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Nurses Entrepreneurial Foot Care Association of Canada

Discussion in 'Canada' started by admin, Nov 30, 2004.

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  1. admin

    admin Administrator Staff Member

    Members do not see these Ads. Sign Up.
    I was always under the impression that things were pretty mixed up with the provision of foot care in Canada. There is different provincial laws for chiropodists and podiatrists. Nurses also play a prominent role in the provision of foot care, which is why I found it interestersting to read this website:

    Nurses Entrepreneurial Foot Care Association of Canada

    As an outsider, what is happening across Canada is ...:confused:

    What say you?
    Last edited: Nov 30, 2004
  2. podrn

    podrn Member

    Canadian Foot Care Nurses

    I have had the opportunity and honor to attend and present at the last two Canadian Foot Nurse Interest Group seminars in Winnipeg. I found out that many of these nurses in Canada work in rural areas and are the only source of professional foot care available. They offer an incredibly valuable service and are some of the most dedicated and conscientious human beings I have ever met, so do not be to quick to judge! Foot care providers need to work together and support each other. It is not sad at all.

    Laura Roehrick RN
    Santa Rosa, CA
  3. Cameron

    Cameron Well-Known Member


    Have you run across Pamela Hopper ?

    She was a nurse who retrained as a podiatist then went back to Canada. As a nurse she got interested in foot care under the circumstances you described and had quite a story to tell about how she orchestrated care. Obviously frustrated at restrictive practice and absence of foot care paraphernalia and requisites. According to Pamela she ended up becoming a distributer as well as a user and the profit she made went to supplement her studies in the UK.

    Quite a character

  4. podrn

    podrn Member

    Foot Care Nurses, International Foot Care Conference and other blather


    No I have not, but I will ask my friend, Pat Mac Donald, who orchestrates these conferences. Is this a UK based site? I am still navigating my way around it.
    Anyone from this forum planning to attend the International Diabetic Foot Conference in Hollywood, CA . March 3-5? I will be there Thursday only to hear international speakers. The rest of the conference is about surgical and wound issues mostly. Beyond my scope of practice. (I specialize in the preventive routine foot care area. My specialty is the debridement of difficult nails! ) I am hoping to meet Dr. Boulton. I have met Dr. Armstrong a few years ago in Arizona and have also met Dr. Bakker, the chairperson for the International Diabetic Foot Working Group. I am trying to become involved with this organization and help set up training programs for nurses in other countries.

    I have also had the incredible opportunity and honor of spending a day at the King's College Diabetic Foot Clinic, with Ali Foster and her amazing staff. Of my 11 days in England (during the heatwave of 2003) it was the best day I had. I was amazed to learn of the lack of involvement of RN's in the area of foot care in England. We now have a special certification available for RN's in the US. It is called Foot and Nail Nursing Certification. I am on the exam committee for the Wound Ostomy Continence Nursing Certification Board. The site with further information is www.wocncb.org

    http://www.wocncb.org/whatsnew/footnail.asp This is the page that has information on the certification

    I am one of the 7 nurses that came up with the questions for this exam. We need all the QUALIFIED foot care providers we can get if we want to make a dent in preventing amputations!

    Ta Ta,
    Laura ;)
  5. Cameron

    Cameron Well-Known Member


    Is this a UK based site?

    Australian , hosted by La Trobe University, Melbourne and under the direction of Craig Payne

  6. podrn

    podrn Member

    Hand and Foot Carers


    Thanks! How are the Hand and Foot Carers being received? I personally think it is a brilliant concept and one that is needed worldwide. There is no way, with our current systems, that we can keep up with the increasing number of elderly and diabetics. We need teams of foot care professionals, each doing foot care to the highest level of their scope of practice using universally approved protocols and procedures. We sure have a long way to go!

