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The New Foot Care Nurse... COMMENTS!

Discussion in 'General Issues and Discussion Forum' started by pw079, Apr 26, 2005.

  1. pw079

    pw079 New Member


    Members do not see these Ads. Sign Up.
    What do all the podiatrists think of this:

    Beginning in January 2005, the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) is offering a new certification credential to Registered Nurses (RNs) who perform foot and nail care. The WOCNCB is dedicated to providing consumer safety and protection by offering this new credential – CFCN™ (Certified Foot Care Nurse). Please review this website for complete information on eligibility, educational preparation, exam content, review references, and the testing process.

    http://www.wocncb.org/whatsnew/footnail.asp
     
  2. random

    random New Member

    they will LOVE them

    Coming out of school carrying a huge debt, it must just do the heart well to see folks with about a thrid of the training one has sweated through doing what you trained hard to do...wonderful they will be met with open arms!
     
  3. C Bain

    C Bain Well-Known Member

    True, true, very true!!!!!!!!!!!

    Regards,

    Colin. (You wouldn't believe it but I got one of the 'trues' the wrong way round! You must pay attention here you know!).
     
  4. W J Liggins

    W J Liggins Well-Known Member

    Well, it looks like a good way of making money! Given the breadth and depth of the example questions, existing practitioners have nothing to fear. To paraphrase, 'Patients with heel spurs will most likely complain of severe pain on the bottom of the foot'. Clearly the examiners have no concept of singular and plural forms, let alone signs and symptoms of foot disorders.

    I think that this must be equated to the increasing use of 'Foot Care Assistants' in the U.K. & Australasia, as well as the parallel situation with nurses in Canada. It may still be possible to manipulate the situation to the professions advantage.

    Bill Liggins
     
  5. Mark Russell

    Mark Russell Well-Known Member

    Bill

    Maybe. But that really depends on what you define as "the profession". There are two views on how the profession is developing. If you support the view that podiatrists are specialist practitioners in the medical and surgical care of the foot and lower limb then we will need to embrace assistants, nurses, volunteers and Irish navvies to fill the void the profession will leave. If you take the view that podiatrists are fundamentally general practitioners within an established discipline that has developed to such a degree that it now has its own specialist clinicians within the same church, then the introduction of assistants and nurses as autonomous practitioners, may very well have an negative impact on the livelihoods of many general podiatrists.

    Do we consolidate, protect and develop the profession to address the demands from a growing foot health market or do we concentrate our focus of the profession on particular areas of the market we want for ourselves - and disregard the rest? Or do you think that by introducing assistants, we could do both?

    Kind regards

    Mark
     
  6. steve_thaw

    steve_thaw New Member

    Mark (& all)
    I used to be a nurse and appreciate their value in areas only remotely podiatric. They are valuable members of the health profession but are traditionally ward-based and, as I know from experience, deal with bodily odours far worse than a 'smelly foot'. The danger of a nurse treating a patient's feet is a point of ethics and legality. The NHS should employ more qualified podiatrists rather than farm out responsibilities to others who have not the qualifications or experience to manage podiatric problems.
    Faithfully, Steve.
     
  7. C Bain

    C Bain Well-Known Member

    Professions Advantages!

    Hi Bill, (A late general reply.).

    1. Which profession will meet Patient Demand,

    1). The NHS. Podiatrist who is virtually refusing to cut nails at this time. A request recently was put in to have their relatives nails cut in my local hospital. The relative was told it will take a very long time to arrange an appointment. It would be better to get your own Chiropodist to visit if you are prepared to pay for him!

    2). The Private Podiatrist who will meet that demand because it is his bread and butter!

    3). The Original Chiropodist will also still meet and supply services to meet the Demand! (Carefully negotiating the mine Field set up by Government under various guises no doubt?). I'm sure the HPC. is well aware of this situation!



    2. 1). Definition of Chiropody is a specialty supplementary to medicine devoted to the care of the feet and the treatment of minor foot complaints..............U.S., chiropody is known as podiatry. [Collins Dict. of Medicine, R.M.Youngson 1992].

