Forging a communication bond with prescribers

By T. Michael Britton, RN, NHA, WCC, DWC

As wound care professionals, we’ve all experienced a time when we felt that our patient didn’t have the appropriate wound treatment orders. However, the physician, nurse practitioner, or other prescriber wouldn’t follow your recommendation. This situation is not only frustrating but can delay the healing process. This article explores why a prescriber might not follow your recommendation and offers solutions. It focuses on physicians, because I’ve had the most experience with them. (more…)

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What you need to know about xerosis in patients with diabetic feet

By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS

Each month, Apple Bites brings you a tool you can apply in your daily practice.


Xerosis, an abnormal dryness of the skin, is one of the most common skin conditions among patients with type 2 diabetes. While assessing for predictors of foot lesions in patients with diabetes, the authors of one study found that 82.1% of these patients had skin with dryness, cracks, or fissures. An unpublished survey of 105 consecutive patients with diabetes revealed that 75% had clinical manifestations of dry skin. (more…)

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How to set up an effective wound care formulary and guideline

wound care formulary and guideline

By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

Navigating through the thousands of wound care products can be overwhelming and confusing. I suspect that if you checked your supply rooms and treatment carts today, you would find stacks of unused products. You also would probably find that many products were past their expiration dates and that you have duplicate products in the same category, but with different brand names. Many clinicians order a product by brand name, not realizing that plenty of the product is already in stock under a different brand name. (more…)

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Imposter syndrome: when you feel like you’re faking it

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Colleen Jackson recently was promoted to a manager position on her unit. At first, she was thrilled with the opportunity to advance her leadership skills, but now she’s having second thoughts. She doesn’t feel confident in her new role and worries how her team views her. She confesses to her manager, “I keep thinking someone will figure out how much I really don’t know and question whether I should’ve been given the position. Sometimes I feel like an imposter. When I mention this to my friends, they tell me to ‘fake it until you make it.’ But I’m not so sure about that!”

Colleen isn’t alone in feeling like an imposter. In imposter syndrome, a person doesn’t feel good enough, is unsure of what she’s doing, and feels she can’t live up to others’ expectations. She may be afraid she’ll be found out as an imposter at any moment. The syndrome is most common among women leaders who feel they don’t deserve the success they’ve achieved despite external evidence of their competence. It’s more likely in perfectionists who constantly compare themselves to others.

Certain situations, such as taking on a new role, can lead to imposter syndrome. For instance, Colleen may think that because she was seen as qualified for her new role, others expect her to immediately have expert knowledge. If, like Colleen, you feel you don’t deserve the career success you’ve had, you may experience deep feelings of inauthenticity and fear you’ll be found out as a fake. (See Inside the imposter syndrome.)

In small doses, feelings of inadequacy may not be a bad thing, because they remind us to work on building our competency. But people with imposter syndrome feel a level of self-doubt that can lead to overwork and a paralyzing fear of failure. The fear of being unmasked causes incredible stress. Colleen and others like her may have unrealistic expectations of themselves in a new role—expectations that can compromise their success.

Overcoming imposter syndrome

For people with imposter syndrome, the response to their success may rest too heavily on others’ approval, recognition, and opinions. A wise mentor once told me we can easily overestimate how much time others spend thinking about us and our behaviors. Most people, she observed, are self-absorbed. This is important to consider, because the idea that Colleen is an imposter probably has never crossed her team members’ minds.

Imposter syndrome can create performance anxiety and lead to perfectionism, burnout, and depression. So learning how to manage these feelings is important. Cathy Robinson-Walker, MBA, MCC, who coaches nurse leaders, provides advice to help cope with imposter syndrome. Her recommendations include the six actions steps below.

Discuss your feelings with a trusted mentor.
Sharing your insecurities with someone you trust and respect can help you separate what’s real from your perceptions of insecurity. A trusted mentor might inform Colleen she’s making good progress as a beginning leader and that no one expects her to be an expert at this point. The mentor can provide guidance about specific areas where Colleen might need additional growth and how to best go about this.