  7. scripps

    scripps Guest

    Canadian RN providing foot care as an independent practice

    Hi there,
    I am one of those fortunate RNs here in Canada being given the privledge to provide foot care for my clients in their homes. I have been nursing since 1982 (in numerous specialized areas), but approximately 7 years ago became interested enough in foot care to take the required training and start my own practice. Unfortunately for the people in the city and surrounding areas that I serve, the nearest Podiatrist is 2 hours away. Although the main focus of my work is to provide good foot care to my clients, I place much importance on teaching, especially to my diabetic clients...I take time during every visit to review the importance of maintaining healthy feet between visits. I am fully supported by the physicians in my community and many of my referrals come from the doctor's offices. Although I know I will never get rich doing what I do, I get great satisfaction from the service I provide.
    Last edited by a moderator: Mar 22, 2005
  8. Kelsey

    Kelsey Member

    I personally have little problem with nurses doing foot care. I was a podiatrist in Vancouver, Canada for three years and many podiatrists were upset about foot care nursing. The problem with podiatry in the Canada is that we are trained as U.S podiatrists but only are able to do a limited amount of these duties. Hospital privileges are pretty much impossible (so you can't generate a large number of surgical cases or admit patients for a diabetic foot infection), so most podiatrists are left with a primary foot care practice or "biomechanics" (orthotics) practice. They feel threatened if anyone else is taking a piece of their limited pie!! I also have heard (don't know how true they are) about many foot care nurses causing harm to patients by trying to treat something that they have no experience doing (i.e, ingrown toenail)!
    I volunteer at a senior's foot clinic program in the U.S and I work with a foot care nurse; no podiatrists here complain about it, because they don't feel threatened by it. They can go the hospital and do surgery, treat diabetic ulcerations, etc., etc. I feel there should be a consensus between the nurses and podiatrists so there is an understanding about scope of practice. I may be ignorant, but I don't believe any foot care nurse administrator has come to the podiatry association and discussed this. Until then, I don't think podiatrists will come on board. Sorry about the rambling....
  9. Arztin

    Arztin Guest

    Nurses performing outside their scope

    I totally agree with the podiatrist from Vancouver. I feel for you, colleague,
    because I do realize that Canadian podiatrists are far more limited than those
    of us in the US. However, as one of the unlucky ones who did not get a
    high power surgical program, I, too, am limited to nonsurgical podiatric care
    of my patients. And many of these are diabetics, elderlies, vascular com-
    promised or a little of all the above. And it sickens me to no end how these
    nurses who should know their places can actually consider themselves "
    entrepreneuers" and not give a care to these patients who deserve a lot more
    than that. And these sell-out podiatrists who seem to not mind so that they
    can run and do these cosmetic surgeries are no help what so ever in this bla-
    tant disregard of providing the highest level of care. If these nurses want to
    play doctor THEN they should simply do what you and many of my fellow
    classmates did. Go to a podiatry school, deal with clinical rotations, take
    tests after tests and then go into practice for themselves. They think
    they're in charge but they're not. They still have to answer to a doctor one way or another so they will always be nurses who obviously have issues
    with that. Nurses are supposed to be caring people... many times more
    so than us doctors. But what they are doing and trying to do in America
    is anything but that. They are merely glorified criminals performing sub-
    standard care that is tantamount to physical assault. I would gladly
    serve on any case of malice against a nurse, a podiatrist and the health
    organization being sued by a patient who sustained serious harm from
    such substandard care performed by a nurse. I wish podiatrists would sim-
    ply stand together and stop allowing others to take away what makes us
    podiatrists. No matter how insignificant the big shot surgeons may
  10. scripps

    scripps Guest

    I totally agree with you when you voice concerns about inexperienced nurses causing harm to unknowing clients, however, making generalizations and placing us all into the same catagory is unfair.

    "it sickens me to no end how these nurses who should know their places can actually consider themselves "entrepreneuers" and not give a care to these patients who deserve a lot more than that."

    Do you, sir, think for one moment that we "do not give a care", and provide this service for entertainment purposes? That we jaunt about from client to client playing doctor with no regards for the human being attached to the feet we are treating? Believe me, sir, I KNOW my place, and my limitations. My clients, not my ego, are my priority, and I pride myself in providing a caring, professional, and much needed service.

    "They think they're in charge but they're not. They still have to answer to a doctor one way or another so they will always be nurses who obviously have issues with that."

