Is this in our scope of practice?

Nurses General Nursing

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Our nurse manager is requiring all of our unlicensed assistive personnel to document that "nail care" was done on each pt. This includes cleaning, trimming and filing. I thought I learned a long time ago that in the state of CA, nurses are not licensed to perform manicure or cosmetology services. Thus, as the RN responsible for all tasks delegated to the nurses assistants, am I (and they) going beyond our scope of practice? I cannot find anything on the internet about this topic.

Thanks-

Kathy

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Moved to General Nursing Forum.

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don't know about CA, but in NC as a CNA we are trained to clean nails with an orange wood stick and a file, however, we are not allowed to clip nails.

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Specializes in Developmental Disabilites,.

I was taught not to do nail care, especially on a diabetic

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Specializes in Family Medicine.

I hope it's not within our scope because I don't have time to do mani/pedis.

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in my nursing school we learned nail care in fundamentals, use a file and the wood stick like Brian Ruff CNA has stated, as well as NEVER use a clipper. PLUS don't do diabetics. But does your nurse manager want this documented each day??? That is crazy, is this LTC or acute care? I could see maybe in LTC and on a weekly basis maybe but everyday, how fast does the NM think someones nails are growing???

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Yep, this is acute care...thanks everyone for your input!

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Specializes in Critical Care.

I would say contact the practice division of the BON. As they establish practice guidelines for your license, only their input truly matters.

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Specializes in Cardiac, PCU, Surg/Onc, LTC, Peds.

We don't even Have nail clippers available to us in the hospital..... cleaning when soiled, yes I can understand, a manicure, no.

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Specializes in ICU.

We can't cut nails, but I see no reason why you couldn't use one of the soft disposible toothbrushes the patients are given, and clean under those nails! I like to soak the bedbound patient's hand in a basin of warm soapy water, then try to clean under their nails. I was once scratched badly by a patient who we rec'd from a nursing home, and she had black gunk under her nails. I had to go to ER and get a tetorifice shot and erythromycin!

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Specializes in Trauma Surgery, Nursing Management.

Hmmm...while on the one hand I am guessing that your NM wants to include this on the care plan because nail care can be overlooked. For example, when I was doing clinicals (a hundred years ago when we still had to rub two sticks together to make a fire for the small dinosaur that we killed for dinner), one of the things that I noticed about my pt in the Neuro ICU was that his nails were still caked with blood from the MVA he was in 2 days prior. On the other hand, I surely hope to goodness that your NM does not expect that your acute care unit will turn into a day spa. I am all for cleaning nails, but I don't think that filing nails would be on the top of my agenda for patient care.

Of course you know that clippers should never be used. I can't believe that s/he even suggested this; it is a basic fundamental practice NOT to use clippers on diabetics. Is s/he going to insist on a separate care plan for diabetics? (Please don't suggest this, or you will no doubt have a separate care plan within 48 hours!)

Is it just me, or have care plans gotten WAY out of hand? The next thing you know, we will also be documenting the amount of tartar (with a nifty measuring device included) buildup on our pt's teeth. Or perhaps we can measure the amount of ear wax our pt has? Oh, I know! We can include how much oil our pt's have in their hair!

Sorry for the snarkiness (not really, but maybe only a LITTLE sorry), but it seems as if our documentation requirements have increased, while our support staff numbers have decreased-AND...you guessed it! Our pay never seems to increase along with each little responsibility added to our list by our dear administrators. When they present new documentation for us, some of it is relevant, and some of the ideas are good ones. HOWEVER, I believe that the 'powers that be' don't realize that every little thing that is added to our care plans takes more time to complete, meaning we have less time at the bedside and more mental stress to complete everything prior to the end of shift.

It adds up, just like when you go to Wal-Mart for "one or two things" and come out with a cart load of items.

I am done with my tangent now. Back to the regularly scheduled discussion.

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Specializes in Trauma Surgery, Nursing Management.
We can't cut nails, but I see no reason why you couldn't use one of the soft disposible toothbrushes the patients are given, and clean under those nails! I like to soak the bedbound patient's hand in a basin of warm soapy water, then try to clean under their nails. I was once scratched badly by a patient who we rec'd from a nursing home, and she had black gunk under her nails. I had to go to ER and get a tetorifice shot and erythromycin!

I agree that nails should be cleaned. I am already admiring you for taking the time to soak your bedbound pt's hands in warm soapy water. You must be a very caring and conscientious nurse. You can take care of me or mine anytime, Apple!

Oh, I am still trying to erase the last portion of your post from my subconscious...it gave me the dry heaves! I am glad you got the t-shot and e-mycin! I would have been trying to figure out how to surgically sterilize that scratch!

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