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 coursethat 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.

 

AlabamaApproved Standardized Procedures
 

AlaskaAdvisory Opinions: Scope > Scope foot care
 

Arizona - Advisory Opinion
 

Arkansas - Nurse Practice Act and Decision Making Model
 

California - Understanding the Role of the Registered Nurse

ColoradoBoard of Nursing > Scope of Practice Algorithm
 

ConnecticutNursing Scope of Practice questions (860) 509-7555
 

Delaware - Board of Nursing > Scope of Practice
 

FloridaPetition for Declaratory Statement
 

GeorgiaScope of Practice Decision-Making Model
 

HawaiiScope of Practice Decision Making Framework
 

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

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

IndianaFrequently Asked QuestionsStatutes and Rules and Indiana Administrative CodeArticle 2. Standards for the Competent Practice of Registered and Licensed Practical Nursing

IowaIowa Administrative Code pending response
 

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

 

KentuckyAdvisory Opinion Statement 
 

LouisianaScope of PracticeRN Scope of Practice Guidelines 
 

Maine - PracticeScope of Practice Decision Tree 
 

MarylandProposed Concepts for Possible Regulation
 

Massachusetts - Advisory Ruling
 

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

MinnesotaScope of Nursing Practice Decision-Making Framework 
 

MississippiFrequently 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


NevadaPractice Decision Request and Scope of Nursing Practice Decision Making Framework


New HampshireScope of Practice and Position Statement


New JerseyDecision-Making Model Algorithms


New Mexico - Practice Acts > Nursing Practice Act 


New YorkPractice Information, requires an order, and restrictions apply, contact NURSEBD@nysed.gov


North CarolinaScope of Practice Decision Tree, Practice, and Position Statement
 

North DakotaScope of Nursing Practice Decision-Making Framework 
 

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

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

OregonInterpretive Statements, Policies, and Information Regarding Nursing Practice > All Licensed Nurses > Foot Care Provided by RNs and LPNs


PennsylvaniaBoard 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 CarolinaAdvisory Opinion # 57  
 

South DakotaPractice and Delegation Decisioning GuidesScope 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) 
 

TexasDecision 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 VirginiaScope 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 
 

AlaskaNursing Statutes and RegulationsARTICLE 6. CONTINUING COMPETENCY

Arizona - RN Renewal Requirements 

ArkansasASBN - CONTINUING EDUCATION, SECTION VII CONTINUING EDUCATIONASBN - APPROVED CERTIFICATIONSASBN - ACCREDITING ORGANIZATIONS 

CaliforniaContinuing Education for License RenewalCourses Approved by Other Entities 

Colorado - RN License Renewal 
 

Connecticut - APRN Continuing Education 
 

DelawareContinuing Education and Audit Information9.0 Rules and Regulations Pertaining to Mandatory Continuing Education

FloridaContinuing Education (CE/CEU) RequirementsBOARD APPROVED PROVIDERS 

GeorgiaCONTINUING EDUCATION REQUIREMENTSAcceptable Providers for Continuing Education 

HawaiiCONTINUING COMPETENCY REQUIREMENTCONTINUING COMPETENCY (including CE)

Idaho - RN RenewalRN continuing education, Belief Statement
 

IllinoisContinuing Nursing EducationIllinois RN Continuing Education Frequently Asked Questions (FAQs) 

Indiana - Continuing Education Requirements 

IowaCE Basic RequirementsWhat Continuing Education Qualifies?

KansasContinuing Nursing EducationCNE Long-Term ProviderIndividual Offering of Approval (IOA)

 

KentuckyCE/Competency - Approved/Accepted CE Providers, Licensure Renewal Requirements 

LouisianaRenewals/Continuing EducationCE BrochureNational Nursing Certification Recognized by LSBN for CEs

Maine - Renewals, License Renewal
 

Maryland - License Renewal 
 

Massachusetts - Mandatory Continuing Education for nurses244 CMR 5.00: CONTINUING EDUCATION

MichiganBureau of Professional Licensing Nursing FAQs 

MinnesotaContinuing Education

Mississippi - Nursing Practice Act > License Renewal - RN evidence of continuing basic nursing competencies (5 years) 

 

Missouri - RN License Renewal 
 

MontanaMontana Board of Nursing RN24.159.2101 STANDARDS FOR CONTINUING EDUCATIONContinuing Education FAQs 

NebraskaNurse Licensing Renewal And Continuing Education 


NevadaContinuing EducationContinuing Education Regulations – Administrative Code Chapter 632 


New HampshireContinuing Education Requirements / Nur 403.01 Continuing Education Requirements for LPN, RN and APRN / Nur 403.04 Method of Calculation of Contact Hours for Individualized Learning 


New JerseyFrequently Asked Questions - Continuing Education (CE) 


New MexicoContinuing EducationContinuing Education Offered by Providers of Continuing Education 


New YorkLicense Requirements: Registered Professional NursingBaccalaureate or higher degree requirement (post 12/18/17)Office of the Professions -Training & Continuing EducationMandated Training Related to Infection ControlPodiatry (topics to consider for independent study) 


North CarolinaContinuing Competence RequirementsAcceptable Providers for Continuing Education 

North DakotaContinuing Education for Licensure RenewalApproved Continuing Education (CE) for Renewal FAQ 
 

OhioLicensing, Certification & Continuing EducationContinuing Education (CE) For Renewal 
 

OklahomaMeeting Requirements for Continuing Qualifications for Practice for License Renewal Guidelines 
 

OregonPain Management Continuing Education (CE) 


PennsylvaniaContinuing Education Requirements for RenewalFAQs ON MANDATORY CONTINUING EDUCATION (CE)
FOR REGISTERED NURSES
 
 

Rhode Island - Outside scope of nursing practice.
 

South CarolinaContinuing Nursing Education & CompetencyCompetency Requirements - CONTINUING NURSING EDUCATION CONTACT HOURS 
 

South Dakotaminimum practice requirement 
 

TennesseeContinuing EducationContinued Competence Requirements 
 

TexasEducation - Continuing Competency RequirementsWhat CNE is Acceptable? 
 

UtahFrequently Asked QuestionsContinuing Nursing Education Resources (ANCC)


Vermont§ 1624. Registered nurse license renewal 

 

VirginiaPractitioner ResourcesContinued Competency - RN/LPN 
 

WashingtonNurse LicensingOptions and Acceptable Documentation of Continuing Competency RequirementsContinuing
Competency FAQ’s

 

West VirginiaContinuing Education (CE)
 

Wisconsin - N 2.40 Renewal 
 

WyomingRenewals