Okay, you guys! You're in for it now!!!!!!
It is well within the practice of nursing to trim and file the toenails. I don't care what part of the pasture you graze in. While there may be some reasons why SOME nails should be CUT by a podiatrist, there is absolutely NO reason why a nurse cannot trim long, thickened nails......and I KNOW that if you are doing your assessments well, you see some pretty 'skanky' toenails.
I make a pretty good living doing just this on an in-home basis. Not only do we trim the nails (including fingernails) of diabetics, people with pvd; people on blood thinning meds, people who are blind, people who are arthritic and people who are mentally disabled, (just to mention a few peoples), we also provide clinics at senior centers and senior citizen apartment complexes.
Do any of you have the stats on the number of lower limb amputations done in this country every year? According to the CDC, between 1980 and 1996 the number of diabetes related LLAs went from 36,000 to 86,000! And that's not counting those with peripheral vascular disease. The Department of Health and Human Services says that people are not receiving adequate evaluation and the American Acadamy of Orthopaedic Surgeons say that people, "don't realize". So, two things come to my mind: lack of assessment on the part of health care providers and lack of education on the part of the public.
How many people do you think really have their feet evaluated on a regular basis? .....and it is the poor, the minorities and the elderly who are more often prone to diseases, disorders and infections of the feet. I would wager that out of every 20 people I see for foot care each month, only 2 have there feet checked by their docs at their q 6 month check ups. Our docs will check the feet of the diabetic, but don't bother with the other 100 who just might have a problem or two with their feet...(like ulcerated corns or calouses.)
There are podiatrists who remove toenails, debride ulcerated calouses, surgically excise bunionated joints and send these people home to do there own post surgical care. Sometimes they end up with infections because they either couldn't change the dressings themselves or their hygienic environment was way less than okay. Since our podiatrists do not make house calls and over half of their clients have difficulty getting transportation, followups are not made. They call us in because they need nail care....they end up being sent to a orthopaedic surgeon--too many times the diagnoses is osteomyalitis. Not a good deal. While I know that there are some really good podiatrists, they are not in my neck of the woods and here is where I have to be. Plus, some podiatrists seem to have a mysterious distrust of nurses. Anyway, around here the podiatrists are UGLY and NASTY-not nice hunks like the one Hoolihan is familiar with-(but, I digress.....
It puzzles me that what shows up at the end of the foot is any less important than any other part of the anatomy. The idea that a nurse cannot take care of a patient's toenails is just STUPID...and it doens't stand to reason. If you can give a hyperdermic, start an iv, perform phlebotomies you can cut toenails...and you should.
As nurses you should be evaluating those feet as well as caring for them. If it's something you think you can't do or don't want to do then call in the person who can and will. And let's not confuse foot care as a nursing service with podiatry or a pedicure. If a doc is needed get a doc, if a beautician is needed get one of those- but, if it's part of the patient's body and you have assessed that nail care is needed and you can fill that need, then it ought to be regarded as a part of nursing procedure. If your place of employment allows you to assess the feet, but not trim toenails, I implore you to find out why. And if they so much as tell you that it is a 'surgical procedure' you tell them I said, "nuts".
We have just instituted LEAP, (Lower Extremity Amputation Prevention) Program into our foot care service. This program uses monofiliments to evaluate the degree of neuropathy in the feet...we will be starting out with our diabetics and those with pvd, and will expand it to all of our clients in the near future. We not only take care of those smelly, ugly, rotton feet, but we also teach people how to take care of them, too. We have a series of teaching programs for senior citizens and caregivers. I think that this testing tool ought to be availabe and used as a part of the overall assessment provided to med/surg patients, LTC patients and Home Care patients.
As a last little bit.....my partner and I reviewed the last 5 years of business records (nursing notes) and found that because foot care was instituted as a nursing service in our rural area, proper assessments and appropriate physician intervention have saved Medicare approximately $1,586,000 in potential costs in lengthy home care services for ulcerative care and costs for amputations and subsequent follow up care costs which that type of surgery entails. So, we think that foot care as a nursing service is real important--how nice it would be if we could ever get the patient who just came home from the hospital who said, "boy, that nurse took really good care of my feet, too". And, yes, it is true: when I'm through with a foot, it looks (and smells) really good! It usually feels better, too.
When I signed on to my very first job as a nurses aide in '64, one of the things I was given was a pair of toenail clippers. In '74 when I graduated from nursing school
, nail care was still considered a part of total patient care. Funny, how things change. So, okay what was the question?