mikeb123

You're probably right, and I expected this might end up being the case. Haha... well she better get used to me leaving toenails fairly long and referring many people up if she expects me to wiz through this like an expert. At least until I find a program that doesn't cost an arm and a leg to pay for myself

Thanks for all the insight. I spoke with my manager again today through email and she basically said that there is an expectation for all registered staff in the building to be performing at least "basic" diabetic footcare. While it is true that RNs here (those trained and those not) have been completing the task, I am the first one making a stink about it. I don't know what they learned in their nursing school, but in the 4 years i attended, nowhere did i receive even vague training on how to do proper foot care on a circulation and/or skin integrity-compromised diabetic. I spoke with my union president and she suggested to look up a foot care course at a local college and approach my manager with it and ask (our contract does have some coverage through employer for continuing learning & certification) if the employer would sponsor it. I did so and presented it to her. She stated that she has no room in the budget for it but if I can "wait til next year" she would be able to fit it in. Anecdotally, my union president started giving me pointers, telling me to cut straight accross and "just be careful"... What do I do now? I asked for training and was indirectly denied (as long as I don't mind waiting a year). I do not feel confident in my ability to perform this task on any diabetic, but especially one with advanced disease and possibly compromised lower extremities. If it falls on me again to perform this task - especially before i can receive training - what should I do? I did it yesterday because she sprung it on me last minute and didn't give me a choice. After thinking about it and my rights as a nurse and a patient's rights for competent care, I don't feel comfortable performing this task at my level of training. I know her and i know that if i counter her email with "Until I'm trained I cannot perform this task" I'm going to get "Then you are not meeting the expectations" in return... Am I not meeting an employment expectation by making it clear that at this time I do not have enough skill for this task? Is this something I should be calling my licencing college about? If this task truly is a general RN skill (which is the arguement at this point, she states it is - I'm not so sure) then it would be my responsibility as a graduate with their degree to know this right?

Thanks for your reply. Let me rephrase the question. I have the theory, and I have the ability to perform the basic task. What I feel I lack (and i certainly can't be the only one) is the training to effectively link the two together in this specific scenario. I guess I am worried from an employment perspective, as I'm unsure when it is my responsibility as an RN to "just know" these things, or when I have a legitimate case to appeal to my employer and confidently request training before practicing a skill. I'm not going to lie, my boss is not the most compassionate leader around, and has a habit of making you feel like not only are you replaceable, but the your job in general is not important. I am definitely not the only RN here who feels pressured at times, and is hesitant to approach management with criticism. Not to mention jobs are extremely tight here for RNs and even just having PT somewhere is miles ahead of like 50% of nursing degree graduates. Is someone viewed as a liability to an employer if they basically say "I won't perform this task unless you train me first"? I realize this sounds bad, and I'm not at all about performing skills that I am not able to perform to some degree of confidence, but I guess I'm between a rock and a hard place. I don't want to get (basically stay at this point) on my employer's bad side - she already has a vandetta against me - but i definitely don't want to risk my licence.

To do something you're uncomfortable with/not trained for. I know this is an issue a lot of nurses face, and my issue may seem frivolous but I still wanted to get some opinions. Diabetic foot care... I've been working for 2 years, and have relatively little experience in this area (I work in LTC, we have previously used designated & trained people to fill this position). Recently over the last year or so they phased that position out and put the responsibility of diabetic patient foot care on the staff nurses, though we still usually manage to have our trained foot care nurses handle the worst cases. I have no problem cutting toenails (I know some people do and just won't do it). My issue is when my nursing manager tells me to use the last 4 hours of my shift to go around the building and do "basic foot care". We have PSWs that do the regular foot care, and if the resident has diabetes they can receive footcare by the applicable RN or by an in-home footcare clinic if they opt to pay for it. There is no standard differentiation between a "basic care" diabetic and a diabetic requiring specific services, aside from (possibly) those who need a dremmel for thickened nails and those who don't. This is the only separating line my employer seems to have drawn which apparently dictates when a certified foot care nurse is required (simply because an RN in my position cannot operate a dremmel). I brought a concern through email today that I felt uncomfortable (though I still followed direction, just did not do diabetics with obvious circulation/skin integrity issues) with this expectation. I feel that if you have a certified foot care nurse come perform diabetic foot care, that you're doing it for more than just the fact that they can legally use a dremmel. I asked if we could either get some training in this area or if they could just exclusively utilize nurses trained for this purpose. Is it reasonable to ask for training with this type of issue? My manager countered back to my concern with "you are expected to do basic foot care". I asked if she could clarify that... because I'm worried that, even with some theory and knowledge, doing even "basic footcare" on a compromised diabetic would better and more safely served through someone who has the skill and training. It's not that i don't have the confidence, I just realize my own limitations as a relatively new graduate who does not have comparatively as much experience as some of the veterans. Is my concern valid? This would definitely not be the first time we have been "expected" to do something we may not necessarily have training for. I've practically become an expert at "winging" it. It is starting to seem more and more that every time management is questioned we get ridiculed and shot down, so a lot of times it's easier to "just do it". Although I wish my nursing manager would put her license on the line for those of us she refuses to listen to when she "expects" us to do XY and Z as part of the job description.