Advanced Footcare

This document outlines practice expectations for registered nurses (RNs), licensed practical nurses (LPNs), and nurse practitioners (NPs) whose practice includes advanced footcare¹. In this document, the term nurse applies to NPs, RNs, and LPNs.

Nurses provide advanced footcare in a variety of practice and employment settings, including self-employment. Nurses who include advanced footcare as part of a self-employed practice should also consult the College’s document(s) related to self-employment, which outline considerations such as consent, advertising, record keeping, duty to report, liability protection, and insurance.

The foundational knowledge needed by nurses to perform basic foot care is part of entry-level nursing education for RNs and LPNs. The competencies required to perform advanced footcare, however, are not currently included in the entry to practice nursing education programs in Newfoundland and Labrador. Thus, to practice advanced footcare, nurses must seek out additional formalized education² and practice experience specific to the foot and lower limb.

Nurses who engage in activities related to advanced footcare are responsible and accountable for knowing and understanding their requirements in the following areas:

Scope of Practice

• Nurses must have the necessary knowledge, skills, judgement, and individual competence required to practice advanced foot care safely, competently, and ethically.
• Nurses practice within the limits of their individual scope of practice.
• Nurses apply evidence-informed best practices (e.g., utilize an evidence informed assessment tool) when assessing, planning, implementing, and evaluating clients’ needs for foot care. They are accountable to apply these practices correctly and in the best interest of the client.
• Nurses must have knowledge of, and use only, equipment approved, licensed, or intended for medical use and designed for use on humans (e.g., rotary device and accessories).
• Nurses are expected to seek professional development opportunities to maintain and enhance competencies in advanced foot care.
• Nurses must seek education and training related to reprocessing of equipment/devices that are appropriate to the volume and complexity of the equipment used.

Infection Prevention and Control

• Nurses follow routine infection prevention and control practices.
• Nurses must perform a risk assessment to determine the requirement for additional infection prevention and control precautions (e.g. appropriate use of personal protective equipment).
• Nurses must be able to differentiate between the foot care procedures and/or treatments requiring clean versus sterile instruments.
• Nurses must adhere to best practices and relevant national guidelines for safe use, cleaning, disinfection, and sterilization of instruments and the workplace environment. They must be knowledgeable of principles of infection prevention and control as they relate to foot care practice, instruments, and equipment, and the safe use, care, and maintenance of non-critical and critical instruments for foot care.
• Nurses must ensure reprocessing of reusable foot care equipment/devices is guided by best practice guidelines and meets manufacturers’ instructions for use (MIFU), current national guidelines such as Canadian Standards Association (CSA), the Public Health Agency of Canada (PHAC/Health Canada), and provincial standards.
• Nurses are expected to safely use, care for, maintain, and perform quality controls for ultrasonic cleaner and autoclave units for the purpose of critical instrument cleaning, disinfection, and sterilization.

Authorization (Legislation and Policies)

• Nurses must be knowledgeable of applicable federal and provincial legislation and remain current with legislative changes.
• Nurses must adhere to best practices for the transportation, disposal, and storage of clean/ sterile/reprocessed or soiled equipment, supplies, and medical devices.
• Nurses must follow or establish policies and procedures that reflect federal and provincial occupational health and safety standards.

Documentation

• In addition to quality documentation of client care and the storage of personal health information in accordance with professional and legal requirements, nurses must maintain documentation related to equipment quality controls.

Collaboration

• Nurses are expected to practice independently and collaboratively within the health care team.
• Nurses recognize when clients’ needs are beyond their professional scope of practice or individual level of competence and consult or refer to professional or health care services appropriately.
• Nurses are encouraged to collaborate and engage with subject matter experts, such as provincial and/or national associations/special interest groups for footcare.

Liability Protection / Insurance

• Nurses should validate with their provider that the liability/insurance coverage they hold is sufficient for the practice they are undertaking.

Questions regarding professional, regulatory, or legislative requirements related to footcare can be directed to the College.

Advanced footcare encompasses nursing care of the lower limb and foot, requiring a specialized body of knowledge and adherence to the competencies specific to advanced footcare. It is not part of entry-level practice for RNs and LPNs.