Nurse Education

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.

4. Find and successfully complete a foot care course* that matches the exam content from your chosen certification board (WOCNCB Exam Content / AFCNA Exam Content).

*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.

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.

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:

6. Apply online for the certification exam (WOCNCB / AFCNA) and pass.

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

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 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.

Hands-on-Training:

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.

WOCNCB has a database for CFCN preceptors, which is new as of 2021. CFCNs can opt in here.

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

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 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.

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)