How to Become a Foot Care Nurse
Review the requirements for your state below and consider these steps:
1. Determine if your State allows nurses to perform routine foot care and what conditions are required to perform foot care (e.g. completion of education and training, certification, working with a podiatrist, an order, etc.).
If nurses are allowed to perform foot care in your State:
2. Contact your local Council of Aging or Aging Services Access Points (ASAP). Ask if there are current foot care programs/clinics being offered and if there is a need for additional foot care services. Other areas for potential foot care needs include elderly housing communities, independent/assisted living/memory care facilities, and churches. Long term care and rehab (skilled nursing faculties) will usually have a podiatrist, but it's good to check if there's a need for help or additional help.
3. Choose a foot care certification board based on your eligibility and preference. This will determine the focus of your foot care content.
a. Wound, Ostomy, and Continence Nursing Certification Board (WOCNCB) to become a Certified Foot Care Nurse (CFCN)*
b. American Foot Care Nurses Association (AFCNA) to become a Certified Foot Care Specialist (CFCS)*
*Neither the WOCNCB nor the AFCNA are accredited by the Accreditation Board for Specialty Nursing Certification (ABNSC) and/or the National Commission for Certifying Agencies (NCCA) for their CFCN / CFCS certifications. However, the WOCNCB CFCN certification is a national certification that is currently included in the Demographic Data Collection Tool® (DDCT) maintained by the ANCC Magnet Recognition Program® (relevant to health care facilities). The WOCNCB may include the CFCN certification in their ABNSC/NCCA accreditations in the future.
*Continuing Education (CE) / Continuing Nursing Education (CNE) / Nursing Continuing Professional Development (NCPD) has varying definitions of acceptable providers depending on the State. Because I may suggest nationally accessible programs/offerings, I also point out programs that may or may not be accepted by every State. Some States have little to no requirements for CNE, while other States require CNE from their own approved Providers. The American Nurses Credentialing Center (ANCC) provides accreditation to Providers and Approvers of NCPD/CE activities. Most States that require CNE hours accept CNE activities that are provided or approved by ANCC accredited Providers or Approvers. Verify your State's CNE requirements below. Practicing as a Foot Care Nurse is dependent on your State, whereas becoming certified is dependent on the certification board. Follow your State's Board of Nursing CNE requirements to determine acceptable CNE providers.
5. Find a preceptor who is a foot care professional who provides routine foot care. Complete 20-40 hours of hands-on-training. Maintain this foot care professional as a mentor for the remainder of your career.
If certification is required by your State, you want to advance the credibility of this nursing specialty, or you want to show your clients you have the knowledge and skills to perform safe, competent care:
7. Determine your infection control policies and procedures, purchase your tools and instruments, determine your documentation process (paper vs. electronic), and get professional liability insurance.
If you have any specific questions, please email me (Kristen).
Foot Care Continuing Education Hours and Hands-on-Training
There are many options for online foot care related nursing education. Whichever source you choose, make sure the content matches the certification exam content (WOCNCB Exam Content / AFCNA Exam Content), even if you decide to not get certified. These two certification bodies are the leading experts on what knowledge and skills are required for competent and safe routine foot care. Also, verify that the content of the activity is accepted as Continuing Nursing Education for your state.
If you prefer to follow WOCNCB standards, I recommend Emory Nursing's online Foot and Nail Care Course. They are an ANCC Accredited CE Provider. The Wound, Ostomy and Continence Nurses Society® Core Curriculum: Wound Management book contains the core content for the WOCNCB exam content and is suggested reading for the Emory course.
If you prefer to follow AFCNA standards, AFCNA offers no-cost webinars* (California Board of Registered Nursing approved Provider). I've linked an old registration, but signing up should put you on an automatic mailing list for future webinars. Another option is Rainier Medical Education Programs, which offers non-credit videos so you can better understand foot care nursing, as well as videos for certification eligibility* (California Board of Registered Nursing approved Provider). Additionally, the University of Wisconsin-Eau Claire offers their Foot & Nail Care Expanded Online Education course, which has been approved by WOCNCB and AFCNA.*
*AFCNA, Rainier Medical, and University of Wisconsin-Eau Claire are not ANCC Accredited CE Providers nor are the offerings approved by ANCC Accredited CE Approvers. If you know of any status updates, please email me.
Making Your Own Course. As long as the Continuing Education offering is approved by your state, you can make your own foot and nail care course. Look for packages that allow for all courses for one price. For example, NetCE is a Jointly Accredited Provider and offers all of their courses for an affordable cost. Western Schools is another ANCC Provider that offers a membership for access to all courses. Follow the WOCNCB or AFCNA blueprints to create your own foot and nail care course. Course suggestions coming soon. I also recommend additional reading:
Armstrong, D. G. & Lavery, L. A. (Eds.). (2016). Clinical Care of the Diabetic Foot. (3rd ed.). Alexandria, VA: American Diabetes Association.
Doughty, D. B. & McNichol, L. L. (Eds.). (2016). Wound, Ostomy and Continence Nurses Society® Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer.
