Foot care training

hoolahan, ASN, RN · Jul 30, 2003

I did!! I went to beauty school! I did not unfortunately get any oedicure experience in school, just the theory. But, I am going to apply to work some PT hours in a salon, and the other nail tech has promised to help me.

I did learn alot in beauty school, but the other day I did my own pedicure, and gave myself such a wretched ingrown toenail by cutting to curved, I decided to go w the salon for some real practice with someone by my side for a bit first.

I learned a great deal in school. You learn disorders from diseases of the nails, what yiu can treat, what needs to be referred. I honestly think I am having problems b/c 1. I have not advertsied and cannot afford to right now

2. In my local area, we have traveling podiatrists, who DO accept insurances, and I do not, and just do NOT want to bother w the hassle of Medicaid, though I may in the future, and 3. I called every nursing home assisted living you name it in two counties, they have their own arrangements already, even the new places!

I am not giving up on it, I am just re-thinking my strategies.

Plus, my fingernails have never looked so darn good!! And I am making a wee bitty bit of extra $$ doing all my dtr's friends. I started them out by making them bring me 2 new polishes as payment, now I have enough colors to make everyone happy. :)

RNsweetie · Jul 30, 2003

The college I am currently attending for my RN offers a foot care for nurses course.

It is three parts, 2 theory then 1 clinical. each course is about 250.00 can.

kernow · Jul 30, 2003

Thanks to all for the replies. I did also consider lookig into beauty schools if nothing else came up and at this point that might be my only option. I'll wait anxiously for LoisJean's video release!

The course in Wisconsin is offered via the University of Wisconsin at Eau Claire, through the continuing Ed dept. http://www.uwec.edu/ce/healthcare.htm. It looks great, a two day course, first day all theory and the second clinical, jsut the type of thinkg I'm looking for!! Anyway if anyone knows of any other schools that offer anything let me know. I am broadening my search to Canada, they seem to have more courses for nurses along these lines and I live in the part of NY that borders Ontario so maybe I'll have some luck there!

LoisJean · Aug 2, 2003

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.

Peace,

Lois Jean

LoisJean · Aug 2, 2003

Well, here I am again....I wanted to add: Since the addition to my nursing staff here, we have set up new foot care clinics at 3 Senior Centers, gained 2 more senior apartment complex clinic sites and, in 6 weeks time have realized a 5% increase in private in home referrals. This means that not only am I seeing a growth in my business but the nurse working with me as a self employed contractor is realizing full time work and decent pay for service...pay that is hers to do with what she wants. I think if referrals continue we will need another free lance RN or LPN by late fall. We are preparing to offer med set ups on a q 2 week basis and monthly IM injections (B12, etc) for an additional fee for service.

We already offer fingernail trimming for diabetics, the blind, stroke victims--(any one who can't do their own safely); and we provide full vital signs with each foot care visit along with med reviews as part of the whole foot care package. (Just had a guy yesterday who was absent of breath sounds ® upper and mid anterior lobes plus a couple other symptoms I didn't like. I called his doc, got him an appointment for the afternoon and took care of his feet. His wife called this morning to tell me he has pneumonia and, "thanks for being here". See, this is what I'm talkin'.

Peace,

Lois Jean

Agnus · Aug 9, 2003

Jean Louise am looking forward to the video. I have not given up. I ALWAYS enjoy your post and learn so much from them. Thank You for being.

Tutti · Oct 5, 2003

When my employer suggested I start doing foot care as one of my many clinics, I searched all over for a training program, and did not find one in the US with proper training. What I did find out is that Canada has laws & regulations for nurses to do foot care, which is why they have college courses on the subject with clinical and all. I feel lucky to have found a nurse in Ontario who has been doing foot care for 17 years, and teaching in the college as well as privately. I took a 10 day private 1:1 course with her and was able to practice on almost all her clients. It was exactly what I needed to feel confident in what I do. I went to Ontario all the way from Seattle to take her course and am so glad I did. I found her on the internet. Her name is Anne Nelson. I know this is late, but just found this site today. She teaches how to start up your own business as well. If you can't find her on the internet, let me know. I might have her e-mail address somewhere! Good luck and best wishes!

azverte · Nov 4, 2003

Foot care is so important because improper or insufficient care can lead to amputation and loss of independence. WE know this but do the payers appreciate this enough to pay for these services? BUT, if the patient is diabetic (and who ISN'T anymore?)while you are there assessing, teaching, caring, you also measured the foot, ordered some diabetic shoes and inserts and billed Medicare - well NOW you're worth your while with the income to prove it.

I love nursing but I also love to eat and appreciate that roof over my head. I am SO glad I started this diabetic shoe business. The products are medical equipment and NEED to be paired with care and teaching. This is perfect a perfect business for a nurse with entrepreneurial talent. I recommend it.

Guardian Angels · Nov 4, 2003

How are the foot clinics funded? How much is charged per visit? RN's provide the care? How much do the nurses make and what is the amount turned over to the business?

azverte · Nov 4, 2003

Hi Guardian Angel! What do you mean "Turned over to the clinic." You are still thinking like an employee! YOU are the clinic! I think the footcare pricing will be defined by the demographics and perceived value of the community. But Medicare pays for shoes and inserts for diabetics the same amount no matter which shoes and inserts are provided. Good luck!

Guardian Angels · Nov 4, 2003

Now, how is Medicare able to reimburse? We have been working on our medicare certification for home health care and until that is received we can not bill medicare or medicaid fee-for-service.

Is the filing under DME Supply? Who is a good supplier?

So many questions!