Nurse Education

How to Become a Foot Care Nurse

Foot Care Continuing Education and Clinical Hours / Hands-on-Training

Regulations Regarding Foot Care Performed by Nurses

Criteria for Qualification of CE Programs/Offerings and Mandatory CE Requirements

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, an order, etc.).

2. Map out your work opportunities. Contact your local Council of Aging or Aging Services Access Points (ASAP) and 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, churches, and home care. Long term care and rehab (skilled nursing) facilities will usually have a podiatrist, but it's good to check if there's a need for help or additional help, especially if there are residents who aren't eligible for CMS or insurance billing. If you're going to work for a podiatrist, you will skip most of these steps and focus on education, training with the podiatrist, and getting certified.

3. Make a list of everything you need for your initial set-up, as well as supplies that need monthly reordering. Because much of this work is independent or subcontracted, you are responsible for all of your tools/instruments, equipment, supplies, etc. Start-up is expensive; maintenance is too. Additionally, ask your insurance agent about general liability insurance and discuss your business type and/or tax requirements with your CPA. If you are going to work independently (versus as a subcontractor for an existing foot care business), determine State/local fees for registering as a business, and explore the cost of a domain and website or advertising in local senior center newsletters.

4. Make a business plan. Combine the information from steps 2 and 3 to compare your projected income and expenses. Is it worth it?

5. Choose a foot care certification board based on your eligibility. If you have any bachelor degree, choose WOCNCB. If you have an associate degree, your option is AFCNA. Not all States require certification (but it's still a good idea). If your State requires certification, contact your State Board of Nursing to find out which certification is accepted.

a. Wound, Ostomy, and Continence Nursing Certification Board (WOCNCB) to become a Certified Foot Care Nurse (CFCN)

-Publicly verifiable certification database (NCCA accreditation Standard 9A*)

-Separate entity from Wound, Ostomy, and Continence Nurses Society (NCCA accreditation Standard 2D*)

b. American Foot Care Nurses Association (AFCNA) to become a Certified Foot Care Specialist (CFCS)

-No publicly verifiable certification database (against NCCA accreditation Standard 9A**)

-Provides both education towards the certification and certification (against NCCA accreditation Standard 2D - conflict of interest**)

The National Commission for Certifying Agencies (NCCA) as well as the Accreditation Board for Specialty Nursing Certification (ABNSC) provide accreditation to certifications, but the Standards include certification board structure. The Standards are set to avoid bias and promote excellence.

*WOCNCB is accredited by the ABNSC and the NCCA for their CWOCN, CWCN, CWON, COCN, and CCCN certifications, however the CFCN certification is not accredited. WOCNCB, as a certification board, follows the NCCA Standards, which allows for high quality certification.

**AFCNA is not accredited by the ABNSC or the NCCA for their CFCS certification and is missing at least two NCCA Standards (i.e. no certification database and combined education and certification board). All education has value and is worth exploring, especially if it is affordable or free. However, certification boards should not be involved in the continuing education leading to certification. Avoid using the AFNCA webinars for your State's continuing education requirement, but take advantage of any and every opportunity for additional knowledge.

6. Find and successfully complete a foot care course* that matches the exam content from your chosen certification board (WOCNCB Exam Content / AFCNA Exam Content) and follows your State's CE/foot care education requirements.

For additional foot care information that may or may not apply to the US, review Canada's certified foot care nurse standards to decide what might apply to your practice.

*States have varying requirements for acceptable Continuing Education (CE). Some States have little to no requirements for CE, while other States require CE from their own approved Providers. The American Nurses Credentialing Center (ANCC) provides accreditation to Providers and Approvers of CE activities. Most, if not all, States that require CE hours will accept CE activities that are provided or approved by ANCC accredited Providers or Approvers. Verify your State's CE 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 CE/foot care education requirements to determine acceptable providers.

7. Find a preceptor who is a foot care professional who provides routine foot care (ideally a DPM). Complete 30 (AFCNA) to 40 (WOCNCB) clinical hours. Maintain this foot care professional as a mentor for the remainder of your career. Best practice tip: If you can't get direct patient care with a DPM, additionally shadow with a DPM for as many hours as possible (ideally 40 hours).

