Why Don’t PTs Handle Wound Care?

I received minimal training in school, just enough to know I didn't ever want to treat patients with burns!  My first job, I was assigned to the burn team and within 6 months was the stand-in team leader until they could find a replacement.  I got on the job training from some amazing professionals and came to enjoy treating burns and wounds.  At that time, the hospital I worked in had the only burn units (pediatric and adult) in the state.  They were high level units so we routinely received patients flown in from three other states.  Even though those nurses were highly trained and specialized to the burn units, they still sent the patients down to PT for debridement and dressing changes.

Because I so enjoyed that field, I took numerous continuing education courses and looked for any opportunity to hone my skills.  Eventually I went to work at another hospital and in time an infection control teaching position open up.  My qualifications were a perfect fit.  I was the most qualified applicant to apply, but the job went to a nurse.  They weren't even requiring a masters level degree...they were just dead set on a nurse having that position.    

We moved to a different state and I went to work in a nursing home where PT did all of the wound care.

My point is, over the years I've had the opportunity to work in a lot of different facilities in a lot of different states and cities.  I've come to the conclusion that who does wound care is largely driven by the facility.  You have some facilities that are administrated by professionals who see the big picture.  They are able to think outside of the box to make a paradigm shift that is beneficial to patients and the professionals who serve them.  Other facilities are run by people who will die maintaining the status quo simply because that is always the way it has been done.  There are some facilities that fall in the middle.  Those may be the most stressful to work at because they have an ongoing internal struggle...where a forward thinking administrator seeks change but has resistance from staff ingrained in what has always been.  Likewise, you can have a progressive staff who gets saddled with a new administrator who lacks vision.  While these dynamics play into every area of patient care, they can be particularly visible in the treatment of wounds.

If you have the skill, the best course of action is to gently educate the staff...but then you are probably already doing that.  You can lead a horse to water, but you can't make him drink.  Sadly, sometimes the only option is to search out a facility that embraces your skill set and deisres to use it to the fullest.

I was very fortunate early in my career to spend 6 months performing wound care for an acute hospital in New York. The MD staff actually preferred the debridement and dressings that rehab did as opposed to the RN staff. Unfortunately even at that facility, once they closed the hydrotherapy unit, wound care went away and back to the RNs. Anecdotally, their rate of iatrogenic wound infection skyrocketed afterwards as well.

It is a shame to have skills that we cannot practice and that the public cannot benefit from.

It amazes me constantly that facilities allow this.  One facility tried an interdisciplinary approach and allowed PT to place e-stim then the nsg would dress the wound.  Most of the time the nurse would try to dress it within their shift change.  I never understood why PT didn't dress the wound as well.  Hours would go by before nsg realized they need to dress several wounds.   I blame the DOR's for allowing it to happen.

I agree.  During my shadowing for the program, I was given a "crash-course" introduction to wound care and it intrigued me.  Upon entering the program, I found out that we were not allowed to even learn wound care in our curriculum.  Disappointing.  Not to mention the fact that a majority of the time, nursing staffs give me the chills.