Check with your state Board of Nursing to verify if programs or offerings are accepted as continuing education. Certain criteria must be met for continuing education to be accepted by your State. Some State Boards of Nursing will accept other State's Boards of Nursing approved Providers, others will not. Look for your State's Board-approved providers of CNE.
Always seek out the latest updates. Every so often, certification boards will survey certified foot care nurses to review new trends and needs for foot care. These reviews may change their recommendations for knowledge and skills required to perform competent and safe care. Stay up to date and informed on their recommendations by reviewing their exam content.
Rainier Medical in Washington is offering hands-on-training in Issaquah, WA. FootCare by Nurses in Greenfield, MA offers hands-on-training. University of Wisconsin-Eau Claire offers hands-on-training in Eau Claire, WI. I highly recommend training with a podiatrist in your area who you can refer clients to if the foot care becomes advanced. Spending some hours with a wound care podiatrist is very helpful as well.
Cape Cod Foot Care does not provide hands on training, but I highly recommend training with a podiatrist who focuses on routine foot care, as well as a wound care podiatrist, both in your area so you have local resources.
Regulations Regarding Foot Care Performed by Nurses:
Most States have adopted a position that follows the Scope of Nursing Practice Decision-Making Framework. After reviewing your State's Nurse Practice Act and other Rules/Regulations that may prohibit specific actions, if you have not had the education and training, it is not within your scope of practice to perform foot and nail care. Some States require certification, some States require evidence of education and training, most States use the above referenced framework (which calls for education and training), and some States have limited the foot care services that nurses can perform. Contact your State Board of Nursing for confirmation/clarification. Many States consider this a legal issue and refuse to give specific direction; at least one state requires an order to perform foot and nail care (New York), while another does not allow nurses to perform routine nail care (Rhode Island).
Most States do not declare the specifics of what a nurse can or cannot do, but will in cases where it puts the public in danger. The purpose of a State's Board of Nursing is to protect the public. It is our job as nurses to protect the public as well. Certification Boards have the expertise to determine what concepts nurses should know, or be skilled in, to be considered competent. Regardless of certification requirements, nurses must have education and training. Certification is verification that you are compliant with State regulations and value your clients' well-being.
Below is a list of States and a starting point for your research.
Alabama - Approved Standardized Procedures
Arizona - Advisory Opinion
California - Understanding the Role of the Registered Nurse
Connecticut - Nursing Scope of Practice questions (860) 509-7555
Florida - Petition for Declaratory Statement
Georgia - Scope of Practice Decision-Making Model
Idaho - Rules of the Board > 04. Practice > a. Perform Acts. (p. 17)
Iowa - Iowa Administrative Code pending response
Kentucky - Advisory Opinion Statement
Maryland - Proposed Concepts for Possible Regulation
Massachusetts - Advisory Ruling
Mississippi - Frequently Asked Questions (FAQs) > Wound & Foot Care > Can a RN perform nail/foot care?
Missouri - Scope of Practice Decision Making Model
Montana - Scope of Practice
New Jersey - Decision-Making Model Algorithms
North Dakota - Scope of Nursing Practice Decision-Making Framework
Oregon - Interpretive Statements, Policies, and Information Regarding Nursing Practice > All Licensed Nurses > Foot Care Provided by RNs and LPNs
Pennsylvania - Board Laws & Regulations, pending response
Rhode Island - Outside nursing scope of practice per Rhode Island Board of Nurse Registration and Nursing Education (401)222-1741
South Carolina - Advisory Opinion # 57
Washington - Decision Tree
West Virginia - Scope of Practice for Licensed Nurses
Wisconsin - Standards of Practice for Registered Nurses
Criteria for Qualification of CNE Programs/Offerings and Mandatory CNE Requirements:
The American Nurses Credentialing Center (ANCC) gives accreditation to Providers and Approvers of Continuing Nursing Education (CNE). State regulations may or may not require that a CNE program or offering is provided or approved by these entities, however courses that are provided or approved by these entities undergo peer evaluation and have set standards for high quality nursing education. Quality Matters is an additional certification body that ensures high quality online education.
Determine your State's requirement for CNE so you are compliant with your practice (table reference - requires verification). Some states don't require CNE for license renewal and therefore do not have criteria for qualification of CNE programs and offerings. Nurses in these states (Arizona, Colorado, Connecticut, Indiana, Maine, Maryland, Mississippi, Missouri, South Dakota, Vermont, Wisconsin) should select CNE programs/offerings that are provided/approved by ANCC Providers/Approvers.
Below is a list of States and a starting point for your research.
Arizona - RN Renewal Requirements
Colorado - RN License Renewal
Connecticut - APRN Continuing Education
Indiana - Continuing Education Requirements
Maryland - License Renewal
Minnesota - Continuing Education
Missouri - RN License Renewal
New York - License Requirements: Registered Professional Nursing, Baccalaureate or higher degree requirement (post 12/18/17), Office of the Professions -Training & Continuing Education, Mandated Training Related to Infection Control, Podiatry (topics to consider for independent study)
Rhode Island - Outside scope of nursing practice.
South Dakota - minimum practice requirement
Vermont - § 1624. Registered nurse license renewal
West Virginia - Continuing Education (CE)
Wisconsin - N 2.40 Renewal
Wyoming - Renewals