Foot care training - page 6

by kernow

175,345 Views | 394 Comments

I have been interested in starting a foot care service for some time now and after reading posts from LoisJean feel this is something I can do. I would like to start out by receiving some kind of training but cannot find anyone... Read More


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    I strongly urge all of you with either an LPN or LVN license to ask your state boards about a certification process for your profession. I know the Canadians are looking into that right now, as most of their foot nurses are LPN's. They are incredibly organized with protocols, procedures and standards of care set up by their state boards ( or whatever their equivilent is!) . That is what has to happen in this country to give creedence to our field. It will also help protect you from litigious situations. We are pioneers and hold the responsibility of doing this the right way. And it is happening! I too have been a foot nurse for 10 years and a sole proprietor for 8 years and now have 2 LVN's and a few RN's waiting in the wings for when our possible government contract comes through or the need arises. But the podiatrist will likely make trouble so it is important to have all these legalities in place. It is an exciting time for us.

    Anyone check out the electric nail filing systems yet? I tell you it will change your practice for the better. They are awesome, safe and time saving.
    Last edit by sirI on Nov 14, '08
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    Thank you so much, Tutti! I agree with you...it was tough! And, for me at times, still is. With the addition of nurses working along side of me--all with the same goal in mind and with their individual and unique talents, I am now able to realize a greater goal...hopefully for the greater good for our clients and the communities we serve. But it's a hard road and it takes a lot of determined PUSH to part the waters of ignorance and arrogance on the part of some professionals.

    First, I salute you, as a fellow LPN, who provides this wonderful nursing service. The fact that you have maintained your position for 3 years is testimony to your skill and to the response of the people who receive your care. It is my experience that Public Opinion is worth everything.

    In my geographical area, people do not respond well to those who provide a service for the sake of the service only. As I have mentioned in other posts here, we provide a complete care. We provide, as a part of our service, (that means: AT NO EXTRA CHARGE), a full assessment of the feet and legs-with appropriate care and/or physician referral for ALL PROBLEMS FOUND; vital signs; heart and lung sounds; medication reviews; assistance with environmental needs by networking with community agencies that can fill those needs.

    We act as a liason between our client and their docs...if we find, during our foot care visit, that the client is, say, not tolerating a medication well, we will communicate that to their doc for them...because often the patient is hesitant to do that for themselves or are unable to.

    From medications- to monofiliment testing- to physician interaction -to advocating- to optimum well being--we do these things and more, AT NO EXTRA CHARGE. Many of our clients are elderly, disabled, financially compromised; many of them are well off and environmentally comfortable--but, all of them are at risk for serious complications due to their respective diseases/disorders. My business does not discriminate between the haves and have nots- everyone receives the same care at the same out of pocket fee for service.

    We instruct. We teach our patients about their feet; if they are able, we give them pointers on self care; if they are not able we instruct their caregivers. If they are unable to care for themselves and have no caregiver, we see to it the appropriate community agency provides one. We provide our clients with information on their medications...(another area of nursing care I am HOT on)-we teach them about their meds; we teach them simple, easy exercises they can do to increase circulation and muscle strength in the lower extremities. I could go on and on about what we do at NO EXTRA CHARGE in the span of a hour to a hour and a half home visit... and that is why my business is successful. The bottom line is the client. Period. And I put THEIR money where my mouth is.

    Tutti, in all these things there is no competition. Personally, I believe that competition is for children playing in the sand box...not for well seasoned, talented and caring nurses who wish to provide a nursing service to the community at large.

    And, yes, we do have foot care clinics set up in Senior Centers and Senior Apartment complexes...all of them successful. We are in Adult Foster Care Homes and we provide foot care in LTCs as private duty care at the request of the patient's family/guardian.

    This is where the Entrepreneural Nurse, who wishes to provide direct patient care, shines. This is where the art and science of nursing comes together to provide a service which not only fulfills the needs of the client but also fulfills the needs of ANY nurse who is sick and tired of being denied her/his right to practice beyond the limited and egocentric scope of an arrogant minded health care system...a health care system, which in this country, is so stuck on serving itself that it ignores those who pay it to care for them.