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:

8. Apply online for the certification exam (WOCNCB / AFCNA), take the exam, and pass.

9. Determine your infection control policies and procedures, purchase your tools and instruments, determine your documentation process (paper vs. electronic), and get professional liability insurance.

10. Start work.

Foot Care Continuing Education and Clinical Hours / Hands on Training

Online Courses:

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 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 Education for your State.

I recommend Emory Nursing's online Foot and Nail Care Course. They are an ANCC Accredited CE Provider. It may seem wound-heavy, but it prepares you very well for the CFCN exam. Read and re-read the suggested reading and review the end of chapter quizzes multiple times.

Emory suggested reading: Doughty, D. B. & McNichol, L. L. (Eds.). (2016). Wound, Ostomy and Continence Nurses Society® Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer. (The Kindle version is most convenient.)

Also consider: Armstrong, D. G. & Lavery, L. A. (Eds.). (2016). Clinical Care of the Diabetic Foot. (3rd ed.). Alexandria, VA: American Diabetes Association.

More course recommendations coming soon. Will be from ANCC accredited Providers or Approvers.

Clinical Hours / Hands-on-Training:

Rainier Medical in Washington offers hands-on-training in Issaquah, WA. FootCare by Nurses in Greenfield, MA offers precepting. University of Wisconsin-Eau Claire offers a hybrid program with clinical hours 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.

WOCNCB has a database for CFCN preceptors, which is new as of 2021. CFCNs can opt in here. AFCNA is starting a list of those who want to become preceptors. Contact AFCNA to become a preceptor.

Cape Cod Foot Care does not provide clinical hours / hands on training.

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 for foot and nail care, it is not within your scope of practice to perform foot and nail care.

Foot care may be allowed, require an order, or not allowed. Education and training may need to be "appropriate", "specialized", or "nationally accredited". Certification may or may not be required. Some States consider this a legal issue and refuse to give specific direction, while others direct exactly what foot care actions may be taken.

The purpose of a State's Board of Nursing is to protect the public and they create Advisory Opinions, Rulings, Guidelines, etc. to ensure nurses stay within their scope of practice, but some States aren't as specific. In these cases, we know it is also our job to protect the public. Regardless of certification requirements, nurses must have education and training specific to foot care.

Certification Boards have the expertise to determine what concepts nurses should know, or be skilled in, to be considered competent. Certification is verification that you are compliant with State regulations, you are acting within your scope of practice, and you value your clients' well-being.

Below is a list of States and a starting point for your research. Contact your State Board of Nursing for confirmation/clarification.

Alabama - Approved Standardized Procedures

Alaska - Advisory Opinions: Scope > Scope foot care

Arizona - Advisory Opinion

Arkansas - Nurse Practice Act and Decision Making Model

California - Understanding the Role of the Registered Nurse

Colorado - Board of Nursing > Scope of Practice Algorithm

Connecticut - Nursing Scope of Practice questions (860) 509-7555

Delaware - Board of Nursing > Scope of Practice

Florida - Petition for Declaratory Statement

Georgia - Scope of Practice Decision-Making Model

Hawaii - Scope of Practice Decision Making Framework

Idaho - Rules of the Board > 04. Practice > a. Perform Acts. (p. 17)

Illinois - State of Illinois Nursing Rules > Joint Committee on Administrative Rules > RN Scope of Practice

Indiana - Frequently Asked Questions > Statutes and Rules and Indiana Administrative Code > Article 2. Standards for the Competent Practice of Registered and Licensed Practical Nursing

Iowa - Iowa Administrative Code pending response

Kansas - NPA by Statute or Rules and Regulations > Requirements for Licensure and Standards of Practice > Standards of practice pending response

Kentucky - Advisory Opinion Statement

Louisiana - Scope of Practice > RN Scope of Practice Guidelines

Maine - Practice > Scope of Practice Decision Tree

Maryland - Proposed Concepts for Possible Regulation

Massachusetts - Advisory Ruling

Michigan - no specific nurse practice act - Public Health Code, Public Health Code (Excerpt), and Board of Nursing - General Rules

