Advance Practice Nurses
Two Nurses Get High Marks From Wound Patients, Doctors
"The thing about wound healing is that it is absolutely a team sport," said surgeon Brian C. Smeal, M.D. "It's the surgeon and doctor, advance practice nurse, podiatrist, infection disease doctor, dietitian and others—they all play a role."
Top: Lori A. McKinney, APN-C, CWS; Bottom: Colleen Carter-Reilly, APN-C, CWS
Among the most appreciated wound healing "team players" are the two nurse practitioners—Lori A. McKinney and Colleen Carter-Reilly—who play both "home and away" roles for Our Lady of Lourdes Medical Center Surgical Associates [3MB PDF].
"They have grown to become a huge part of my practice," said surgeon Matthew J. Finnegan, M.D., who developed the surgical practice's program of "aggressive treatment" of non-healing wounds in all settings. "They use excellent clinical judgment and evaluate and treat patients with the utmost respect and compassion."
Surgeons often are best suited to manage wound care because of the frequent need to surgically remove dead tissue. But there is a small and diminishing number of surgeons in the wound care field, the surgeon explained.
"Those we call 'physician extenders'—especially nurse practitioners—are becoming more integrated into practices," Dr. Finnegan said.
Some patients may interpret the appearance of a nurse practitioner as a lesser level of care ("I'm seeing a nurse, I must not be a good patient.") but in fact the nurses are well-trained experts who allow the physician to extend his or her expertise to more patients, he explained.
The human touch is much on the minds of nurses Carter-Reilly and McKinney as they visit patients not just in the medical center but at Magee Rehabilitation Hospital, in out-patient offices and in a network of area nursing homes.
"In the nursing homes, patients, family members and staff are grateful that Colleen and I are able to provide this level of care at the facility so that the patient does not have to leave their familiar surroundings," said nurse McKinney.
Nurse Carter-Reilly said that approximately 60 percent of the wounds she and her associate see are related to pressure, 30 percent are from lower extremity wounds secondary to venous or arterial disease and 10 percent are trauma or surgery-related. Most nursing home wound cases began in a home or hospital.
She said there are only a handful of nurse practitioners in the region who are currently working in the field of wound care. In addition to being Advanced Practice Nurses, Carter-Reilly and McKinney both are board certified in wound management.
Dr. Finnegan noted that because the nurses can evaluate wounds and determine whether or not a patient requires surgery, he has more time to do the actual surgeries and his other duties. "They also assist by arranging for staff to provide advanced wound management and surgical management, pre- and post- operative," he said.
Dr. Finnegan likened the teamwork to working under a ship's captain (surgeon) and said he and the nurses review all cases together. "I am intimately involved in every decision they make. No one is put onto the O.R. schedule that I don't know about."
Nurse practitioners such as those at Lourdes "make a large surgical practice more efficient, more patient-friendly, and allow for more patient education," he said.
There are more than 100,000 nurse practitioners in the U.S. and the field is growing. Nurse practitioners are trained to order, perform and interpret diagnostic tests such as lab work and x-rays; can diagnose and treat acute and chronic conditions such as diabetes, high blood pressure, injections, wounds and injuries; and can prescribe medications and other treatments.