    Why on earth would I want to participate in a system which I personally abhor? Am I afraid that I will starve? Am I afraid that I will go bankrupt? Am I afraid that I won't get my worthy monetary dues? Do I really think that I could get to more people if I prostituted myself to a pimping government health care insurance system? Well, maybe. But at what cost to me? What would I have to give up in principle in order to participate in what others may see as practical? Fact is, I suspect that those who continue to play the Medicare game are ultimately doing so because they like the assurance of a 'regular paycheck'. Never mind what hoop they have to jump through--and never mind that the hoop gets smaller and smaller. And never mind that the one who gets squeezed out ultimately is the patient. Fact is, it costs a health care provider more to participate in Medicare than it does to simply 'agree to serve' for an 'agreed upon' out of pocket fee for service.

    I like simple contracts. I like the philosophy behind the, 'Gentleman's Agreement'. My business is based on that. I could care less about what a Podiatrist says; I could care less about what some other person who speaks like one in authority says about what I might or might not do. My little business will continue to succeed because Public Opinion has made it so.

    I am free to serve. I am free to set my fee for serving. I am free to design a plan of nurse delivered service. Now there are 4 heads designing plans of care not just mine...(not to mention a certain head that calls itself Hoolihan who has shared with me some great ideas, too), ...how exciting is that!? And now, not just my success, but the successes of other nurses who share in my passion.

    Foot care is the Primary focus of my business...affordable foot care nursing services available to EVERYONE, ANYWHERE who is at risk. I would not be able to claim any success at all if my clients were not successful, too...those people who still maintain independence on two feet because the circumstance which would have resulted in the inevitable amputation was caught early and treated. They are the real success stories.

    I have received support, encouragement and WORKABLE suggestions and business solutions from nurses on this Board Forum since the first day I joined in. Entrepreneural Nurses understand each other in a way that is uniquely different and heartwarming. We have a wealth of experience that goes far beyond the norm. We can help each other in ways no other entity can.

    I, and the nurses working with me need to hear from everyone who provides this type of service. We need your input, your experience and your insights. We need to know how you got started, what procedures you use, your protocols for assessments. Everything.

    Peace,
    Lois Jean
    Kookie2412 and sallyspring like this.
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    Lois Jean, Wow! I am speechless! You are amazing. You do so much. You are right. These folks need more than just a "pedicure", I hate it when people refer to what I do as a pedicure. I always correct them. It's Nurse Foot Care. We are nurses, and part of being a nurse is to do Patient teaching. And it feels so good when we are able to help someone because of what we have taught them. Or helped them through our assessment, and caught something no one else has. Thank you so very much for writing. I love doing what I do, and don't want to stop now. I have the drive again this morning because of you. Today is the day I meet with our marketing manager. We'll see where this road shall take me. Thanks again for your input.

    I took foot care training in Ontario Canada. They are way ahead of us when it comes to Nurses practicing foot care. By going to that one weekend seminar, you have done all that you are supposed to do to be able to practice foot care here as a nurse. LPN or RN. The only person I like to hear speak at the conference is guess who? The Nurse. And she is good. And she has been doing foot care for a long time. I will do what I can to help the LPN's on board to continue to practice foot care, and yes, we need a real certification course for this field. I intend to do what I can to help get the process going. I haven't checked out the electric nail files yet, but I will.

    ~Tutti~
    Last edit by sirI on Nov 14, '08 : Reason: referred to deleted/edited post
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    tutti

    can you give me a fax number or email address and i can fax or email you my makeshift consent?

    I found out something I did not know today from the consultant at the state board of RN for California. They told me that an LVNLPN can not have an independant practice in this state. So they can not own their own businesses providing nursing services. How strange. I wonder why it is different in other states.????

    How is it that in other states LPN's can own their own businesses? Maybe you know- LOISJEAN, because I am assuming you own your own business.

    I also found out that if I am to incorporate my business, it has to be a PROFESSIONAL CORPORATION and the words Registered Nurse or Nursing have to be in the title of my companies name. How strange is that. We were going to form an LLC.

    I also got some information about becoming accredited through the American Accrediation organization that accredites out patient facilities. It is the
    AAAHC. It sounds like a tremendous amount of work involved and expense. Has anyone looked into that? That process would certainly make sure that you had your ducks in order. I am not sure I want to go that route yet.
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    Thanks, I would love a copy.


