Adding a Wound Care Nurse: Lippitt's Change Theory in Practice

Introduction: The Case for Specialized Wound Care

Wound care nurses play a special role in the hospital environment, and hospitals without these specialized nurses may not be able to offer the same level of care as those that employ them. Wound care nurses, sometimes referred to as wound, ostomy, and continence (WOC) nurses, specialize in wound management — the monitoring and treatment of wounds due to injury, disease, or medical treatments. Their work promotes the safe and rapid healing of a wide variety of wounds, from chronic bed sores or ulcers to abscesses, feeding tube sites, and recent surgical openings (Nursing Schools, 2012).

While it may seem as if any nurse should be qualified to perform these functions, it is critical to recognize that wound care is a specialized field. Their main objectives are to assess wounds, develop a treatment plan, clean wounds, and monitor for signs of infection. If wounds worsen, these nurses must be able to recognize symptoms that could require surgical debridement or surgical drains. Wound care nurses also work with patients and other caregivers to educate them on wound prevention (Nursing Schools, 2012).

While it may be possible for other types of nurses to provide comparable care, it is unlikely that they can consistently match the level of care that wound care specialists deliver. Best practices therefore suggest that a hospital with a high number of wound patients should employ a dedicated wound care nurse to manage these injuries and engage in patient education. Because the floor where I work sees a high volume of serious wound patients, the hospital would benefit significantly from the addition of a wound care nurse. This paper uses Lippitt's phases of change theory to describe how to tackle the challenges of securing a certified wound care nurse for this hospital floor.

Hospital and Floor Description

At this time, I work in a hospital with no dedicated wound care nurse. I work on the orthopedic and post-trauma floor as a staff nurse, and part of my duties include wound care. However, some of the wounds seen on that floor are very serious and require specialized knowledge to treat properly. While the nurses on the floor are adequate at caring for wounds, providing appropriate care for the most serious cases sometimes requires additional research time, which delays services for all patients — not simply those with the serious wounds.

I believe that the addition of a wound care nurse would provide significant benefits to the hospital. Most importantly, a dedicated wound care nurse would increase the quality of patient care, which is the most critical consideration when evaluating additions to a hospital's nursing staff. Beyond patient benefits, a dedicated wound care nurse would reduce staffing concerns for nurse managers, decrease the burden on floor shift nurses, and more properly align nursing duties with industry standards for job performance.

Stakeholders and Their Interests

Several stakeholders are involved in the implementation of any change in the hospital. The first group includes the hospital's board of directors, who must manage the hospital's budgetary concerns. The second group includes the nursing staff. The third group includes the patients. While it may appear that all three groups share the same interests, that is an oversimplification of the personal stakes in this scenario. All three groups share the same overarching goal — the provision of affordable, high-quality health care in a supportive environment — but each is driven by a distinct set of primary concerns.

The board of directors, for example, must not only budget for an additional staff member but also consider the legal consequences of hiring a wound care specialist. If a specialist is on staff but another nurse manages a patient's wound care and the outcome results in infection or other complications, does the existence of an unused specialist raise liability issues? Conversely, does the hospital's failure to employ a specialist in the first place create its own liability exposure? These are the questions the directors must weigh when evaluating this proposal.

The nursing staff might theoretically offer unanimous support for the addition of a wound care specialist, since it would free them for their other duties. However, a wound care specialist could also be perceived as undermining the apparent authority of the floor nurses. Research suggests that individuals often claim to access knowledge through formal channels such as journals while in reality consulting colleagues from their own and other professions. Like nurses, doctors also have vested interests in claiming to use research information as the basis for practice (Thompson et al., 2001). This indicates that patients may currently not be receiving state-of-the-art wound care, and the arrival of a specialist might reveal those gaps in service. Additionally, assuming a fixed nursing budget, the addition of a specialist who does not perform general floor duties would likely produce no significant reduction in workload for other nurses and could reduce the likelihood of raises.

Patients would generally have an interest in receiving the best-quality care, and the added cost of a wound care nurse, distributed across the floor's patient population, would not significantly increase any individual's financial burden. However, patients often grow attached to their floor nurses. It is worth considering whether a dedicated wound care nurse might undermine their confidence in their regular nurse, or whether patients would resist having a nurse specifically assigned to wound management. All of these questions reflect the genuine concerns of patient stakeholders.

Conclusion

My hospital currently has a clear need for a specialized wound care nurse on the floor where I serve as nurse manager. The floor sees a high volume of severe wounds that require specialized knowledge and attention. While floor nurses — like other professionals — understand the importance of research-based best practices, many rely on colleagues and other healthcare professionals for guidance when managing severe wounds. This approach risks compromising the level of patient care and places patients, the nursing staff, and the hospital at risk.

Hiring a dedicated wound care nurse would improve patient outcomes, reduce the burden on existing floor staff, and decrease the hospital's exposure to risk. Implementing such a change may initially face resistance from some stakeholders, but if managed carefully through structured change management, it has the potential to benefit all interested parties. Lippitt's phases of change theory provides a practical, agent-centered roadmap for making that implementation as smooth and effective as possible.

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