Innovation Series: Advancing Foot Care Nursing in B.C. One Step at a Time, by Sandra Tetrault, RN

When Judy, a registered nurse, moved to B.C. in the late 1990’s, she arrived having taken a foot care course from a Podiatrist in Ontario. In fact, she had been practicing in Ontario as a foot care nurse for 10 years before moving to B.C. On her arrival to register with what was then the RNABC, they told her they had never heard of a foot care nurse working for herself. Judy set out to prove them wrong! She shortly met another R.N., Ruth who was a mobile foot care nurse locally, and together they started an interest group of about eight Foot Care Nurses.

Even within the nursing profession today, many nurses are unaware of what Foot Care Nurses do (although the title may sound obvious). Foot care nursing is not a new practice, and has been delivered for decades by the Victorian Order of Nurses. However, only within the last 15-20 years have nurses begun owning and operating their own foot care business.  Currently, any nurse regardless of designation (LPN, RN, RPN, and NP) who has completed a foot care course is considered a Foot Care Nurse. Most of these nurses own their own foot care business, providing clinical care, education and referrals in variety of settings including home care, senior centre clinics, assisted living and complex care facilities.

Clinical care typically involves nail care, and care for corns, calluses, dry or cracked skin, as well as short term padding for off-loading as needed until new shoes or a Pedorthist may be seen for orthotics.  We’re trained to assess diabetic patients for peripheral neuropathy using the monofilament test or tuning fork, provide education to patients, families and healthcare providers, assist in the prevention of foot issues, and make referrals to other healthcare professionals such as Wound Care Nurses, General Practitioners, Podiatrists, Pedorthists or diabetic clinics.

However, with the lack of established competencies, the quality of care being delivered has been an on-going issue within the foot care nursing community. While nursing has a long history of delivering foot care, ensuring nurses are providing the safest and highest quality of care while utilizing best practices has been difficult to do. Recognizing this issue, a group of nurses met in 2007 at a conference in Ontario and started Foot Care Canada with the goal of developing national guidelines for foot care nursing. In 2010, Foot Care Canada became the Canadian Association of Foot Care Nurses (CAFCN), with provincial and territorial advisors from each province.

Fast forward to spring 2015, CAFCN voted to hire two student nurses to gather information on the various foot care courses being taught across Canada. In the summer/fall of 2015, Dr. John Collins who had been contracted to facilitate the process of competency development asked members of CAFCN for volunteers to go through all of the competencies found in the foot care courses being taught across the country. Subsequently, the group identified a list of standard competencies for foot care nursing.

The group involved in this process consisted of nurses from all across Canada with varied nursing experience from varied foot care nurse career paths-many of us were educators in foot care programs. We met approximately weekly on "Google Hangouts" between October 2015 until April 2016 with Dr. John Collins as our facilitator. While it was a challenge for the nine of us to meet, considering our busy work schedules and time differences, we finished the competencies, and sent them out to 40 volunteers for peer review. Feedback back was subsequently reviewed, and a draft was developed.

Just a few months ago in May, the draft competencies were presented to the delegates at the CAFCN conference in Montreal, Quebec. With feedback from the conference delegates, the competency document is now currently being put together to be shared with external stakeholders before being finalized.

Some may ask: why bother with developing competencies in foot care? Well, first, they promote standardized foot care education across Canada. Currently courses range from anywhere from 8 to 180 hours, which has implications on the safety of patients. It also ensures that foot care nurses are following best practice guidelines, eliminates out-dated practices, and protects the public.  Last, it helps with looking to the future to regulation and certification of Foot Care Nurses.

Pioneers such as Judy and Ruth have truly advanced foot care nursing over the past 20 years. From owning their own foot care businesses to mentoring many new Foot Care Nurses, these retired nurses are still involved in the meetings of the Lower Mainland Foot Care Nurse Interest Group and continue to have a part in assisting new Foot Care Nurses. There have been so many positive changes within foot care nursing over the past two decades, and the nurses that have been involved in advancing this specialty have been true leaders and innovators. As we continue to see the development of foot care nursing competencies, I am sure we will enhance our ability to provide the highest quality and safest care possible.



Sandra has been practicing as a Foot Care Nurse for 8 years. She is a Certified Foot Care Nurse (CFCN) with the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB- U.S. Certification), and currently works as Foot Care Nurse Educator. She is the B.C. Advisor to CAFCN, ARNBC Network Lead for Foot Care Nursing, Co- Instructor for Foot Care Nursing programs at Vancouver Community College and Co- writer of online foot care nursing program for Camosun College, Victoria. She is also the owner of Healthy Feet Foot Care, and Co-Owner of Pededucation: B.C. Centre for Nursing Foot Care Education and Clinical.

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Cindy Lazenby

Excellent article Sandra!

Lorna Gail Proudfoot

Very much looking forward to the publication of competencies for nursing foot care. A template to review my practise, examine my skill base and plan my continuing education.
A very grateful thank you to the nurses and nurse educators for your commitment in developing competencies in our specialty of nursing foot care.