    2). Definition of Patient rights, the entitlement of patients, especially those in hospital, to considerate and respectful care.....................[Collins, as above].

    3). Definition of Demand, a desire of would-be purchasers or users for commodity. [The Concise Oxford Dictionary 1982].

    Our Patients have paid through their taxes or privately by putting their hands in their pockets to pay for a SERVICE that practically no longer exists in their NHS.

    WHY?

    I wonder whether someone well versed in our profession such as you Bill would care to comment on relationships between the profession and the Patient if you would be so kind? Nurses etc. were doing it before chiropody arrived on the scene, they still work under their Doctors. Some would say that we are much more skillful than they, or are we? I hope I have not dropped you in it Bill but I would like to here your opinion even if it's out of step with mine!!!

    Regards,

    Colin.

    P.S. I, of course have centred on the U.K. only here!
     
  8. Arztin

    Arztin Guest

    who are we and why bother to continue...

    Who are we and why bother to exist at all? I have just email my concern as
    a direct response. Please see attachment for the rest.
     
  9. random

    random New Member

    Like everything else

    bottom line of this whole argument is $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$, not health care
     
  10. Craig Payne

    Craig Payne Moderator

    Who treats feet?

    Podiatrists
    Orthopedic surgeons
    Pedorthists
    Physiotherapists
    Orthotists
    Nurses
    Chiropractors
    Osteopaths
    Biomechanists
    General medical pactitioners
    Dermatologists
    etc
    ...you can even get your custom made orthoses via eBay

    Podiatrist don't, and have never, "own" the foot.

    Its been that way since year one. Its was like that when I graduated and has been since then. The negativists have been predicting the end of Podiatry since then as well. Despite that the Podiatry profession has continued to grow in size and scope of practice in every country. Whats the issue?
     
    Last edited by a moderator: May 7, 2005
  11. C Bain

    C Bain Well-Known Member

    A Mythical Profession?

    Hi Craig,
    The old state registered sector of our profession in the NHS - UK. appear to have withdrawn from basic chiropody. Nail, corn and callus cutting?

    The withdrawal has not taken place through the attitude of working podiatrists but the manipulation of the NEED/DEMAND. Putting it bluntly it would appear that the application of older patients to have their nails cut because they cannot reach them themselves have met with rejection for various reasons by those in the profession dictating policy within the NHS.! Or this is the impression one is given when talking to these patients seeking someone, anyone to cut their nails??? Removal from treatment lists also comes to light from time to time when corns and callus have to be taken outside the NHS?

    The Point I suppose I am making is despite the abolishing of Grade 2 type chiropodists in our Giant NHS-UK. the Patient Need/Demand appears to be increasing not decreasing as the elderly grow in numbers!

    If podiatry cannot or will not meet this increasing Demand who will?

    Nurses are an obvious choice! Problem is now they are degree level standard? This means in practice lower numbers coming forward into nursing. They are not able even to sustain the numbers they have already got. Never mind increasing them to take on additional duties like feet? Foreign nurses galore being shipped in to replace the SEN's now degree standard!!!

    Chiropody is not at the top of the list regarding nursing if I was to hazard a guess.

    It appears a new RULE now exists, and that is what is different I think today, and was not so apparent in the past,

    ..."Promote a profession to Degree Level standard automatically reduces the numerical strength qualifying?"...
    This leaves a high proportion of PATIENTS without adequate care!!!

    A NEW PRACTITIONER APPEARS ON THE HORIZON TO SATISFY THE NEED/DEMAND!!!

    The HPC. ends up regulating themselves! The profession can fit into a telephone box. Is this an extreme consequence of a academic interference in a natural cause?

    Could there be other consequences I wonder,

    1. A very small Podiatry Profession of Specialists doing other things? Not in touch with CHIROPODY, the Patients NEEDS...DEMANDS!

