Can Assoc. RN cut diabetic toenails?

**RosesrReder, BSN, MSN, RN** · Oct 5, 2005

Jess... good question.. never apologize.
Diabetics have to be meticulous about foot care. Any open wound is great risk for infection to the diabetic. Their lower extremeties are already at risk due to compromised bloodflow to the area. One of the reasons many diabetics end up being amputees.. gangrene, etc.
Careful, cautious trimming of toenails is essential.

Oh thanks jnette for explaining.

**RosesrReder, BSN, MSN, RN** · Oct 5, 2005

Good question, Jess,
Yes, there are issues. If this is not done correctly and an injury occurs, the individual could, over time, end up with an amputation.
Diabetics who cut their own toenails can and often do injure themselves.....cut the skin. Because they have decreased sensation involving their extremities, this injury can often go undetected until there is a horrible infection. This is usually most difficult to control (as the diabetic has significant issues healing properly) and can lead to amputations.
The nurse should be skilled in cutting/trimming toenails. Some facilities do not allow nurses to do this unless they have extra training and some physicians do not allow anyone but another physician, podiatrist for example, to do this.
In my state/area, the nurse is allowed to trim nails. Does not matter what education, ie, ADN, BSN, etc.......
I know jnette had already answered, but, reinforcement is good, too.....

Thank you kindly ladies.

See........everyday I learn something useful here. :-)

PepRN · Oct 5, 2005

I have emailed the board and have not received a reply yet. It's not like I really am thrilled about trimming the toenails, but some of the patient's really need it.

Sounds like you may work in a LTC environment. In AR, there are no restrictions on a licensed person performing foot care on a diabetic. If you have emailed your board, it will probably not get as quick a response as you wish. I would recommend going to your state boards web site where you can access, view and even print your nurse practice acts, scope and standards, etc. My bet is that you, as a licensed person, should be able to trim the toenails of a diabetic without restrictions. One piece of advice would be to see if your current facility has a policy, procedure and/or protocol for such treatment. If so, follow it as closely as possible. If you feel you need to document your training and edcucation, simply have your D.O.N., Staff Developer, etc go over it with you and document. I applaud you for keeping your assessments patient centered. Toe nails aren't the glam nursing job, but it is the heart of nursing. Doing for others who can no longer do for themselves.

maolin · Oct 5, 2005

I don't know what Tx nursing practice acts states specifically, but I remember the instructors made a huge point in fundamental skills that we (as students and eventually as RN's) could not trim nails (finger or toe) whatsoever - it required a Dr order and a podiatrist or specialist (wound care IIRC) had to do it. Rationale was R/F altered skin integrity & infection and it was not within the scope of practice. As I said - I don't know what the NPA actually states, but this was really drilled into us in class.

Was curious if anyone out there knows if an ADN can cut diabetic patient's toenails in Texas. I have just recently heard that we cannot. This is truly the first I have heard of it.
The podiatrist comes every 3 months or so and it seems as if these patients need to get their toenails trimmed more often.
Thanks in advance,

Nurse Ratched, RN · Oct 5, 2005

I believe it's often a facility-specific policy rather than board-dictated. I doubt it would be differentiated by ADN vs. BSN.

I feel very comfortable giving foot care and will do it in a heartbeat for those that need it. Not my favorite task, but SUCH a relief for those who literally have them poking through their shoes they are so overgrown. Yes, I will work on a diabetic person's feet VERY carefully. I feel it's less risky than leaving them untouched and having the toes crinkle up because the feet wont fit in their shoes.

neneRN, BSN, RN · Oct 5, 2005

I've only done ER, so never had to do it, but I do remember being taught in nursing school that the nurse should NOT trim a diabetic's toenails for all the afore mentioned reasons.

Hellllllo Nurse, BSN, RN · Oct 5, 2005

On a side note, I am curious, why would there be a differentiation of tasks for an ADN vs a BSN? It IS the same license isn't it?:uhoh21:
Cheers!

There is no difference in ADN vs BSN licensure or scope of practice. I am an AAS RN in TX, and have cut and filed diabetic toenails as part of routine pt care and assignments.

I also do q mo diabetic foot checks and refer pts to a podiatrist. I have never heard that this is not allowed.

night owl · Oct 5, 2005

We used to do it until someone cut the nail too short which resulted in a very bad infection from an ingrown toenail and had to get his toe amputated. Now only the podiatrist is allowed and he visits once a month.

Shell5 · Oct 5, 2005

I didn't mean to make a big deal about the toes. I have always cut the toes up until just recently. I was told by another nurse that nurses in general could do it until years ago when we were all supposedly "banned" against this by the powers that be. I thought it was absurd myself. I couldn't believe it, so I went on the hunt for info. out of curiousity and I definately don't want to be doing this and get into trouble.

Anyway, the only nurses I could find online that were cutting diabetic toenails was BSN nurses and APN. That is the only reason I mention the difference between ADN and BSN, not for any other reason. :kiss Sorry for the confusion.

I am going to look up the policy this weekend, if we have one. We are still in the archaic ages at my job, no computer. Wish me luck..... :wink2:

ptadvocate81 · Oct 5, 2005

The hospital that I work in (Texas) it is policy that NO nurse, ADN, BSN, MSN is allowed to cut a diabetic pts toenails because of the risk for infection. Check your hospitals policy, I don't think that education matters, or shouldn't anyhow....

icugirl33 · Oct 6, 2005

At my facility, it also requires a doctor's order and a podiatris would have to trim the toenails. I found out when a family member made the request. On top of everything else I do, trimming toe nails is not something I would like to add to my list of nsg duties. Most of the patient's on my floor need a good trimming, but I would need a chainsaw to cut through the toenails I have run across.

In addition, a nurse is a nurse, regardless of ADN or BSN. A policy that pertains to registered nurse, pertains to anyone employed in the facility with RN behind their names. I have a BSN, and it just prepares you for Masters level study and easier entry into management (only if you have the drive to begin with)..

oldnurse newnurse · Oct 6, 2005

IN MN, we are obligated to trim diabetic toenails. However, if the task looks to challenging...off to the podiatrist they go.

Wow I have been a diabetic for 24years and they tell me not to cut my own toenails so I don't if nurses or anyone, should cut a diabetics toenails unless they are a podiatrist.