    I believe the laws are different from state to state on this issue. My state is only just starting to implement laws/regulations for nurses to do foot care. They have not yet specified who can do what. They have only said we need to take so many lecture hours and (clinical) hahaha...to follow a podiatrist around for so many hours. And that one seattle seminar covers it for the lecture part. Not that I am relying on that. I have went up to Ontario for training in Canada, and I've worked with three different podiatrists (not by choice). And I'm still looking for more training. Luckily, I do work for a company right now and I'm not out there on my own, but there are those out there, and some do not even have the training. I wouldn't touch another person if I didn't think I knew what i was doing. I am about to write a letter to the state board of nursing here...
    Take care!

    ~Tutti~

    tutti

    can you pm me a fax number or email address and i can fax or email you my makeshift consent?

    I found out something I did not know today from the consultant at the state board of RN for California. They told me that an LVNLPN can not have an independant practice in this state. So they can not own their own businesses providing nursing services. How strange. I wonder why it is different in other states.????

    How is it that in other states LPN's can own their own businesses? Maybe you know- LOISJEAN, because I am assuming you own your own business.

    I also found out that if I am to incorporate my business, it has to be a PROFESSIONAL CORPORATION and the words Registered Nurse or Nursing have to be in the title of my companies name. How strange is that. We were going to form an LLC.

    I also got some information about becoming accredited through the American Accrediation organization that accredites out patient facilities. It is the
    AAAHC. It sounds like a tremendous amount of work involved and expense. Has anyone looked into that? That process would certainly make sure that you had your ducks in order. I am not sure I want to go that route yet.
    Last edit by sirI on Nov 14, '08 : Reason: removed personal contact information
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    I was just browsing through our California Nurse Practice Act ( a very interesting document!) and found out that there is such thing as "implied" consent. In other words, if a client voluntarily comes to your asking for foot care, takes off his or her shoe and places their feet in front of you, it is implied consent and a written cosent is not necessary. So guys and gals, take out your Nurse Practice Act and look in the index for consents and you probably will find similar wording. The only people who need written consent are people like minors or mentally impaired. So there you are! I will now take the consent forms out of my charts. One less piece of paper to deal with.
    :hatparty:
  7. 0
    tutti

    can you pm me a fax number or email address and i can fax or email you my makeshift consent?

    I found out something I did not know today from the consultant at the state board of RN for California. They told me that an LVNLPN can not have an independant practice in this state. So they can not own their own businesses providing nursing services. How strange. I wonder why it is different in other states.????


    How is it that in other states LPN's can own their own businesses? Maybe you know- LOISJEAN, because I am assuming you own your own business.

    I also found out that if I am to incorporate my business, it has to be a PROFESSIONAL CORPORATION and the words Registered Nurse or Nursing have to be in the title of my companies name. How strange is that. We were going to form an LLC.

    I also got some information about becoming accredited through the American Accrediation organization that accredites out patient facilities. It is the
    AAAHC. It sounds like a tremendous amount of work involved and expense. Has anyone looked into that? That process would certainly make sure that you had your ducks in order. I am not sure I want to go that route yet.
    No assumption there...I have owned and operated my business for ten years. I am known in my community as a business woman, as a nurse and as a provider of foot care--all in the same package. My business name is KNOWN on the local, state and federal level; I take my losses and my gains and continue to expand in a way I feel appropriate and correct for the type of business I own.

    Plans are in the works for a new business structure that will pull together the talents and skills of myself, another LPN and two BSNs. This structure will incorporate the four of us as a functioning business unit with all the bells and whistles. This is going to happen because it has been a long term goal for my business, for my clients and for the communities I have served all these years. I realize that I have reached the maximum of my ability to work solo; the time has come for my business to grow stronger; there are many more goals to reach. Because of the addition of these three most excellent nurses, I can now live with some peace in my heart that a full service of affordable care will be developed and delivered to those people AT RISK who need it the most...POOR, ELDERLY and DISABLED.

    I have two passions: the work I do and the right of ALL nurses (do I have to specify who is included in 'ALL'?) to practice their profession and specialties as free agents. I am committed to pursue every avenue possible to insure the Independent status of myself and the nurses who work with me, and to continue to develop a plan and protocol of care which provides optimum care for every one of our clients. To that end, I continue in….

