Foot care training - page 7

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... Read More

  1. by   lilrascal
    [font=Comic Sans MS]Hi Everyone - I've been an RN for 14 years, an LPN for 6 years prior to this. My background is Home Health and Longterm Care. While in the Home Health realm, I happened upon so many older clients who could not care for their own feet, and they slipped through the system because it was their only need. I found myself taking them on during my own time because I couldn't abandon them. I got so busy, that I actually had to find another competent individual to take the clients from me so that I had time to work, etc. In hindsight, I gave away a business. This was 12-14 years ago, when it was less acceptable to do this on your own. Now I'm ready to do again, because I know I can, it's acceptable, and I'm disappointed with nursing otherwise. [font=Comic Sans MS]I live in Wisconsin. My question(s) are: Do I need to form an LLC or something similar? If I name the business something other than my name can I use my social security number or do I have to then go the Tax ID # route? Does anyone recommend just using your own name to keep it simple? Does RN have to appear in the name of the business? Is there insurance other than malpractice that is recommended? Or, is that where the LLC comes in? I'm slightly confused as you can tell. If I can just take off and not visit a lawyer that would be great, but probably not recommended. My husband has an accountant for his business, I intend to use him also. Is it necessary to sit down with him ahead of time or is tax time soon enough? Any and all information is appreciated. Lastly, do I need to inform or ask anything of the board of nursing here? Thanks to all. I look forward to hearing from you.
    [font=Comic Sans MS]lilrascal in Wisconsin
  2. by   guest***
    If I were you I would do the following. Call the local chapter of SCORE and make an appointment to get some free advice from them. They are great and free. Also, call your local small business administration and do the same. They put on a lot of free and low cost business workshops. There is an incredible amount of help out there for the small business person. The JC's also have many short courses.

    I have my own (free) lawyer that is helping me with my business through my local chapter of the small business administration. I have seen him for 3 visits, one hour each. My husband is now going with me to these visits to help as I have a hard time "getting" with the business end of things. I have been in business eight years and am a sole proprietor, but am investigating incorporation. I have way too big of a business now (about 350-400) regular clients) to not know what I am doing. I just wish I had done some of this stuff years ago. I do not think I will incorporate, too complicated, but am still looking into the pros and cons. You can start out as a sole prorietor and then change.

    It is not hard to file for a fictiscious business name, and will probably be more memorable to clients. Getting the accountant or a good book keeper on board early on is a great idea. They should be able to help you with many of these questions. Start a seperate business checking account right away. That will really help you sort out things.

    There is talk of a Canadian Foot Care Course (48 hours long and very comprehensive) coming to California and possibly Tucson Arizona. Maybe as early as next spring. Anyone interested, pm me and I will put you on a mailing list. THIS WOULD BE A GREAT COURSE! Probably cost about 2,000. But when you think of the potential earning power it will give you, not to mention the peace of mind and thrill of having your own business. It would be well worth the investment. There are times now, doing group homes, that I make $200 and hour. I have a lot of overhead, and these clinics really help cover those costs. I do a great job, the clients are happy and the relatives who I bill, are happy.

    Do contact your state board and have them send you the citation in your nurse practice act that covers what you will do by providing foot care services. It may be a very general clause or very specific to feet. I think Wisconsin has some specific verbage, because of Tara Beuschar's work, but I could be wrong. You need to have something in writing to defend yourself when you start getting flack from podiatrists!!! It is worth it. You go girl!
    Last edit by sirI on Nov 14, '08
  3. by   lilrascal
    Thanks, for your response. I'm planning to contact the Board of Nursing as well as the small business development center located at the closest University. I'm also thinking that I will attend the class in June offered by Tara Beuscher at the University of Eau Claire here in WI, which is about 2.5 hours away. I'm not familiar with what SCORE is, but I am assuming it is equivalent to our small business development center. Thanks again for your reply, it helped much.

    Last edit by sirI on Nov 14, '08
  4. by   lilrascal
    Hi everyone,

    I'm just wondering where the best tools for foot care can be found. I've read some of the postings that the dremmel is being frowned upon. Any input would be nice. Going shopping soon. Thanks for the help.

    lilrascal in WI
  5. by   lilrascal
    I attempted to enroll in the UW Eau Claire Foot and Nail Care Class but it is full for June. I'll go on a list for now. Thanks for the information though. I did order the book that was recommended for Salon Pro's. I'll be meeting with a lawyer soon. Just need good equipment and where to find it. I'm finding out that I came to this site a little late. Not much activity. You're all out doing nail care!

