What a nurse practitioner can do at a wound visit
A nurse practitioner (NP) is an advanced practice registered nurse with graduate training and a license to assess, diagnose and treat within a defined scope of practice. A nurse practitioner is different from the registered nurse or licensed practical nurse who carries out a wound care plan.
At a home wound visit, a nurse practitioner can:
- Take the history and examine the wound, the limb and the skin around it
- Measure and document the wound so progress can be tracked
- Decide on the dressing type and the schedule for changes
- Perform bedside debridement when it is within scope and appropriate for the wound
- Order dressings, supplies, offloading devices, compression, labs and imaging
- Prescribe medications, including antibiotics, within their scope and any required collaborative arrangement
- Set the follow-up schedule and decide when a physician or podiatrist should be involved
In Missouri, nurse practitioners practice under a collaborative arrangement with a physician, and the visiting clinicians through Gateway work within that structure. Learn more on our page about nurse practitioner house calls in St. Louis.
How nursing supports the wound plan.
Home health and facility nurses carry out wound care under the treating clinician’s orders. That may include dressing changes, skin checks, teaching a caregiver and reporting changes in the wound.
Gateway works with those teams so updated orders and clinical notes reach the people providing day-to-day care. Changes in drainage, redness or pain should reach the treating clinician promptly.
If you already have a home health nurse
Many patients who call Gateway already have a home health agency. That is not a problem and it does not need to change. Home health nurses are skilled at carrying out a wound plan. What they usually cannot do is write the plan, order the supplies or change the treatment when the wound is not responding. That requires a treating clinician.
Gateway fills that gap without replacing the agency. The visiting nurse practitioner, podiatrist or physician assesses the wound and writes the orders. The home health nurse continues the dressing changes between visits, now with a current plan and a clinician to call. Gateway shares every update with the agency so the patient is not caught between two sets of instructions. See wound care for home health patients and our guide to home health versus mobile wound care.
Home health, private duty nursing and wound care visits compared
Families often use the words interchangeably, but these are three different services with different rules, and knowing which one you need saves weeks.
- Home health is skilled, intermittent care from a licensed agency under a physician's orders, usually covered by Medicare for a limited period when the patient is homebound. It includes nursing and therapy visits but not the treating clinician's assessment and orders.
- Private duty nursing is hourly or shift-based nursing or caregiving, usually paid privately or through long-term care insurance. It provides hands-on help and supervision but, again, not the clinician who directs the wound plan.
- Wound care visits through Gateway are visits by the treating clinician: a nurse practitioner, podiatrist or physician who examines the wound, sets the plan and writes the orders. Gateway is not a home health agency and does not provide hourly nursing. It works alongside both.
Our guides compare private duty nursing and home health and in-home nursing and house calls in more detail. If what you need is a home health agency, our page on home health in St. Louis explains how to find one and how Gateway works with them.
Dressing changes between visits and what caregivers can do
Most of a wound's healing happens between visits, which means the person changing the dressing at home matters as much as the clinician. Family caregivers can do more than they usually think, with the right instructions:
- Wash hands before and after, and set up a clean surface with everything laid out first
- Remove the old dressing gently, soaking it if it sticks, and note what the drainage looks like
- Clean the wound exactly as ordered, usually with saline or the solution the clinician specified, and nothing else
- Apply the new dressing as shown, without packing it tighter or using more than instructed
- Write down the date, what the wound looked like and anything that seemed different
- Call when something changes, rather than waiting for the next scheduled visit
Ask your treating clinician or home health nurse to show you how to change the dressing. If you are unsure about any step, ask for another demonstration before doing it on your own. Our guide to managing wound dressing changes at home covers supplies, technique and common mistakes.
To ask about wound care, contact Gateway. Our guides to wound care in St. Louis and mobile wound care explain the care options. For a medical emergency, call 911.
Common questions
Is Gateway a home health agency?
No. Gateway provides clinician-led wound care and primary care. We work alongside home health agencies and facility nursing teams; we do not provide hourly nursing or replace a home health agency.
Is a nurse practitioner the same as a doctor?
No. A nurse practitioner is an advanced practice registered nurse with graduate training and a license to assess, diagnose and treat within a defined scope. Some hold a DNP, which is a nursing doctorate. We never describe a nurse practitioner as a doctor or a physician. When a wound needs a physician or podiatrist, Gateway arranges that visit.
Can a nurse practitioner prescribe antibiotics for an infected wound?
In Missouri, nurse practitioners can prescribe medications, including antibiotics, within their scope of practice and collaborative arrangement. Whether a wound needs antibiotics is a clinical decision made at the visit.
Do I need a doctor's order for a nurse practitioner wound visit?
You do not need an order to call Gateway or to arrange a first visit. Some insurance plans require a physician's involvement for certain services, and we will tell you if yours does. See our guide on whether you need a referral for wound care.
Who schedules nursing visits?
Your home health agency or facility manages its nursing schedule. Gateway coordinates the wound treatment plan and follow-up with that team.
How often will someone come?
The treating clinician determines the wound follow-up schedule. Dressing changes between visits may be carried out by home health nurses, facility staff, a trained caregiver or the patient, following the clinician’s instructions.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.