To do something you're uncomfortable with/not trained for. I know this is an issue a lot of nurses face, and my issue may seem frivolous but I still wanted to get some opinions.
Diabetic foot care... I've been working for 2 years, and have relatively little experience in this area (I work in LTC, we have previously used designated & trained people to fill this position). Recently over the last year or so they phased that position out and put the responsibility of diabetic patient foot care on the staff nurses, though we still usually manage to have our trained foot care nurses handle the worst cases.
I have no problem cutting toenails (I know some people do and just won't do it). My issue is when my nursing manager tells me to use the last 4 hours of my shift to go around the building and do "basic foot care". We have PSWs that do the regular foot care, and if the resident has diabetes they can receive footcare by the applicable RN or by an in-home footcare clinic if they opt to pay for it. There is no standard differentiation between a "basic care" diabetic and a diabetic requiring specific services, aside from (possibly) those who need a dremmel for thickened nails and those who don't. This is the only separating line my employer seems to have drawn which apparently dictates when a certified foot care nurse is required (simply because an RN in my position cannot operate a dremmel).
I brought a concern through email today that I felt uncomfortable (though I still followed direction, just did not do diabetics with obvious circulation/skin integrity issues) with this expectation. I feel that if you have a certified foot care nurse come perform diabetic foot care, that you're doing it for more than just the fact that they can legally use a dremmel. I asked if we could either get some training in this area or if they could just exclusively utilize nurses trained for this purpose. Is it reasonable to ask for training with this type of issue? My manager countered back to my concern with "you are expected to do basic foot care". I asked if she could clarify that... because I'm worried that, even with some theory and knowledge, doing even "basic footcare" on a compromised diabetic would better and more safely served through someone who has the skill and training. It's not that i don't have the confidence, I just realize my own limitations as a relatively new graduate who does not have comparatively as much experience as some of the veterans.
Is my concern valid? This would definitely not be the first time we have been "expected" to do something we may not necessarily have training for. I've practically become an expert at "winging" it. It is starting to seem more and more that every time management is questioned we get ridiculed and shot down, so a lot of times it's easier to "just do it". Although I wish my nursing manager would put her license on the line for those of us she refuses to listen to when she "expects" us to do XY and Z as part of the job description.