    I AM in charge of how I run my practice. I personally do not run a clinic, but provide foot care to people in their homes, people who would otherwise have no care or education regarding their feet. I do not, however, consider myself "in charge" to the degree that I place myself in position where there is no requirement for me to "answer to a doctor". I keep detailed charts on all my clients, complete with a list of medications, medical conditions, allergies, and a detailed assessment form is completed at every visit. Any concerns identified during a visit are well documented, and a letter is sent to the family physician. All concerns are followed up by the doctor, and myself. So you see, sir, I have no issues answering to a doctor. Perhaps you should look more closely at some of your own isuues concerning your working relationship with nurses (please don't assume that I am practicing psyciatry here).

    "Nurses are supposed to be caring people... many times more
    so than us doctors. But what they are doing and trying to do in America
    is anything but that. They are merely glorified criminals performing sub-
    standard care that is tantamount to physical assault."

    The majority of us are caring people, thank you for recognizing that...but glorified criminals? I'm not sure what is happening in the States regarding nurses performing foot care, but here in Canada we are required to take specialized training in basic, advanced and diabetic foot care, and are held accountable by our provincial governing bodies for ALL that we do. Continued education specific to foot care is considered important, and is provided. It is expensive and is funded by the individual. If we didn't care, would we spend the time and money? If you were to ask any of my clients about the service provided, I promise you, physical assult would not enter into their responses.

    "I wish podiatrists would simply stand together and stop allowing others to take away what makes us podiatrists."

    As I mentioned in my original post, there are NO podiatrists in or near my city, as is with many other places, so where do these clients turn? Most of my clients were seeing aesthetitians before me, people with absolutely no medical training at all.

    In closing, I would like to say that I almost didn't respond to this post, because I presumed from the tone of your letter that you would be less than receptive to my opinion. However, everyone is entitled to their opinion, and I think you hit on some very important points... but, assuming that all nurses provide the same sort of care, whether it be foot care or not, is narrow minded and ignorant. Some of us ARE out there with the client's health and safety being our primary goal.

    Regards...from Canada
    Last edited by a moderator: Apr 30, 2005
  11. C Bain

    C Bain Active Member

    Nursing - Foot-care!

    Hi All,

    I have knowledge of a nurse advertising in a local paper around Kirkby Stephen in Cumbria, (I suppose I had better write UK.!).

    She took qualifications 'to do with feet', satisfying the Royal College of Nursing if I remember rightly? This was about seven years ago! I haven't seen her advertise recently, however, and I didn't keep the ad. silly me! The Royal College considered her application to them, (If that was what it was as far as I can remember?).

    She worked under her identity as an S.R.N. and used 'CHIROPODY' to describe her home service. I wonder how she would go down with the HPC. today? I certainly cannot see anything wrong with this, (And I've tried!!!! I was considering setting up myself! 2,000 population, could have been wrong?).



    P.S. Nurse could well have all she can cope with and doesn't need to advertise now!!!
  12. podrn

    podrn Member

    reply to Artizin

    It has taken me several days to ponder the highly emotional and illfounded comments by Artzin. It makes me incredibly sad to realize that that sort of mentality exists. I have been a foot care health provider for the past 12 years. I work to the highest level of my legal scope of practice, which happens to be that of an RN. During my time as a foot care nurse I have volunteered at the homeless shelter, had free clinics at the senior center and the local church that has provides alternative care for HIV and Aids patients. I have orchestrated the collection of thousands of pairs of socks for the homeless. I have also taught foot care to health professionals, been a mentor to many nurses, presented at a dozen conferences and attended equally as many foot related conferences. I have foot care friends, including many podiatrists, all over the world. I use the best instruments money can buy and have individually sterilized packs for each client. I have an autoclave and use better infection control practices than than anyone other foot care provider I know. I use the best electric nail filing systems around, NOT the dremel, and would challange anyone to match my debridement techniques. I do not diagnose, prescribe or perform surgery and refer for anything out of my scope. Nurses were doing foot care long before the field of podiatry was invented. We are here to help and serve the people who are not being cared for, now that medicare has dropped routine foot care ( due to the billions of dollars of fraudulant claims I might add ) In case anyone has noticed there is an epidemic of diabetes and these patients who are not high risk, need proper foot care. There are not enough podiatrists to managing the increasing numbers of these patients. In fact there are not enough nurses either. That is why I think the Foot and Hand Carers profession is the way of the future. We need to work together folks!
  13. ehresources

