Common Challenges in Wound Care Nursing

Wound care nursing is rewarding and often intense. It offers nurses the chance to truly get to know their patients and specialize in one area of patient care. But it is not without its share of difficulties. These are some of the common challenges in wound care nursing.

Patient engagement

Healing difficult wounds is hard enough, but if we are unable to get our patients to “buy into” their role in healing, it is significantly more challenging. Patient education must be constantly reviewed and reinforced.

Even with constant reinforcement, there will be those patients who just won’t follow through — such as offloading and managing their blood sugar. For times such at this, a compliance contract may be written up, gone over with the patient, and signed by the patient and provider.

Recruitment and retention

We all know that healthcare workers are suffering from burnout and even leaving the profession altogether. Recruitment and retention of qualified, engaged employees is harder now than ever before. Employers are tasked with creating an appealing workplace. This can be accomplished in many ways. Some suggestions are:

• Staggered staff scheduling to allow staff to come in early, leave late, or have a standing day off during the week
• Making sure all employees are “pulling their weight” so other employees don’t feel overburdened
• Open and transparent communication from leadership
• Making expectations known
• Not micromanaging
• Scheduling patients in a way that ensures all staff receive adequate mealtime and breaks
• Making sure staff have available, working equipment

Unaddressed, ongoing staff frustrations is detrimental to retaining good staff members. Voiced concerns and frustrations should be addressed sooner rather than later.

Strategic scheduling

Office and clinical staff need to be able to work closely together to create an effective, flowing schedule. Staff responsible for scheduling patients should understand how patient acuity, type of equipment needed for a visit, length of time necessary for a specific treatment, and time allotted for new patient visits can alter the clinic flow.

It may also be helpful to limit nurse-only visits to the first and last appointment times on the schedule. This will keep the rooms and staff available for provider visits throughout the day. Strategic scheduling will improve clinic efficiency and increase patient and staff satisfaction. In turn, patient outcomes will improve, and qualified staff will be retained.

Supplies

Supply cost and availability is a frequent challenge in wound care nursing. When nurses realize a specific dressing isn’t available in the supply room, it creates frustration. Nurses then must spend time obtaining an order for an alternate dressing that may be less ideal.

During the height of COVID, this was an almost daily occurrence. Today, the situation has improved, but backorders are still common. The wound care team should be made aware of any supply challenges, backorders, and attempts at locating alternatives.

This is where a respectful working relationship with the materials management department is vital. Understand that they are facing constant challenges. Be kind and work together to find a solution.

In addition, it’s always a good idea to perform product cost comparisons at times. This could save the clinic a lot of money. There are very few dressings that are significantly unique to warrant paying exorbitant brand name prices. Most supplies are comparable from brand to brand.

Also, realize that you don’t have to purchase every new product introduced by a vendor. If the wound care team tried a new product and wants to start using it regularly, assess which product you currently have that this new product can replace. It’s simply not good business and unnecessary to stock your supply room with multiple, expensive products that perform similarly.

Improving outcomes

Does your team work hard every day and excel, but it seems that upper management and the C-suite are always looking to improve your data? Before you get upset, remember that they are business-minded people. They want their business to be a top choice for patients and referring providers. It’s their job to look for ways to make that happen.

There are always ways to improve outcomes. If you’re looking to improve healing times, examine if the team is doing consistent, adequate patient education.

Is the clinic ordering offloading equipment for pressure ulcers at the patient’s first visit or the fifth? How long are you letting stagnant wound measurements go before ordering vascular studies? Have you truly offloaded your diabetic foot wounds, or have you simply given them the speech about staying off their foot for the past four weeks?

There are many ways healing times can be improved. There are also simple ways to improve patient satisfaction scores. Be certain that the patient is allowed to speak and feel involved during the visit. Utilize strategic scheduling to reduce patient wait times and keep patients informed of delays within the clinic.

Complex decision making

Another common challenge in wound care nursing is feeling like you’re in primary care. Welcome to wound healing! There are many factors that go in to wound healing, and addressing comorbid conditions is required.

We cannot ignore the fact that our diabetic patient’s hemoglobin A1C is 11% or that our venous ulcer patient has an ejection fraction of 25%. Not being aware of our patient’s comorbid conditions can be dangerous. At best, it will result in stagnant wound healing.

Reaching out to our patient’s other providers is common and necessary. We may need to obtain notes from other providers for results of procedures performed elsewhere. We may need to refer out to vascular, cardiology, or to a diabetes educator. There are many variables we may run into daily. Maintaining open, kind, and professional communication is required to assist in providing the best care possible.

Learning from challenges in wound care nursing

The challenges in wound care nursing are like puzzle pieces that only fit together with critical thinking. Through all the challenges, if we stay focused on the goal and put our patients first in our decisions, we can end each shift knowing we made a difference.