Cape Cod Foot Care

Review the requirements for your State below and consider these steps:

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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.).

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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. 

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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 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.

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4. Make a business plan. Combine the information from steps 2 and 3 to compare your projected income and expenses. Starting a business is an investment. High quality work is more than your knowledge and skill set. It includes high quality supplies, tools, and equipment, as well as proper tool processing and the time commitment beyond the visit. Do the research on tool processing. Proper disposal of chemicals is expensive. Regardless of type of tool processing, the CDC recommends a separate set of tools for each client seen off-site so that tools are processed appropriately. How many clients will you see in a day? How detailed do you want your work to be? More detail means more burrs. 

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My business plan was (was = MLA) to bridge the gap between manicurist and podiatrist. Manicurists can't work on fungal nails in Massachusetts and podiatrists (due to time constraints) aren't able to provide detailed work, or the visit may not be covered by CMS or health insurance, which can be a very expensive visit. I started up an office, which was becoming very successful until I had to close it. Office visits will bring in primarily ambulatory clients who tend to do well with self-care. Detailed work can be done in 30-45 minutes. After I closed my office, I focused on home visits, which take 60-90 minutes for several reasons. The first reason is that clients who find it difficult to get out to see a podiatrist may also have trouble with self-care and be more prone to fungal nails or excess dead skin build up, which will take more time to resolve. Setting up and packing up also takes additional time. Finding a working outlet for your vacuum can add to the time. If the client isn't ready or needs a break will add more time. Time spent driving between clients also means you will see less clients for the day. For these reasons, home visits cost more than office visits. 

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The foot and shoe assessment, client education, and recommendations are important for every visit. But the detail of actual foot care varies between nurses. For some foot care nurses, it may just be about getting the nails short so feet can fit in shoes and nails don't cut into the skin, which is the fundamental reason for foot care. For me, it was also about helping clients' feet feel good and look good. You can get a nail short and call the job done. You may spend additional time thinning the nail so it doesn't rub on the top of the shoe. How much you thin it takes time due to heat build-up. And going further, it takes time to carefully remove cuticle build up that's so severe that it can be mistaken for the nail plate. Then there's calluses, corns, and dead skin build up.

A thorough job takes time, focus, and effort. You can do the job just shortening the nails and providing some nail thinning - but - you still need separate tools for each client. See the Instrument Processing page for more information. If you can't properly clean your tools and properly disinfect them, while having an approved method of disposal for the high level disinfectant, you should have multiple sets of tools. And if you use a high speed rotary drill (electric nail file or podiatry drill - never a Dremel tool), you need a vacuum with at least a HEPA filter. Every job, thorough or not, requires the right tools and equipment.

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I loved my work. I miss it and I miss my clients. I had a passion for high quality foot care, so my work was very detailed and thorough. I hope at the very least that you do the research for yourself; verify what educators or supervisors are teaching you. Strive for lifelong learning and follow your nursing pledge: to "...do all in my power to maintain and elevate the standard of my profession... and devote myself to the welfare of those committed to my care".

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If you think you can make a living while following your pledge, continue to the next step.

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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**)

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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. 

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**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.

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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.

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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.

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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).

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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:

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

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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.

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10. Start work.

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