    ehresources Member

    I'll add my two-cents here as well.
    Scripps & Laura did a great job but I thought I'd lend my support.
    I'll admit that in Canada, things are getting more confusing. In Ontario, our Standards were retired and we have been left without the strict guidelines we once had. That is why there is a large movement by foot care nurses to develop best practice guidelines and educational requirements for what we do. We have in the past and will continue to work with the podiatrists/chiropodists to achieve these goals!!! Many podiatrists speak at our conferences to share their knowedge with us. They provide support and guidance and we function well as a team. There are good and bad in every profession but does that mean that the good should be stopped because of the few bad????? If that were the case, no one would ever be able to do anything! As nurses, we are held accountable for our actions and are regulated. Much better than the hand and foot nail carers that are being discussed on another thread and why create a new category like a pod assistant? With the vast knowedge and skill that podiatrists have, I am always troubled that they are so threatened by trained professionals assisting with the basics. Nursing has "lost" many roles that are being taken up by "new" professions - i.e. respiratory therapists, physio, etc. etc. etc. as the need for more specialized care and education are required to ensure the best possible care can be given to the patients/clients. If nurses fought over who got to put a bedpan under someone (I know, I know it's not the same but work with me here), we would be spending more time doing that than using our vast knowedge base to provide care to our patients. There is a role for everyone. We need to clarify these roles in a calm and rationale manner.
  14. Arztin

    Arztin Guest

    Leave foot care to the licensed specialists even if...

    You know, I did not want to play the race card but you all have forced me to.
    It seems that the more blacks enroll in podiatric colleges in the US, the more
    the dominating masses of white males come up with new ways for us black
    podiatrists to be limited to certain duties within the profession. White
    nurses in my area in Illinois have helped to keep me from getting contracts
    with nursing homes to provide simple surgical reduction (as defined by our
    medicare program) by siding with males to "muscle me" out as had happend
    recently with this VIP Manor nursing home in Wood River, IL. They went
    all the way to Kansas City, MO to get a contract with those guys so that
    they can cease from using my services. They only put up with me because
    since Febuary of 2004, no podiatrist had visited this facility. I only pro-
    vided services there from October 2004 until Febuary 2005. So I have
    an especially awful personal relationship with nurses who believe I have
    no business being a podiatrist. Now my own colleagues seem to be "push-
    ing" nurses into providng the only service I am allowed to provide in this
    very bias profession.
    A black person eg. a woman is far less likely to get a high -power
    surgical program than a white male. This will only get worse with the
    increase number of blacks choosing podiatry as their carreer choice.
    Now just to get on hospitals require that you have done a surgical
    program and/or become board certified by a surigcal board (not my
    board). This is all done on purpose to undermine the roles of black
    podiatrists in this country. RPR practically (or perhaps not at all)
    exists in meager numbers. These programs were about the only ones
    blacks could get. Now it is not enough to have even done a program
    at all to become a SUCCESSFUL podiatrist in this country. That is
    I know I will get all kinds of arguments about these comments. But
    unlike the alleged religious conservatives, I seek the truth and embrace
    reality even and especially in a nation that is forever in denial about ra-
    cism and perhaps lately human rights period (you see racists whites
    are so adament about keeping blacks in their place that they are willing
    to sacrifice their own in the process). So when I now am forced to give
    up that which I can only do in a profession that only respects you the
    more you cut up on people to a bunch of nurses who are only too happy
    to obliged and see that the title of DOCTOR is bestowed on whtie males,
    you are darn right I am going to be irate about it. And there are actually
    people (mostly feminist which I am not) who believe the world would be
    better if women ran it. I gravely beg to differ.

    Dr S. A. Brooks, DPM
    PS If I get a rebutal then it only proves what I already know about the
    prevalent racism and classism in the (for now) US podiatry profession.
    If that is the case, then podiatric recruiters, please stop recruiting
    black students just so you can commit them to a life of struggle.
  15. Kelsey

