Rant about toenails

I see it all the time. Even alert, oriented walkie-talkie patients come in with nasty nails.

It's such a weird thing, I agree. Toenails don't grow overnight, so why do some patients/families suddenly need their toenails trimmed STAT? Did they just notice it now?

We also have a policy against clipping toenails. We don't carry clippers in our Pyxis either. When I explain that to patients/families they get so confused any annoyed. They'll ask why we can't clip nails since its a basic thing to do. I usually smile and explain that they may bring clippers and trim the toenails themselves but sorry, we can't. If they want a podiatry consult then they will need to discuss that with the physician. I want to say if it's so basic, why aren't you doing it at home?

I had a woman come in with an awful UTI/pyelonephritis. When I pointed out that her one inch fake acrylic nails are probably harboring germs and contributing to her frequent infections, she looked at me horrified and asked, "can you take them off now?". No ma'am, I can't, but I recommend you go to your nail salon and get them removed after you leave here. The fact that she was scratching herself and never wanted to wash her hands after going to the bathroom wasn't helping her either.

Yes! This is asked of us even during short visits in the ER. Just no. Lol

Had a patient with NO past medical history in for respiratory distress following pneumonia, young and totally alert/oriented/capable, whose significant other asked if I could clip the patient's toenails.

Umm what? No. Even if I was allowed to (our hospital states it has to be done by a podiatrist regardless of diabetes or not), NO. If you are with it and steady enough to refuse a bed alarm and heparin/colace, you are with it enough to clip your own toenails.

Family is more than welcome to clip the patient's nails. Our facility does not allow the nursing staff to do so. Otherwise the physician needs to consult a podiatrist to do it. Usually the family will do it themselves after I explain that to them.

When my dad was ill, I was willing (not thrilled but it was more than my mom could handle with my father's devastating diagnosis, and I was the only other family member other than my then 5 year old) to trim his nails, even brought new toe & finger nail clippers. The poor new grad nurse was so hyper focused that she was not to clip nails while working she actually made me wait until she had a verbal order that family could perform nail care and cut nails. Her preceptor had a good chuckle. It was the opposite of the typical request of those posted above, so she wasn't sure what to do. I felt bad for stressing her out.... Though It was easier to do it in the hospital bed because the mechanics actually worked!

No clipping of nails on my unit, diabetic or not, family or otherwise. Family or pt may file nails with emery board if needed.

The reason. I work with severely pancytopenic pts undergoing aggressive treatment for leukemia. Most of my pts have no platelets to clot with and no neutrophils to protect them and aid them in healing from minor nicks.