    2. Nurses, FHP's, Voluntary nail cutters appearing out of the woodwork to satisfy the demand?

    3. Private Sector 'Jack of all Trades', some good, some not so good?

    Where have I seen this before, 1960 perhaps?

    Regards,

    Colin.
     
    Last edited: May 7, 2005
  12. Craig Payne

    Craig Payne Moderator

    Given health care resources are limited, what resources are available should be spent on where the health gains are the greatest. Where is the health gain in providing a toe nail cutting service?

    Podiatry (and every other profession) are under pressures like this for a very long time. Podiatry is a growing profession, the numbers of Podiatrists are increasing, the scope of practice is increasing. I see all this as a positive and not the beginning of the end.

    The creative and innovative who take advantages of the opporunities being presented will thrive. If Podiatry "looses" in the marketplace, don't you think we deserve to loose?
     
  13. C Bain

    C Bain Well-Known Member

    Hi Craig,

    Take your point!

    My point is that we have raised the professional skill above the basic demand of the PATIENT! (It's not what they want!). Degree level is to high for basic chiropody, basic nursing, etc. We have cut out very conscientious bright people who are craftsman, technicians! They do not need degree standard to do the job. A whole strata of health workers have been removed and dust-binned without putting anybody in their place!

    Worse than this, we now have rationing of treatments developing! Government bodies in the very near future to decide who lives and who dies. NICE in UK has decided that all and sundry can have certain treatments but not the old!!!

    Getting off the point I think but possibly a good illustration?

    Regards,

    Colin.
     
  14. Sean Millar

    Sean Millar Active Member

    More than routine care

    Routine care is more the cut and come again. As I explain to students on pratice placements. When you graduate you spend the first few years mastering your podiatry skills. Along the way you start to develop new skills in assessment, understand how it all fits together. As you progress to a more advanced practitioner, you start to see the whole patient and not just the feet. I am sure many of you have diagnosed systemic diseases and problems in your patients. The practitioner then becomes a vital tool in linking these patients to resources whether GP's, or others.
    The patients appreciate the level of expert practitioner you have become, not just the routine care you provide. If it was purely nail and dermatological lesions they wanted addressed they could seek out a nail tech. and similarly a nurse suitably qualified.
    I recall a incident were a podiatry position (could not be filled) was replaced by trained nurses. They went through 3 nurses who all developed RSI.
     
  15. Sean Millar

    Sean Millar Active Member

    Public systems always in demand

    In may be skeptical, but it is in the best interst of governments to create demand. If they spend millions of dollars on providing access to services such as podiatry. then those in private insurance will wonder way they bother with their insurance. The result is individuals drop out of private health insurance and sign up with the newly revised all bells and whistles governement service. Now again longer waitlists, and now the system is again under resourced.
    Longer wait lists and unresourced services keep individuals in private health insurance. This helps maintain an lid on health spending required. Spend a little as required but never fix it. That way the government is seen to do the right thing. A vote winnner.
     
  16. Craig Payne

    Craig Payne Moderator

    Waiting lists are a legitimate way to allocate scare/limited public resources..... the problem is thats its hard to accept this when you are the one on the waiting list.
     
  17. Arztin

    Arztin Guest

    But we don't push back.