    Kelsey Member

    In general, I disliked to highlight the race card, because I am an optimistic type of individual (some people call it blind). I am a Black male and agree there is institutional racism in the podiatric system. Yet, I haven't let that stop me from doing things in podiatry that I wanted to do! Fortunately, I got a high power surgical residency program (the second Black person ever to get this program), so people can't really ignore me. Using my surgical training as a springboard, I have diversified my knowledge of biomechanics and sportsmedicine into a particular niche for myself, especially when I was in Vancouver. I was volunteer coaching and coordinating sportsmedicine care for sportsteams, which really built up my reputation as a sportsmedicine expert. I always tell podiatrists in Canada to find a niche for yourself and aggressively go for it! Explore things outside the podiatric norm (wound care associations, biomechanics organizations, sportsmedicine associations, etc) and use it to build yourself in the community. I believe the days of just doing nail cutting is gone! Just my two cents which I think comes back to the original posting (?)
  16. ehresources

    ehresources Member

    It was always my understanding that podiatrists did way more than just cut toenails. Most I deal with want very little to do with it and choose to utilize their knowledge & skill to deal with the problems that are more suitable to their training. Again, it's back to the bedpans...nurses have the knowledge & skill to do more than bedpans & pass medications. We all need to work within our scopes of practice and use the knowledge we have learned in our training.
    So many of us (health professionals) are frustrated by the in-fighting (as is obvious by the postings on this website). We need to start within our own organizations and associations to come together as a group to establish the roles of our members. No wonder there is so much fighting and arguments between professions and people feeling threatened. If we are not comfortable with what we are doing, of course we will want to push everyone else down. Messy, messy, messy. Not unique to any one profession, that's for sure!
    Chins up and keep plugging along.
  17. Arztin

    Arztin Guest

    You are in the right place

    Dear Dr Kelsey:
    I am glad that you are doing well. But please remember that you are
    in a country that allows you to be a success. My mother has multiple ill-
    nesses and is on a fixed income and I have a daughter who is about to
    go to college soon. There is a reason I emphasized "black woman pod-
    itrist". Because unlike men we cannot just up and leave our responsiblities
    to our family. And when push come to shove a nurse will always cater
    to a male doctor (even if that doctor is black) before catering to a female.
    I am happy again that you have beat the odds. But you are not in America
    (much congratualtions) and your blues are nothing like mine.
    Toenails are my "niche". It is the only card dealt me in this country.
    Patients do not seek my services for anything else but toenails and cc.
    The other, more involved stuff usually is incidental to the initial visit and
    that is very rear. You say the days of just toenail procedures are gone.
    That's today. Who can truly promised that next it won't be sports medicine
    or injection thearpy or biomechanics (your niche). Already, a nurse in
    my area has gotten shoes for a diabetic I am seeing for his toenails
    only. So I am not too far off.
    I thought this particular thread has lost its fire and that people went on
    to something else. But apparently this rn who actually calls herself podrn
    and another nurse somehow felt that I am unstable and have issues and
    felt they need to continue batching me for just trying to protect my way of
    living. I also thougth I not only asked to unsubscribe to this thread but
    also to unsubscribe to this website all together. You all seem to be having
    a great time undermining the points I am trying to get across and enjoy
    letting these nurses put me the lowly black female foot doctor down.
    Well I get enough from the racist doctors in this country without Canadian
    nurses doing more harm. I will forward the comments I received from
    those two nurses to the American Nurse Association so that they know
    just what kind of sadistic colleagues they have in the not so neighborly
    country of Canada. You nurses here should be real proud that you have
    to keep beating on me just to make yourselves seem important.
  18. Dr Brooks

    I’m not sure if this website (or any other) is an appropriate place to raise the issues you have in relation to your professional practice. I suspect most podiatrists world-wide have concerns at the introduction – and possible manipulation of – assistant grade practitioners or foot care nurses. It seems obvious that as the profession diversifies and specialises, we need to service somehow our core areas of practice and it may well be that assistant grade practitioners are the best way to do so, especially where the demographics don’t add up. But we need to keep a careful eye on territorial encroachment and the possible manipulation of staffing placements by governments/employers who desire the cheapest option in health delivery.

    Whilst there is a case to be made on both sides, I regret to say I find your overtures of racism wholly undesirable in the current debate. Clearly you have issues with many colleagues – both podiatrists and others - but do you really think it is right and proper that allegations of a personal nature are raised in a public/professional forum? As entertaining as they may be, might I suggest a court of law as an alternative venue?


    Mark Russell
  19. admin

    admin Administrator Staff Member

    This topic is closed.
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