    Last edit by sirI on Nov 14, '08
  6. by   ehresources
    Hi everyone!
    I have visited the site a couple of times and couldn't resist getting involved in this topic. I have been doing nursing foot care in Canada for over 9 years. I am also an associate professor at the local college for the nursing foot care program. There seems to be a lot of confusion out there!!!! Let me try to help. Foot care is considered an added nursing skill. Here, we have training courses (some good, some bad). There is no "certification" course. There are guidelines and a scope of practice that distinguishes what we do from what podiatrists/chiropodists and estheticians do. (Although at times, I do put nailpolish on for my clients, just like I would braid or cut a client's hair when necessary or to make them feel good - definitely part of nursing!!!). Nursing Foot Care does require additional training to be competent in the skill. Unfortunately things do vary depending on where you are. If you are interested in courses, do your research!! A nursing based program will be best because who else knows what a nurse is capable of?! I am tired of attending conferences, etc. where other health professionals just say refer, refer, refer without explaining what they'll do when we refer them and really understanding what we can do up until we refer them. I have actually started putting on conferences for foot care nurses to improve this situation! Anyway, if I can give any of you more info let me know...
  7. by   4mostuser
    Hi, Fellow Footers.....I am in Pennyslvania and have just started my "Sweet Feet" Adventure. I have only made four phone calls to Senior Centers and I have four "gigs"!!!! I am so excited. I go to Vancouver in June for a refresher and for the opportunity to commune with others who find that foot care is more than a is something that my spirit just longs to do.

    Yesterday, a man who just came out of prison after 20 years came into our health clinic. All I could think of was "Boy, I would like to do his feet." We are so lucky to be able to have such wonderful relationships with people!

    To anyone who is thinking of starting foot care as an independent practitioner....remember that is how nursing started in the first place. Nurses indentified the needs of people and took care of things. Cheers,
    Quote from LoisJean
    Hi, Guys!! Erin, it's the way of this world....Canada, Germany and a few other European countries all have nurses trained in the delivery of foot care...and the government provides payment. But not here.

    Hey, I've been in touch with kernow via PM. The video ought to be up and running by late October. It will be a professionally done video and I'm scheduled for the taping in mid September. I know this has been long in coming.. my initial idea was to have a family member do a 'non professional' type thing, but I was slowly coaxed out of that notion. I want to be in a position where I can sell the thing to people with big bucks. (the exception, of course, will be the sales of this video to nurses for a very low charge- probably shipping and handleing). My promise to you is that as soon as I get it, you'll be the first to know via PMs.

    Pity the podiatrists! They do not get recompensed for ROUTINE foot care. Not by any insurance provider. So, they do not soak the feet, they do not massage the feet; they do not get paid for the routine trimming of toenails. They are paid per Medicare on a q 2 month basis for foot care on Diabetics and others who show a required number of symptoms relating to various diagnosies. These various diagnosies must be certified by a MD/DO before the pod can be compenstated for his work. If the required number of symptoms are not present, the pod does not get paid. Therefore, many podiatrists in this country falsify thier documentation. This is a fact of life which occurs not only with pods but with other Professional entities who feel they need 'mo money. Often they bill an atrocious amount hoping to reap at least half. This makes the average consumer of podiatry care quite unhappy because when they see what the pod charged for a basic xraying and 10 minutes of nail trimming and calous cutting they feel, and rightly so, that somebody is getting cheated. Well somebody is: namely Mr. and Mrs. America who see money taken out of their paychecks to pay Dr. Pod.

    For many pods to get paid for ROUTINE foot care they have to charge an out of pocket fee which can range from $75. - $175 per foot (and sometimes more depending on where and on who).

    I don't care how far and wide a pod might travel to provide in home services-- he is not getting to the majority of those who need him and what little service he provides leaves little desire for the patient to have him back. Podiatrists have their place: their place is in foot and ankle surgery, orthotics- (an up and coming speciality which some nurses are looking at seriously when thinking of a speciality), diagnosis and treatment of disease processes--(fungal nails, gout, calcium deposits, etc); basically the things that took them 6 years of school to learn and obtain Professional licensing for.

    But, routine foot care is a definite nursing function which relates directly to health, comfort, hygiene and the overall prevention of more serious problems which can occur if there is not regular inspection. By regular inspection I am talking about the ideal advantage of either monthly or qom foot examinations and basic care. This is neither excessive or unnecessary in light of potential risk factors. I frequently see a problem one month that wasn't there the month before. We keep accurate records on all of our clients including wound care assessments and progress sheets. Rapid referral to the client's physician has resulted in treatment that other wise would have been delayed.

    75% of all our clients are elderly and diabetic. 23% are elderly and suffer other debilitating problems such as decreased vision/blindness, severe arthritis, cardiac problems, stroke, neurologic disorders and so on- many of these are on blood thinning agents such as Coumadin. The remaining 2% are people who may be elderly, may have some difficulty caring for their own feet, but who are basically not at risk. They simply want the care given by a nurse. Out of the total patient numbers seen, 32% are homebound, require 24 hour care givers, and of that number, 18% are the frail and elderly dependent upon Medicaid for health care services.

