President's Message
--by Patti Gable Burke, RN, BSN, CWOCN
WOCNCB President 2008-2009
This year the WOCNCB turns 30 years old. During this time the Board has achieved many things. I recently attended the American Board of Nursing Specialties (ABNS) meeting, which is attended by nursing certification boards. As I listened to the various organizations discuss their accomplishments over the past year, I thought of how progressive our Board is. While other organizations were beginning down the path to computer based testing, portfolio development, considering international testing or preparing for accreditation, the WOCNCB had already traveled down these paths.
Today the WOCNCB is accredited by ABNS and the National Commission for Certifying Agencies (NCCA). WOCNCB administers computer-based exams for six credentials, allows recertification through the portfolio process, has administered the WOC exams internationally and will be administering the Foot and Nail exam this year in Saudi Arabia. Today, there are over 5,000 nurses who have earned the WOCNCB credentials in wound, ostomy, continence and foot care.
The WOCNCB credentials are considered the “Gold Standard”. I truly believe that we have earned this title due to the hard work and dedication of our past and present board and committee members, whose ideas and dedication have made the WOCNCB credentials valued among the healthcare industry. During my tenure on the Board, I have sat through many meetings and conference calls. Ideas are brought up and discussed, but never have I heard an idea that could not be accomplished.
The WOCNCB has come a long way since 1978, when it administered its first paper and pencil exam, which included all three specialties and was given twice a year. I would like to thank all the certificants who have chosen to certify through the WOCNCB. Most of all, thank you to all the individuals who have committed their time and talents to participate on the Board, a Committee or as a Reviewer. All of your hard work and efforts have truly made the WOCNCB credentials the “Gold Standard”.
Foot and Nail Certification Update
Foot and nail care as a nursing specialty conjures up so many questions and fosters so many misconceptions with everyone except for those providing or receiving foot care services. These trailblazers and their loyal patients will tell you, without reservation, that foot and nail care is the essence of nursing. The specialty, like every nursing specialty, embraces assessment, treatment and education. It combines the science behind nursing with the art of healing. It fosters a commitment to preventing complications. It minimizes deficits and maximizes potential. It forges a partnership with patients and their families. It is the best that nursing has to give.
Foot and Nail Care is a new and growing specialty. This specialty allows registered nurses, regardless of their degree program, to prepare for and obtain board certification as a Certified Foot Care Nurse. Once the individual has achieved this goal, their future is truly up to them. They can follow any number of professional pathways or find a new use for this specialty. There are countless opportunities to incorporate this new role into an existing wound, ostomy and/or continence nursing practice or use it as an entrepreneur.
As a CWOCN invested in limb salvage, I have always felt that foot and nail care was a critical building block of my plan for every high-risk foot patient. It gave me valuable clues in assessing my patients. Whether I was involved with inpatients or in the outpatient clinic, these were my patients. As a nurse, I felt compelled to give these patients my best. In order to provide that, it was impossible not to provide quality, competent foot and nail care.
Just today, I assessed a gentleman with bilateral venous hypertension. In examining his classic lower legs, I also assessed his nails. Several of his nails had Beau’s lines (onychomadesis) extending horizontally from one edge to the other. Based on this finding, I asked about any major challenge to his health in the last 3 months. Because of my understanding of nail morphology, I was not surprised when he shared that he had been diagnosed with cancer and had a major surgery. The nails have stories to tell and they need dedicated and certified foot and nail care nurses to listen.
Research has proven that these patients are often underserved with the most basic tenets of assessment routinely being missed. Surveys and research have shown that less than 30% of diabetic patients have been given a basic neuropathy check by their primary care physicians. In my experience, few physicians will take the time to trim nails or remodel callus. Fewer yet will assess foot structure, gait, shoes, and inserts. Patients deserve competent health care providers who are willing to provide this care. We know that education and early intervention are key elements in prevention amputations and complications. We know the facts, we know the statistics, we even know the patients. Who better than nurses to help fill in these gaps in care and provide the solutions that patients so desperately need.
My practice is fairly traditional with a mix of inpatient and outpatient services. My peers continue to impress me with the infinite opportunities available to them in this growing specialty. Let me share their stories and their passion with you. You may be the next CFCN to make a difference working from the ground up.
