The certified wound, ostomy, and continence nurse (CWOCN) and the certified foot care nurse (CFCN) are valued members of the healthcare team. Current research indicates that CWOCNs and CFCNs improve patients' quality of life and wound, ostomy, and incontinence outcomes.1,2 They are outstanding educators, mentors, and leaders who assist their organizations in reducing cost and increasing efficiency.1–3 The multiscope credential is unique to our nursing specialty and certification in 1 or more specialties shows an extraordinary commitment to the holistic care of this patient population.4 Maintaining that certification is imperative.

Every 5 years, the Wound Ostomy and Continence Nursing Certification Board (WOCNCB) certified nurses must demonstrate ongoing competence in their specialties using one of 2 pathways: examination or the Professional Growth Program (PGP). If you choose to recertify by examination, keep in mind that the exams evaluate current entry-level knowledge of the specialty. Test takers should carefully review all content areas listed in the Exam Handbook, which is accessible on the WOCNCB Web site. Here you will also find a list of references, helpful study tools such as practice exams (Self-assessment Examinations), and flash cards, which are available for purchase.4 Completing practice questions, such as the ones included in this article, is a useful strategy for exam preparation.

In June 2023, the WOCNCB launched its revised PGP. The original PGP, developed 25 years ago, was outdated and overly complicated, with only 33% of credentialed nurses choosing this option to recertify. A Task Force, comprising current and past PGP committee members and chairpersons, portfolio reviewers, and 2 members-at-large, met virtually. Their goal was to simplify and streamline the PGP, without compromising the integrity of the process.

The basics of the revised PGP requirements (Box) are unchanged from the original; however, accruing points and recording them in portfolios have been streamlined and simplified. The revised PGP has 3 activities: Continuing Education (CE), Practice Hours, and “Teaching, Research, Writing, Volunteer Activities and Programs/Projects” on which to build portfolios. In comparison, the original PGP was made up of 9 activities. Continuing Education is still a required activity; however, those choosing to use professional practice CEs may only do so if the content of the CE meets the definition for professional practice, and the CEs are sponsored by the following organizations: Symposium on Advanced Wound Care (SAWC), Wound Healing Society (WHS), World Council of Enterostomal Therapists (WCET), National Pressure Injury Advisory Panel (NPIAP), Wound, Ostomy, and Continence Nurses Society (WOCN), Society of Urologic Nurses and Associates (SUNA), American Association of Nurse Practitioners (AANP), American Nurses Credentialing Center (ANCC), or Association for the Advancement of Wound Care (AAWC). Professional practice is defined as activities that do not directly/clinically relate to WOC or foot care (FC) nursing-specific activities, yet directly impact or enhance the role of the WOC or FC nurse.

BOX. PGP Portfolio Requirements

Each Specialty requires a Portfolio.

Each Portfolio must include 80 PGP points.

40 of the 80 points must relate to the Specialty.

10 PGP points must come from Continuing Education and relate to the Specialty.

Portfolios must be completed online.

Portfolios must be submitted at least 3 months prior to certification expiration date.

The new Practice Hours category is defined as “hours practiced within the role of a Wound, Ostomy, Continence or Foot Care nurse in ANY work setting (Acute Care, Long-Term Care, Home Care, Academia, Administrative, Industry, etc)” and allows one to claim anywhere from 5 points (250 practice hours PER SPECIALTY, per 5 years) to 40 points (2000 practice hours PER SPECIALTY, per 5 years). A CWOCN or CFCN working full-time (1.0 FTE [full-time equivalent]) will practice approximately 2000 hours per year or 10,000 hours over their 5-year certification period. Certified nurses will need to look at their practices and determine the number of hours worked within each specialty over the 5-year period and then claim the appropriate point value for this activity.

The third category, “Teaching, Research, Writing, Volunteer Activities and Programs/Projects,” encompasses the remaining activities found in the original PGP. Point values in this category range from 5 to 40 and are classified as “Specialty” or “Professional Practice” activities.