    We give good care! We soak the feet--that feels really good and relaxes the muscles and tendons as well as softens the nails, corns and calouses. It also cleanses, removing bacteria from the skin surface which helps to decrease contamination. The nails are cleaned around the outer edges and under nail tip. Removal of the debris between toes is done. After ascertaining that the client is not sensitive to alcohol or betadyne or that their are fissures or cracks on the skin, we swab the entire foot including between the toes with either of these agents, (nurse's preference), that kill fungus on contact--we want our work area clean!

    The entire foot and leg is inspected. We look for not only the obvious problems but also the ones not so obvious. Often, a foot care nurse will spot the signs of early cellulitis and refer promptly. Pedal pulses need to be present--if they are not readily felt the foot is observed for other evidence of circulation present or absent. People need to see their docs PDQ when pedal pulses are absent or faint or not in sync with the radial/apical. We provide monofiliment testing every 6 months. Not only on diabetics but anyone who presents with circulatory embarrassment. We ask alot of questions regarding pain, cramping, ambulation, and so on. We check shoes. We look for mold, worn heels, nail heads or other protrusions, etc. We keep a check on medications and do reviews every 3 months.

    We trim the toenails. Straight across if possible, but always the way the nail naturally grows. Nails often will grow in a crooked or off center way when the digit is affected with arthritis or other cause of misalignment. A nail should never be 'force cut' to grow contrary to it's position on the nail bed. We inspect corns and calouses. We smooth them down using an emory type file. We look to see if there is any evidence of ulceration underneith, we want to know the degree of pain the person is having when walking or standing. We will provide a padding right away and send them to their doc for further treatment. Everything is done by hand. We never use battery operated appliances such as dremmels--these things are evil and ought to be destroyed. They do nothing but damage a sensitive nail plate and can cause destruction of tissue surrounding a calous or corn. We never use razor blades or scaples. We never invade tissue. To do so is beyond our scope of practice- number one -and number two, it can further worsen the the situation.

    Movement is important. If their feet hurt or if they have
    peripheral neuropathy, they are subject to falls. We observe them walking. We can see where there is a problem with alignment. We can refer them to a Orthopaedic Surgeon for evaluation. Perhaps a brace for additional support is needed. Perhaps they simply need a tripod or walker for added support. Point is, we can refer.

    We massage. We know how to massage the feet of the elderly...the kind that gives them visions of younger, more orgasmic days. It feels so good to them. It completely relaxes them down. Increases circulation, decreases strain and stress on the spinal column, energizes and gives a long acting sense of well being. We do not mess around with the idea of pressure point massage which affects other problem areas of the body. Often, with our clients who are elderly, the increased pressure is painful and not tolerated well. We simply massage, keeping in mind that there is a right way and a wrong way to massage the feet.

    Proper foot care when provided by a nurse- including the time for assessment and evaluation--ought to take approximately 45-60 minutes. I challenge anyone to find me a podiatrist who will take that kind of time to provide this kind of care for $20.00 per person.

    And, finally, we act as a referral and networking agency. We provide a means for our clients to enlist the help of other supportive agencies if the need arises. We can assess a living environment and can ask questions regarding need. Our clients are usually very open and honest with us about these things because we have generated a care for them which is personal yet professional. They talk with us. We see them on a regular basis without fail and this has helped to build up their confidence in us.

    Foot care needs to be looked at again as a viable nursing procedure. We need access to a means of certification for this kind of care (and I mean for LPNs as well as RNs. Because if LPN/LVNs are not included in the mix, I will burn my license and sever my legal status as a nurse, in protest). With proper certification health care insurances might provide payment for service or at least offer a reimbursement to the client paying out of pocket.

    Some, if not many or all, podiatrists are inherently, it seems, leery and a bit paranoid regarding nurses doing this work. I am at a loss regarding this because it would be finacially benefial for them to make nice with us because we provide the referrals based on nursing assessment....however, since in my area they aren't so nice, I refer my client to his physician of note or to a orthopaedic surgeon. I can do this because I work for myself. In fact, it is my business policy that all nurses working under my business name do this. If the MD/DO wants to send them to a Pod, fine. Most of them do not.

    It does not take a rocket scientist to learn foot care. Actually, I take care of feet the way I want my feet cared for and the way I took care of feet when foot care WAS a care provided for patients in hospitals and LTC homes by nurses and nurses aides. I simply have added the extra employment experiences of geriatric nursing, home health care nursing, med/surg nursing, CCU/ICU nursing and a whole bunch of other stuff garnered over 30 years as a nurse; I acquired excellent assessment skills (my teachers were RNs just like many of you)...