CFCN Certification — A High Point of my Career
As I contemplated over the outstanding accomplishment of WOCNCB’s launching of the CFCN (Certified Foot Care Nurse) credential, it brought back many pleasant and enjoyable memories of my personal involvement. I had the pleasure of coming on board when the idea of this new credential was only a concept in 2004. It was an exciting time for me, as I had the honor and privilege of being one of the original group of foot and nail nurse experts who built the foundation for this examination from the ground up.
The Foot and Nail Care Examination Committee, who were instrumental in bringing this credential to fruition, developed the WOCNCB multiple-choice examination. As the initial committee members, we were part of an elite group of nurses that had the privilege of treading new frontiers. This group of nurses was the first to receive the CFCN credential in 2005, as a testament to their hard work and diligence in writing and reviewing all of the tests questions for relevancy, consistency, accuracy and appropriateness.
Even though the work was hard and grueling—it was satisfying and rewarding as we worked cohesively to accomplish great things. A great deal was learned as we developed multiple versions of the certification tests, and the Self-Assessment Examination (SAE). While working with this dynamic committee, many lasting friendships were forged as a result.
The memory of being a pioneer for this awesome CFCN certification is one of the high points of my career. It has afforded me the opportunity to recognize complicated problems in a diabetic foot, which requires appropriate referral for further treatment and evaluation. The CFCN credential is highly beneficial and well worth any nurses’ time to pursue. Your patients, peers and employer will thank you.
Foot Care as a Nursing Specialty
A World War II veteran, who stormed Normandy on “D” day, with diabetic retinopathy and peripheral neuropathy; a former university president with intractable plantar keratosis; a retired missionary who’s authored two books, receiving anticoagulation therapy; a real rocket scientist with severe hallux valgus and hammer toe deformities. These are the feet and faces of a few of the seniors that see me at the foot care clinic in the retirement community, where I serve about 125 clients.
Foot care is my nursing specialty of choice for many reasons. First, I actually have the time to form genuine lasting friendships with my clients. Second, I like to see the results of my work immediately. It doesn’t take months of tallying up the results of patient satisfaction surveys to know that my clients are satisfied with my work. Everyone leaves with a smile on their face, after having only spent less than an hour in the exam room. In this brief amount of time, I’ve accomplished everything that I used to dream nursing would be and should be. I’ve used my critical thinking skills in assessing the high risk foot. I’ve performed specialized clinical procedures that have made me an expert in my field. Most importantly, while using these skills, patient teaching, hands on nurturing, and healing are taking place.
When I entered the nursing profession, I was somewhat disillusioned to find that some of the specialty fields I was exposed to didn’t allow me or my patients to experience these things. I am so grateful that I didn’t burn out before being exposed to foot care. This is a specialty that incorporates all aspects of nursing in such a way that causes a nurses heart to feel full and satisfied. Although my brain has been stretched and I‘m physically tired, I too leave the exam room with a smile.
How I Use My Certification as a Foot Care Nurse
Being a foot care nurse provides a true purpose for my career. I gained certification as a foot care nurse in 2005, in the infancy of this specialty. I have provided private pay foot care for the community on an outpatient basis since 2001. Each session includes a foot bath, nail trim, and foot massage. My clients appreciate the nail care provided, but each client looks forward to the massage. Many depart their session stating, “I feel like I can dance, my feet feel so good.” It is rewarding to know that a little tender loving care means so much.
An additional part of foot care includes an annual comprehensive foot and lower extremity exam for each client. Those at risk for injury or ulceration have ongoing assessments and evaluations. At risk clients are also instructed on self care, including skin care, appropriate foot wear, and factors to promote good health.
A lot goes on during the half hour I spend with each client. They share facets of their daily lives and I look forward to checking up on each limb of my foot care family. I have been able to intervene and make referrals for new onset of edema, a diabetic foot ulcer, and preceptor for a nurse seeking foot care certification.
Other nurses may tease me about my specialty, but I take the jokes in good humor knowing the value that foot care provides to the community. Some clients could have routine nail care paid for by Medicare or their insurance but they state that they prefer individualized care from me. I take pride in the fact that clients refer their friends and family to this service.
Foot and Nail Care Certification Exam Eligibility Requirements
- Current RN license, and either #2 or #3:
- Completion of formal foot and nail program including five hours didactic; three hours of clinical practice with direct foot and nail care, or
- Completion of experiential pathway including five hours CE; eight hours of clinical practice under the supervision of an expert.
Visit the http://www.wocncb.org/footnail/ website for complete information.