    Peace,
    LoisJean
    Last edit by sirI on Nov 14, '08 : Reason: quoted/referred to deleted post
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    After a year of meetings and planning, I have decided not to incorporate with the non-nursing business partner and his wife I have been meeting with. I think it is great, Lois, that you have found nurses who you can share the journey with and I wish you all good things. I have not regrets, and because of all these business meetings, I now have good liability coverage and a great office with all the "bells & whistles". I would have done none of that if not for the thought of this partnership. I have found I can afford all of this on my own and now have my independence back. I have to pay them back some expenditures, but better now than after forming any legal bindings.

    My husband and I will incorporate out business, so it will be 100 % ours. I was finding that I really did not like the "business" mentality that does not take into consideration any emotional factors. I am relieved to have my autonomy back. Tomorrow I meet with a lawyer from the SBA regarding incoporating. I am also going to see about getting a microloan to get some products into my office.

    I have been selected to be on the Exam Committee for Foot & Nail Nursing Certification process and will go to Kansas City next month to meet with the 4 other nurses who are also on it. I am so thrilled. So things are progressing.

    I did a homeless shelter clinic the other night and plan to get more involved in that arena when time permits. Did you know that one of the most helpful things you can do for those with, what I call "mush foot" ( very wet feet from walking in wet shoes and socks for long periods of time) is to soak them in tanic acid (tea water). The tanic acid helps the feet expel moisture after the soaking. So that is your tip for the day!

    So, my fellow foot soldiers, keep on keeping on.
    Last edit by sirI on Nov 14, '08
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    You have made my day! Thank you for responding to my post.

    I am excited about the changes that have taken place over the years with my business. And, I am excited for you and the changes you are planning. I knew that no matter what kind of business structure I maintained, I would be doing foot care..and since my focus has never been on 'the money', my concerns were not great when thinking about 'what to do' as far as expanding. My concerns came when I became aware that the demand for this nursing service was growing and I might have to stop taking new referrals. That thought bothered me greatly. All I can say is that when the time was right the right nurses came along side and filled in the gap, so to speak. I call these happenings, 'serendipities'.

    I, too, have provided foot care in inner cities. Missions and soup kitchens have been supportive. I am hoping that with the additional nurses on board now, I can get back to doing more foot care in those areas where it is so badly needed.

    Nothing would please us more than being able to participate in the certification process which you mention. How would this be possible for us? If you could give me more information on this, I and the nurses who work along side of me, would be very grateful.

    Olive oil is a wonderful softener and conditioner for callused areas, dehydrated skin and dry, brittle nails. I lightly massage it into the affected areas after the foot soak and before filing or cutting. I found that by using the olive oil cooking spray I could cover more area and it's far less messy.

    Peace,
    LoisJean
    After a year of meetings and planning, I have decided not to incorporate with the non-nursing business partner and his wife I have been meeting with. I think it is great, Lois, that you have found nurses who you can share the journey with and I wish you all good things. I have not regrets, and because of all these business meetings, I now have good liability coverage and a great office with all the "bells & whistles". I would have done none of that if not for the thought of this partnership. I have found I can afford all of this on my own and now have my independence back. I have to pay them back some expenditures, but better now than after forming any legal bindings.

    My husband and I will incorporate out business, so it will be 100 % ours. I was finding that I really did not like the "business" mentality that does not take into consideration any emotional factors. I am relieved to have my autonomy back. Tomorrow I meet with a lawyer from the SBA regarding incoporating. I am also going to see about getting a microloan to get some products into my office.

    I have been selected to be on the Exam Committee for Foot & Nail Nursing Certification process and will go to Kansas City next month to meet with the 4 other nurses who are also on it. I am so thrilled. So things are progressing.

    I did a homeless shelter clinic the other night and plan to get more involved in that arena when time permits. Did you know that one of the most helpful things you can do for those with, what I call "mush foot" ( very wet feet from walking in wet shoes and socks for long periods of time) is to soak them in tanic acid (tea water). The tanic acid helps the feet expel moisture after the soaking. So that is your tip for the day!

    So, my fellow foot soldiers, keep on keeping on.
    Last edit by sirI on Nov 14, '08 : Reason: quote/referred to edited/deleted post
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    WOW!! I am so impressed with all the information thats been shared here and am equally impressed with you all and your success in creating a very much needed service. You've taken a need that isn't being met by others d/t lack of time or for whatever reason and capitalized on it. Your courage and digilence are an inspiration to all nurses that are sick of the system and want to make a change for themselves. Congratulations and I wish you all continued success!


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