    None of us would be interested in self employment if we didn't believe that we can, within the essence of knowledge and experience, provide something for others in a far better way on our own rather than through the restrictive modalities foisted upon us by employers with corporate mentalities and methodologies. Most of us detest the shackles that bind us to those blocks. Most of us working in conventional employment scenerios become restless, irritable and discontent on a regular basis no matter how many different places we work, no matter how many different clinical settings we work in, no matter how many degrees or certifications we acquire...eventually we get bored, pizzed and basically burned out. We keep trying different venues but nothing seems to work right for us. Mostly, we are people who heartily disagree with management protocols. We find that those protocols leave us over-worked, under-paid and worse, not allowing us to provide for our patients in a manner which we know we ought to and in the way we were taught to. Often, the nurse with the Entrepreneural spirit inside of her or him, cannot understand why the higher up they go in thier profession, the deeper down they go in depression. Perhaps this has been the way for some of you, too. What everyone needs to know is that NOT ALL NURSES WANT TO BE SELF EMPLOYED, BUT ALL NURSES CAN BE SELF EMPLOYED.

    At any rate, and I know this has been very lengthy...sorry..maybe I oughta write a book.

    Lois Jean
  8. by   guest***
    There will be a 2 day foot course in Winnipeg in Oct on the 4th and 5th. I AM NOT INVOLVED IN PUTTING ON THIS COURSE. I might be a speaker.
    Last edit by nightingale on May 20, '04
  9. by   guest***
    One way that I have known people to get experience with nail trimming, is to approach a friendly podiatrist and see if he wants a nurse to do nail care in his/her office. There are many young, hot shot podiatrists who have no interest in nail care and would love to provide that service in their office, with someone else doing it. You may want to say you would follow them around for free for a bit to give it a try, and then if it works out, get a percentage of every patient you see. You could be an independant contractor and still have a lot flexibility and be in control of your life. It is my opinion that in order to be a sucessful foot care nurse that you need to have experience doing A LOT OF NAILS, before you are qualified to set out on your own. Some podiatrists are great and would welcome the help. It could be a win win situation.
  10. by   Catherinefrances
    Quote from LauraRoehrickRN
    There will be a 2 day foot course in Winnipeg in Oct on the 4th and 5th. I AM NOT INVOLVED IN PUTTING ON THIS COURSE. I might be a speaker.
    Do you have any more info regarding the course in Winnipeg in October

  11. by   guest***
    As soon as I get details, I will pass them on. As of now this is what I know. This is a one day conference sponsored the a group I believe is called The Foot Nurse Interest Group. They have an anual conference on the first Monday of October. This year it will have a second day that will have break out sessions. I may be doing a session on the use of electric nail fining systems where nurses will be shown these machines and get to use them on each other. This is a great group. I went last year and did a presentation on making medicinal salves.

    There is going to be a second course in late October, also in Winnipeg. It will be a 5 day Complete Foot Course. I am hoping to go to that also.

    I should have more details within the week and will keep you posted.
  12. by   ehresources

    First thing is to take a course and check for any regulations/guidelines that you can get your hands on. After that, the basic tools and equipment are: nippers or ingrow scissors (or a mixture of both), Black's files and Diamond Deb files. These are metal tools that can be sterilized between clients. I have a rubbermaid tool box stool that is easy to carry the supplies in and sit on while providing care. The other supplies are: 70% isopropyl alcohol, cotton balls, towels or dental bibs, masks, gloves and goggles (I don't wear the goggles but I really should to protect from flying nails and dust). I always wear uniforms to keep my work and regular clothes separate. I also prewash my uniforms and towels in bleach and then put them through a regular wash to reduce the spread of nail debris. It is a surprisingly inexpensive business to set up. The most expensive items are the nippers. I will recommend that you spend the extra cash and get good tools. You may save some money initially but the less expensive tools have to be replaced more frequently. I have the same good quality nippers that I bought over nine years ago, the cheaper ones are long gone. I think that is about it. Good luck
    Quote from nightngale1998
    What supplies / tools does one need to get started in Foot Care?

  13. by   ehresources
    I am very interested in finding out as much info about this as possible. I am hoping to initiate a similar thing in Ontario Canada and would love it to be nation-wide. Whatever info you could give me would be great!!!!!
    Thank you

    Unfortunately WOCN is only a RN organization. You need to contact your board of nursing and take the bull by the horns and make it happen! There are hundreds of LPN's in Canada with their own businesses and they are very organized. It needs to happen here in the states and it takes people like you with strong feelings to make it happen. Remember, this is a new field of nursing and it takes grass roots efforts to get these things organized. It is not going to magically happen. So you go girl! Make it happen. Do not wait, because you could be on the ground floor of some very exciting things. Take the initiative. There are many LNP's, it seems, who are writting in on this discussion board. Organize yourselves. If you do not, I bet you will always regret it. Call your state board and talk with a nurse consultant and see what they say.
    Last edit by sirI on Nov 14, '08