The start date for the revised PGP is January 1, 2024, and the end date for the original PGP is March 31, 2024. Candidates with PGP submission deadlines between September 1, 2023, and December 31, 2023, who want to use the revised PGP may request to have their credentials extended by submitting a written request to the WOCNCB. The credential extension form can be found on the Board's Web site.

Remember that you must submit your PGP portfolios 3 months prior to your certification expiring and may submit portfolios up to 1 year in advance. So, review your certification dates to help determine the best PGP option for you. The WOCNCB will launch additional resources to help you navigate the change. These include e-mail blasts, mailed postcards, updated PGP handbook, “Frequently Asked Questions,” WOCNext 2023 PGP presentations, podcasts, and a Special Edition PGP Office Hours. Check the WOCNCB Web site for more information.

Certification connotes a commitment to professional development and lifelong learning. Moreover, it shows a dedication to providing the best quality of care based on the most current evidence as defined within the WOC scope of practice. No matter which path you choose for recertification—examination or PGP—the WOCNCB is there to guide you along your journey.

Continence Care

1. A 67-year-old woman with hypertension, insomnia, vitamin D deficiency, obesity (body mass index of 42), and osteoarthritis presents to the outpatient continence clinic with a new chief complaint of intermittent, small-volume urinary incontinence over the last 2 weeks. Her medication list includes hydrochlorothiazide (HCTZ) 50 mg once daily for hypertension, lorazepam 1 mg at bedtime to help with anxiety/sleep, and vitamin D3 50 μg (2000 IU) daily. She is a smoker (1 pack per day for 20 years). She has 3 adult children (born via vaginal birth). She first noticed leakage of urine when she was moving furniture at home, but it has now been occurring when she laughs and sneezes. Which type of urinary incontinence is this patient experiencing and what is the first-line treatment recommended by the certified continence care nurse (CCCN)?

Neurogenic lower urinary tract dysfunction (NLUTD). Consult urology for further recommendations and a medical workup with urodynamic studies. Urge incontinence. Recommend follow-up with her primary care provider to reduce the dose of HCTZ, as thiazide diuretics often cause urinary incontinence. Stress incontinence. Provide patient education on diet, lifestyle, weight loss, reducing smoking, and pelvic floor exercises. Encourage the patient to keep a bladder diary and schedule follow-up in 3 weeks. Mixed incontinence. Contact the nurse practitioner to request a prescription for semaglutide (2.4 mg once weekly), as the patient has voiced difficulty with weight loss in the past and obesity is a contributing factor to mixed incontinence.

Outline location: 010201, 010202

Cognitive level: Analysis

ANSWER: C

Rationale: Stress incontinence is the most common type of urinary incontinence in females due to unique health issues including pregnancy and childbirth. Initial management strategies of incontinence should start with noninvasive and nonpharmacologic therapies such as education, lifestyle modification, weight loss, and smoking cessation. In obesity, the pelvic floor muscles support excess abdominal weight, as well as the pelvic organs, which can lead to stress incontinence. Smoking is a bladder irritant, and smokers may also develop a chronic cough, which can place pressure on pelvic muscles, causing them to weaken and increase the chances of developing stress urinary incontinence. Keeping a bladder diary is important as it may help identify the times and causative factors of stress urinary incontinence.¹

Neurogenic lower urinary tract dysfunction typically occurs in the setting of impaired sensory awareness and in the presence of underlying neurologic disease. This usually occurs in the setting of a spinal cord injury or multiple sclerosis.¹ A urology consult would not be warranted yet, as less aggressive attempts to mitigate the urinary incontinence have not been exhausted. Urodynamic studies are utilized in the diagnosis of NLUTD, but this is not consistent with the current patient presentation.¹

Urge incontinence occurs when there is a sudden need (urge) to urinate with typically large-volume urine loss. Urge incontinence is usually associated with pregnancy, menopause, pelvic trauma, or neurologic diseases.¹ Although HCTZ is a diuretic and may contribute to incontinence, it is also used to treat high blood pressure in this patient and it is not recommended to modify a medical plan in place by the primary care provider if it can be avoided. Instructing patients to take diuretics earlier in the day could be helpful in terms of lifestyle education and medication management to reduce trips to the bathroom later in the day and throughout the night.