Pay attention to your own self-talk and consider whether your thoughts are empowering or disabling.
Do you often say to yourself, “I achieved this only because I work harder than anyone else, not because I’m more competent”? Valerie Young, author of The Secret Thoughts of Successful Women: Why Capable People Suffer from the Impostor Syndrome and How to Thrive in Spite of It, makes a strong case that your internal script is a well-rehearsed pattern that serves as a key to feelings of being an imposter. She cautions that individuals with imposter syndrome may sabotage themselves as a way of holding back, due to feelings of being a fraud.

Instead, choose a different script and talk yourself down during times of self-doubt. Instead of thinking, “I’m the wrong person for this job,” retrain yourself to say, “I have a lot to offer in this position.”

Make of list your strengths.
Take the time to make a written list your strengths and what you contribute. Ask others for input, and refer to the list in times of self-doubt. If you’re in a new role, remember that you were chosen for a reason. In Colleen’s case, her supervisor saw her leadership potential. Also realize that most people overestimate their abilities; people with imposter syndrome underestimate theirs.

Accept that perfection is unrealistic and costly.
Trying to be perfect and feeling you need to “know it all” is unrealistic and can be costly on a personal level. Perfectionists typically believe anything short of a flawless performance all the time is unacceptable. But none of us can live a mistake-free life; we all make errors. Those with imposter syndrome hold themselves to impossibly high standards and feel shame, insecurity, and low self-esteem when they don’t meet their own expectations. But progress, not perfection, is what really matters.

Know you’ll need to develop your competencies at certain times in your career.
Throughout your career, you’ll go through periods when you’re on a steep learning curve and will need to further develop your competencies. You may feel like a novice and have to work hard to build new competencies.

Be honest about what you know and don’t know, and seek advice from experts on your unit or in your organization. The simple act of saying, “This is new for me, and I’m working hard to learn this role” can be empowering. Colleen, for instance, might be surprised at others’ reactions to hearing this from her. They might perceive her as a more authentic leader.

Be willing to be uncomfortable and move through your fear.
In Fear of Flying, author Erica Jong urges readers engaging in new experiences to feel the fear and do it anyway. Fear is a useful emotion, as long as it doesn’t escalate to the level of paralyzing behaviors. Practice and preparation can help ease new leaders’ fears. The fear of new challenges will never truly go away, but it can be managed.

Building competence leads to competency
People with imposter syndrome generally are intelligent, thoughtful, and capable but lack self-confidence. Over time, clinicians like Colleen will grow out of feeling like an imposter as they build their competency and become more comfortable in their roles. Eleanor Roosevelt said, “I believe that anyone can conquer fear by doing the things he fears to do, provided he keeps doing them until he gets a record of successful experience behind him.” If you feel like an imposter, this is good advice to ponder.

Selected references
Clance PR, Imes S. The imposter phenomenon in high achieving women: dynamics and therapeutic intervention. Psycho Theor, Res and Prac.1978;15(3):241-7.

Jong E. Fear of Flying. Austin, TX: Holt, Reinhart & Winston; 1973.

Robinson-Walker C. The imposter syndrome. Nurs Leader. 2011;9(4):12-13.

Sherman R.O. Imposter syndrome in nursing leadership. Emerging RN Leader: A Leadership Development Blog. May 7, 2012.
. Accessed February 26, 2013.

Young V. How to feel as bright and capable as everyone seems to think you are: a handbook for women (and men) who doubt their competence…but shouldn’t. 2004. http://
Accessed February 26, 2013.

Young V. The Secret Thoughts of Successful Women: Why Capable People Suffer from the Impostor Syndrome and How to Thrive in Spite of It. New York: Crown Business; 2011.

