Why not nails?

  1. I am in my first semester ADN school. This may seem like a really rediculous question but here goes - I can't seem to get a definitive answer from my instructor.

    We were instructed that we were never to trim or file toenails or fingernails.

    I understand about the risk of Diabetes and ingrown nails; I understand there is a special technique, a fungus can cause complications, etc. But I can't disassociate this risk from ALL the risks we will be taking everyday - meds, IVs, wound dressings, allergies, etc.

    I have been in healthcare as an echo/cardiotech for about 18 years and it never occurred to me that I never saw a nurse trimming nails!! Saw lots but not that!

    I hope some of you experienced nurses can help.

    Thanks, Steph
  2. Visit swkbmckay profile page

    About swkbmckay

    Joined: Sep '01; Posts: 13


  3. by   P_RN
    I wonder if this is one of those undocumented "traditions" we have so many of?

    Other than the really raunchy, hard, thick toenails that really need to be seen by a podiatrist, I have done many many trimming/filings. I also do a pretty good nail polish too.
  4. by   sharann
    Hi there,

    I say count your blessings. That's one less task to not have to do. Nurses already do just about everything else in the hospital.
    But really, I think that it's pathetic that your instructors can't tell you why a rule exists. When I was in school, they told us it was because of the diabetes patients foot care etc...
    If it really bugs you, see if the director knows the answer.
  5. by   prmenrs
    I routinely do a tutorial on how to cut a baby's nails as part of my teaching!!
  6. by   nur20
  7. by   hoolahan
    Hhhmm, how to dissassociate it from other risks, tough question!

    Maybe b/c if we cut the nails, we would then be responsible for any complications, the hospital would be held liable, etc...? If a nurse trimmed the toenails of a diabetic, or someone with peripheral vasuclar disease (PVD), and the pt developed an infection, then a wound, then multiple debridements, osteomylelitis, then ended up with an amputaion, all starting from a badly trimmed toenail, well we'd be in big trouble. Maybe it started years ago, when nurses decided they didn't want responsibility for this, or maybe the AMA decided this was a job for a specially educated person, the podiatrist.

    Honestly, I don't care why, since I feel the same about it as others here, let someone else trim those skanky toenails!! LOL

    BTW, many people are not aware of this, but many positrists do home care to do routine foot care, and nurses do it too. So urge your diabetic and PCD pt's post-op, who are homebound to make phone calls, try the local VNA, to find out which docs and nurses do this in their area. It is a very important part of follow up and DC teaching. (Right Lois Jean? She does this. Hey, maybe she can answer this question!! BTW LJ, I KNOW the toenails you do no longer look "skanky!" LOL!)
    Last edit by hoolahan on Oct 3, '01
  8. by   Charles S. Smith, RN, MS
    Ask your instructors what research there is to back up this admonishment..It may be what I call "nursing witchcraft"..those things that we do because they are tradition, not based in fact or science.

  9. by   BrandyBSN
    LOL, I never thought about it. And you are right, I have never seen a nurse do nail care. General Footcare yes, but not trimming nails.

    I am just going to count my blessings. I hate feet! And gross thick yellow toenails.... ick! Give me 100 bed pan patrols, but dont make me clip those nails
  10. by   NICU_Nurse
    I don't know about ya'll, but just the other day I had to clip the fingernails of a semi-unconscious patient to get the pulse-ox to fit on her finger- her nails were soooooooo long, the monitor would barely fit. I found out that our hospital didn't routinely keep fingernail clippers ANYWHERE on the unit; had to improvise and use a pair of bandage scissors. ;>) Though, now that you mention it, I dont' think I've actually SEEN anyone clip anyone's finger or toenails before. Hmmm..
  11. by   Chuckie
    Last edit by Chuckie on Jan 17, '03
  12. by   LoisJean
    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?
  13. by   hoolahan
    Whew LJ, you go girl!!
    But stop telling all my little secrets, like my crush on the hunky podiatrist!!

    Seriously, I always thought we weren't allowed to trim toenails, though, like the original poster, I am not sure why.

    But, I am willing to learn, hint hint. Guys, I asked LJ to send me some info on her biz. And all I can say is WOW WOW WOW, you saved Medicare 1.5 mil, you need to make them aware of that, that is very, very impressive, not to mention the quality of life you have improved and the amputations you have prevented. Those ortho and ugly/mean podiatrists in your area should be shaking in their shoes at the way you can put them out of biz! I'll touch the skanky toes (that's why they made gloves, right?) to improve someone's life, and I love pt teaching, so bring it on LJ. Am I gonna have to come down there, bring my hunky podiatrist, and get the info myself??!! LOL! I guess you have been busy!!
  14. by   hoolahan
    Sorry, please indulge me in my apologies to Lois, she is true to her word, I got info about her biz today, and she is something else! A true dynamo and a beautiful person, both to her patients and her peers. Thanks for all your dedicated service Lois!!