Mixed incontinence is common in older adult females; however, prescription weight loss drugs should not be used as a first-line treatment. Education, lifestyle modification, and bladder diaries are all initial steps in managing urinary incontinence. Newer studies have shown effectiveness with using semaglutide for weight loss; however, this is not considered first-line therapy in managing obesity as it relates to urinary incontinence.²

Wound Care

2. Which of the following is located in the dermal layer of the skin?

Melanocytes Hair follicles Keratinocytes Stratum basale

Outline location: 010301

Cognitive level: Recall

ANSWER: B

Rationale: The dermis contains blood vessels, nerve endings, hair follicles, and glands.1 Melanocytes and keratinocytes are found in the epidermal layer of the skin. Stratum basale is the deepest layer of the epidermis.2

Foot Care

3. A 65-year-old woman with type 2 diabetes mellitus presents to the CFCN after discovering a thick callus on the medial aspect of her midfoot. On assessment, the FC nurse notices an erythematous, swollen protrusion in the midfoot. The CFCN recognizes these features as indicators of what foot condition?

Gout Bunionette Raynaud's disease Charcot arthropathy

Outline location: 010208

Cognitive level: Recall

ANSWER: D

The correct answer to this question is Charcot arthropathy, more commonly referred to as Charcot foot disease. Charcot arthropathy is caused by disruption of some of the foot and ankle joints and is sometimes misinterpreted as cellulitis due to the redness and swelling.1 In addition to redness and swelling, initial signs of Charcot arthropathy (or Charcot foot) may include pain and warmth to the touch. In this question, the most pertinent information is the history of diabetes and where the concerning area of the foot is located anatomically.

Charcot arthropathy relates to poor glucose control due to diabetes, and though Charcot arthropathy can affect bones or joints in the feet and ankles, the most common presentation is a protrusion in the midfoot.2 This is not true of the incorrect choices to this question. A Bunionette is a bulge of the fifth metatarsal joint, which is on the lateral foot, not medial as described in the question text. While gout is a well-known foot condition, it is more common in males and related to high levels of uric acid, typically affecting the great toe, ankles, and knees.2 Finally, Raynaud's disease is a foot condition related to blood flow in response to cold and stress but does not involve redness, swelling, or deformity.2

Ostomy Care

4. The WOC nurse is seeing a 55-year-old patient who is being treated with infliximab for moderate to severe Crohn disease. It is October and the patient is asking about an influenza vaccine. Which of the following is an appropriate statement to counsel the patient regarding an influenza vaccine?

You will need to hold your infliximab therapy before you have an influenza vaccine. Influenza vaccines should be avoided while taking infliximab. Live vaccines should not be given while taking infliximab. All types of influenza vaccines are safe while taking infliximab.

Outline location: 040301 and 040311

Cognitive level: Synthesis

ANSWER: C

Rationale: Infliximab is one of the current anti-TNF agents approved by the Food and Drug Administration for use in Crohn disease. It is classified as a recombinant humanized monoclonal anti-TNF-α antibody and is indicated for individuals with moderate to severe Crohn disease to induce and maintain remission.1,2 The primary mechanism of action for infliximab is to prevent synovial and intestinal inflammation by suppressing the immune system.2 As a result, patients who are treated with infliximab become more susceptible to infections, including influenza, and may experience complications. According to the Centers for Disease Control and Prevention (CDC), everyone 6 months and older should get an influenza vaccine every season, ideally during September or October, which is often the start of influenza season.3 It is recommended to bring patients up to date with all vaccinations prior to starting infliximab.2 However, this may not coincide with the timing of influenza season and an influenza vaccine may be administered while the patient is being treated with infliximab. There is no evidence to support holding treatment to administer the influenza vaccine, making answer option A incorrect. Answer option B is incorrect as the CDC recommends immunocompromised individuals should receive an age-appropriate inactivated or recombinant influenza vaccine, such as IIV4 or RIV4, for prevention of influenza.3 However, not all types of influenza vaccines are safe options for those taking infliximab, making answer option D incorrect. Live attenuated influenza vaccines, such as LAIV4, should not be given with infliximab.2,3