Rose O. Sherman is an associate professor of nursing and director of the Nursing Leadership Institute at the Christine E. Lynn College of Nursing at Florida Atlantic University in Boca Raton. You can read her blog at

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Wounds on the Web: Accessing the best online resources

By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

Knowledge is exploding online, making it essential that you’re comfortable using the Internet. You can also go online to save time and find a job, among other tasks. (See Online value.)

However, you also need to keep in mind that anyone can put information on the Internet. As the caption of a cartoon by Peter Steiner, published in The New Yorker says, “On the Internet, nobody knows you’re a dog.” (more…)

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Clinician Resources


Here are resources that can help you in your busy clinical practice by giving you information quickly. Don’t miss out!

Free educational and clinical resources on pressure ulcers

Access valuable educational and clinical resources from the National Pressure Ulcer Advisory Panel. Among the free resources are:
• poster of best practices for prevention of medical device–related pressure ulcers (available as a PDF)
• pressure-ulcer prevention points (available as a PDF)
registered nurse competency-based curriculum: pressure ulcer prevention.

Tutorials on diabetes foot care

Take an interactive tutorial on foot care for patients with diabetes. The module was published by the Patient Education Institute. You can also choose to watch in a self-playing mode and download a PDF text summary.

Quality assurance resources for long-term care

The resources in “Quality Assurance Performance Improvement (QAPI) Resources” are targeted toward those working in long-term care. The list includes links such as:
Advancing Excellence in America’s Nursing Homes National Campaign, which has resources and tools for nursing homes to improve in several different areas
Implementing Change in Long-Term Care, a detailed guide on how to engage nursing home staff in the change process
The Long-Term Care Improvement Guide, developed by Planetree in partnership with Picker Institute.

Prescription assistance programs

Do you have patients who need help paying for their prescriptions? “Understanding Prescription Assistance Programs,” from the National Council on Patient Information and Education, explains how these programs work and provides resources.

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From the Editor – Wound care superhero

by Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

What an honor it is to be the wound care “superhero”—the guru, the healer, the go-to person. Unfortunately, this honor may be accompanied by wound care overload—too much to do in too little time.

Once someone is crowned the superhero specialist, others may try to transfer every aspect of wound and skin care to that person—all treatment plans, assessments, documentation, prevention, education, and accountability. Superheroes don’t cry, so they don’t complain about the workload. Yet, the overload must be controlled. (more…)

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Understanding stoma complications

By Rosalyn S. Jordan, RN, BSN, MSc, CWOCN, WCC, OMS; and Judith LaDonna Burns, LPN, WCC, DFC

About 1 million people in the United States have either temporary or permanent stomas. A stoma is created surgically to divert fecal material or urine in patients with GI or urinary tract diseases or disorders.

A stoma has no sensory nerve endings and is insensitive to pain. Yet several complications can affect it, making accurate assessment crucial. These complications may occur during the immediate postoperative period, within 30 days after surgery, or later. Lifelong assessment by a healthcare provider with knowledge of ostomy surgeries and complications is important. (more…)

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Compression therapy for chronic venous insufficiency, lower-leg ulcers, and secondary lymphedema

By Nancy Chatham, RN, MSN, ANP-BC, CCNS, CWOCN, CWS, and Lori Thomas, MS, OTR/L, CLT-LANA

An estimated 7 million people in the United States have venous disease, which can cause leg edema and ulcers. Approximately 2 to 3 million Americans suffer from secondary lymphedema. Marked by abnormal accumulation of protein-rich fluid in the interstitium, secondary lymphedema eventually can cause fibrosis and other tissue and skin changes. (more…)

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What’s causing your patient’s lower-extremity redness?

patient lower extremity redness

By Robyn Bjork, MPT, CWS, WCC, CLT-LANA

The ability to understand or “read” lower-extremity redness in your patient is essential to determining its cause and providing effective treatment. Redness can occur in multiple conditions—hemosiderin staining, lipodermatosclerosis, venous dermatitis, chronic inflammation, cellulitis, and dependent rubor. This article provides clues to help you differentiate these conditions and identify the specific cause of your patient’s lower-extremity redness. (more…)

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