that connection. So it it really is tying it all together, not just with with bringing the teams together, but the education and the overlap of where all that happens. Right.
Speaker: Because I think that's the disconnect in a lot of situations. I think we could literally have about four more podcasts. We probably could. Just on this topic. And Alicia, we would love to keep keep going and keep talking. um i But I think that, so wait, so what is the next podcast? How to Break Down the Silos with with Better Education? Is that the next podcast that we're going to do together? Sounds like a good one. it sounds like I like it.
Speaker: Well, Alicia, we are so happy that you joined us today. And I know we kind of went in 50 billion directions, but that's the whole point of this conversation. And i hope that we put some some food for thought out there for our listeners. And maybe we were a little harsh, but you know, that's...
Speaker: That's okay. That's okay. It's okay to be direct and get to the point. You know, when I do presentations, I have a lot of nurses that come out, come after and say, Hey, thank you for just getting to the point and not beating her on the bush and putting in fluff.
Speaker: Right. Yep. it's It's time. We need we need to get to the root cause and really analyze it and fix it. And i think being direct is a good thing, specifically in wound care. And I just want to say thank you to you both, because you guys are pioneers in the wound care industry. And you guys are doing so many amazing, incredible things, not only for the current community,
Speaker: individuals who practice wound care, but for the future of wound care. So I want to say thank you guys. Thank you. Alicia, I'm going to cry. Thank you so much. I know we've always been kind of champions for each other over the past couple years. So to have that support from you for us, thank you.
Speaker: that That means a lot. thank you. Yes. Thank you. Thank you. All right, well, Alicia, I'm so happy that you joined us on Healing by Design. And I'm sure we will speak again soon. Everybody, I hope you enjoyed this conversation. If you have any questions, comments, or even pleas of impassioned outrage, please let us know. And we will see everybody later.
Speaker: And that's a wrap on today's episode. Thank you so much for spending time with us. These conversations are why we do this, and we don't take it lightly that you chose to listen to us today. Before we head out, just a reminder. Everything you heard today is meant to educate, not to replace the advice of your own health care provider. Please don't make medical decisions based on what you hear on this show. Your provider is the right person for that. Our guests share their own opinions and experiences, not the official positions of POSIC or anyone who supports this show.
Speaker: If you're dealing with a wound care emergency, please get to someone who can help you right away. And if today's episode was useful, subscribe and share it with someone in your corner of wound care.
Speaker: It helps us reach the people who need it the most.
