So your boss/manager tells you...

[mikeb123]

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.

[Asystole RN]

If you are not comfortable with performing a patient task, have not been trained for, or believe that said task is outside of your professional skill level then it is your professional, and legal, obligation to inform your manager that you cannot perform said task.

Performing a task that you are not able to safely accomplish is not acceptable. There is a reason why the state licenses you and not the facility. Protection of the patients comes before protection of employment.

Be professional and kindly, and respectfully, inform your manager that you would like additional training and or education on performing said task.

[AgentBeast, MSN, RN]

Actually states license Nursing Homes too.

[mikeb123]

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.

[BrandonLPN, LPN]

There's a reason there are certifications for specific specialties like diabetic foot care, wound care, oncology, etc. Our general education (both RN and LPN) prepares us to be generalists, not specialists.

When I worked at the jail, we (LPNs) had to do "seg rounds" daily on inmates who were placed in segregation, usually for psych reasons. This "assessment" consisted of looking at the inmate through a small window and yelling questions through the door. We determined a baseline LOC and then asked them if they needed to be seen by nursing. Then we moved on to the next cell. Well, we had an inmate in segregation commit suicide. We LPNs were read the riot act because apparently we should have picked up on his suicidal tendencies during our "rounds". Please. If they wanted appropriate psych evaluation they should shell out the money for an actual psych staff. If the OP's facility wants professional foot care they need to provide the training. It's all about $$$$.

[iluvivt, BSN, RN]

I have a question > I know in Ca there are podiatry companies that go into nursing homes/SNFs and all they do is foot care and cut nails an other stuff as needed. The MD writes an order and then the podiatrist or their assistants set up a schedule for the pts. Once on the service the pt stays on the service until d/ced. A pt of mine owns one of these companies and she told me they usually see the pts every 3-4 weeks. They usually bill medicare and she told me this is a service covered by them. So these SNF do not lose or gain money but it certainly frees up the nurses . Can this be done there?

[Asystole RN]

Actually states license Nursing Homes too.

The state gives you your nursing license, not the facility.

Context.

[serenidad2004]

At the LTC facility I worked at we had a podiatrist that came in once every 6 weeks for all pts and more frequently if needed for some. Nursing staff did NOT clip toe nails because of the risk of wounds with compromised circulation and/or diabetes

[itsmejuli]

When I worked in LTC in Florida we were not allowed to do any footcare. We had a podiatrist that came in to do footcare, we just added people to the list for him to see. Same thing here in Alberta. Even trimming finger nails is risky.

If I was in your shoes I'd ask the manager why a podiatrist isn't coming in to do footcare.

[SHGR, MSN, RN, CNS]

When I worked in LTC in Florida we were not allowed to do any footcare. We had a podiatrist that came in to do footcare, we just added people to the list for him to see. Same thing here in Alberta. Even trimming finger nails is risky.

If I was in your shoes I'd ask the manager why a podiatrist isn't coming in to do footcare.

That was my experience, as well. Compromised circulation, tough nails- too many factors that could lead to osteo, loss of a foot, too risky.

[wish_me_luck, BSN, RN]

I agree with other posters. We learned that nurses typically do not do foot care (not for lack of wanting to but because of skin integrity issues, etc.) unless there is a physician order (then, it's cut nails across and file down with emery board). Podiatrists usually do it. I definitely would not do it, OP, just because the higher ups want it because it's your license not theirs if you do it and something happens.

[Cold Stethoscope]

The state gives you your nursing license, not the facility.

Context.

Nursing home administrators are not licensed by the state?

In Florida, the Long Term Care Unit of the Bureau of Health Facility Regulation licenses nursing homes.

In fact, in Florida, a massage establishment owner must get a massage establishment license.