State Board of Nursing in regards to nail care

This is to summarize the declaratory statement on the role and scope of practice of the registered nurse in performing foot care interventions. Over 14 years ago the board of nurses published a 3 page document regarding foot care interventions and the role of the nurse. This was in response to a letter from the Louisiana state board of medical examiners regarding the practice of an RN employed by a diabetic foot clinic.

The board determined that there are 3 levels of care:
Basic: Level 1, intermediate: Level 2 and advanced: Level 3.

Level 1: means hygiene, comfort and patient education interventions provided to patients that have intact skin, toe nails of normal length and thickness, and normal sensation. After a Nursing assessment, level one tasks can be delegated to an LPN or CNA.

Level 2: require a doctor’s order and may be provided by an RN who has specialized knowledge and training and experience. Intermediate foot care provides:
Diabetic foot screening, Toe nail trims, wound care and care of non painful corns and calluses, evaluation of footwear and referral for treatment of a disease and for corrective footwear devices.

Level 3:Advanced means prompt nursing interventions of specific foot complications for patients who have impairments in function, circulation and sensation. Such as paring of painful corns and/or calluses; wound care management and referral. The foot care interventions of this level are reserved for the advanced practice registered nurse or physician for treatment of infections and partial excision of nail plate for an ingrown toenail.

Registered nurses who are currently certified by a national certifying body such as wound care nurses are allowed to perform wound care management and paring of painful corns and calluses.

Concluding statement:
The board believes that foot care is an integral part of providing care supportive to or restorative of life and well being and that intermediate foot care is a part of executing health care regimens as prescribed by licensed physicians. Therefore, the provision of basic and intermediate foot care is clearly with in the scope of practice of professional nursing. Intermediate foot care requires additional education due to the knowledge needed to assess Level 2 patients and the nature of skills. Where as advanced foot care denotes an even higher level of competence as demonstrated by national certification that encompasses foot care.

And finally:
The majority of home care clients require basic and intermediate levels of foot care. The goals are to educate the client or their care giver in regards to proper foot care, maintain toenails of normal length and thickness, smooth calluses, promote skin integrity and education to prevent skin ulcers or injuries.