Minnesota - Scope of Nursing Practice Decision-Making Framework

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

Nebraska - Advisory Opinion: Safe Practice: Nursing Roles and Assignments: Competency and Nurse Licensing Scope of Practice

Nevada - Practice Decision Request and Scope of Nursing Practice Decision Making Framework

New Hampshire - Scope of Practice and Position Statement

New Jersey - Decision-Making Model Algorithms

New Mexico - Practice Acts > Nursing Practice Act

New York - Practice Information, requires an order, and restrictions apply, contact NURSEBD@nysed.gov

North Carolina - Scope of Practice Decision Tree, Practice, and Position Statement

North Dakota - Scope of Nursing Practice Decision-Making Framework

Ohio - Practice RN & LPN > RN and LPN Decision Making Model and The Nurse Practice Act - Ohio Revised Code (ORC) pending response

Oklahoma - Guidelines, Position Statements > Decision-Making Model for Scope of Nursing Practice Decisions

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

South Dakota - Practice and Delegation Decisioning Guides > Scope of Nursing Practice Decision-making Framework

Tennessee - Nursing Practice Code and Rules > Standards of Nursing Competence and Position Statements > Decision making Guidlines (pp. 19-20)

Texas - Decision Making for Determining Nursing Scope of Practice and Scope of Practice Decision‐Making Model

Utah - R156-31b-703b. Scope of Nursing Practice Implementation and Section 801 Practice within limits of competency

Vermont - Nurse Practice Act and APRN/RN/LPN Scope of Practice plus Decision Tree

Virginia - Nurse Practice Act and Decision Making Model

Washington - Decision Tree

West Virginia - Scope of Practice for Licensed Nurses

Wisconsin - Standards of Practice for Registered Nurses

Wyoming - Advisory Opinion RN Scope of Practice and Decision Making Model

Criteria for Qualification of CE Programs/Offerings and Mandatory CE Requirements:

The American Nurses Credentialing Center (ANCC) gives accreditation to Providers and Approvers of Continuing Education (CE). State regulations may or may not require that a CE 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.

Most, if not all, foot and nail care programs will have specific CE hours assigned to the courses. As such, these courses must be treated as CE and therefore follow your State's CE requirements. Remember: foot and nail care practice is based on your State's requirements, not the certification boards', which will accept CE that is not approved or provided by a nationally accredited entity.

Determine your State's requirement for CE so you are compliant with your practice (table reference - requires verification). Some States don't require CE for license renewal and therefore do not have criteria for qualification of CE programs and offerings. Nurses in these states (Arizona, Colorado, Connecticut, Idaho, Indiana, Maine, Maryland, Mississippi, Missouri, South Dakota, Vermont, Wisconsin) should select CE programs/offerings that are provided/approved by ANCC accredited Providers/Approvers, as a best practice.

Below is a list of States and a starting point for your research.

Alabama - CE requirement, Prorated CE chart, ABN CE Providers, Approved CE

Alaska - Nursing Statutes and Regulations, ARTICLE 6. CONTINUING COMPETENCY.

Arizona - RN Renewal Requirements

Arkansas - ASBN - CONTINUING EDUCATION, SECTION VII CONTINUING EDUCATION, ASBN - APPROVED CERTIFICATIONS, ASBN - ACCREDITING ORGANIZATIONS

California - Continuing Education for License Renewal, Courses Approved by Other Entities

Colorado - RN License Renewal

Connecticut - APRN Continuing Education

Delaware - Continuing Education and Audit Information, 9.0 Rules and Regulations Pertaining to Mandatory Continuing Education,

Florida - Continuing Education (CE/CEU) Requirements, BOARD APPROVED PROVIDERS

Georgia - CONTINUING EDUCATION REQUIREMENTS, Acceptable Providers for Continuing Education

Hawaii - CONTINUING COMPETENCY REQUIREMENT, CONTINUING COMPETENCY (including CE)