    To Payne:
    My issue is that if someone wanted to prescribe a back brace that would
    help to correct a scoliosis and in turn reverse a drop foot condition due to
    radiculopathy as a podiatrist, one would never hear the end of it from the
    orthopod to the certified orthotist/prosthetist. There are codes here in
    the USA for gait analysis that we are not allowed to use but a PT can use
    and get paid for it. I don't mind other doctors doing what we do because
    I know there are so few of them doing it that I am not threatened by them
    taking over the main thing we do...corns, calluses and toenails. I don't
    even mind PT getting paid for gait analysis especially if they are as astute
    in biomechanics as Jahrling Lothar is of Germany. If anyone should be upset
    about them getting paid and not us (in the US) then it should be directed
    at our healthcare system for the absolute insult and discrepancy. But it
    is much easier to insult each other and back stab each other then it is to
    push back and protect our profession from others. Now we got these nurses
    wanting to do nails etc. and again where is the PUSH. As primary care
    podiatric physician, we should be able to give flu shots to our diabetics.
    Nurses and even pharmacists can give them. Why can't we. But all of
    a sudden a nurse can work on the feet. If we can't do what they do then
    they shouldn't do what we do. PLAIN AND SIMPLE. I do not even care if they
    DID start first (as the other gentleman mentioned). Apparently, they were
    not doing it well enough. Otherwise, chiropody would not have needed to
    be invented.
    Yes, we have expanded upon podiatry. But the bottom line is that we
    are also becoming "too big for our bridges." There is going to come to a
    point when surgical debridement of severely deformed and fungal infested
    toenails wil take preference over that bunionectomy especially with at
    risk patients. Then what will we do? If I was an insurance company, I
    wouldn't pay some surgical fanatic anything for that damn pointless
    surgery if there have also been cases where he or she turned away
    palliative care. In fact, a diabetic patient consistently lost toes be-
    cause his fancy foot surgeon would not do his toenails. A DIABETIC
    patient. I started seeing him because he had started to develope distal
    clavi at his remaining toes. I have trimmed them off and they were
    doing okay until he went to one these absurd casino gambling boats
    and did lots of walking and lots of standing at the slot machines.
    According to his not much help herself wife, they offered him a wheel
    chair to get around in but he refused. The one toe wind up getting
    severely infected and I had no choice to send him back to the surgeon.
    He winded up losing another toe and I even tried to prescribe special
    orthotics and diabetic shoes which his SURGEON never did do. When I
    tried to schedule him for the casting, he refused saying he wanted to
    keep wearing those Stacy Adams. Well, he wasn't my primary patient
    so I can understand why he did not feel comfortable with me. But for
    his insurance to keep paying this surgeon for REMOVING toes that could
    have been prevented is just irresponsible especially since according to
    the spouse, the idea of toe filler orthotics & shoes was never even
    presented.
    You know, we can go back and forth with this mess we ALL got ourselves
    into until the end of the world comes (if you believe in that). No one is
    going to fix it for us but us. Incidentally, this is my last visit. I really
    have no use for a forum that is so willing to involve nurses in a site, I
    thought, was designed for licensed podiatrists/chiropodists (happy,
    Payne). I really was embarassed when it was suggested that patients
    should not post anything after a patient who really needed OUR help
    wrote in. This is the time when we SHOULD have an open house for the
    only people we should answer to...patients with foot problems. If
    some nurse can write in then why can't patients. Just goes to show
    that we have gotten too big for our patients. The OT-forum.de takes
    messages from patients. Why can't podiatry arena. Good bye.

    Oh, no one never HAS answered the question, when and where
    podiatry was invented. And why.
     
  18. C Bain

    C Bain Well-Known Member

    Comparisons!

    Hi Arztin,

    A few comments re. your Post above, I hope without malice,

    1. I think, '....when and where podiatry was invented. And why....'. This has been shown and answered in English History in the 16th.,17th.Century I think? Sorry but I cannot remember which historian?

    Answer, "The Barber Surgeon who did it all because the Physicians just might have been killing to many people at the time? There were some good physicians about, however, they where HERBALISTS!" Not to happy going to the barbers these days to have my hair off, teeth out and toes off, however! Although I don't know though!!! Have a look at 'The Royal College of Surgeons' Website I'm sure they will have one?

    2. I don't mean any disrespect but if, (US., UK. and EU. (Who I'm trying to give up, a terrible malfunction of the brain!), and Australia, (If I can spell it at this time in the morning?)), as I strongly suspect are all different with respect to PODIATRY as defined by different ruling bodies. I can only quote mine, 'A chiropodist/podiatrist diagnoses and treats disorders, diseases and deformities of the feet.' [HPC. Windows Screen Registration Section May,2005! www.hpc-uk.org/.

    The Nouns, Podiatrist/ Podiatry, I think have several meanings in several country's around the world?

    3. Using Websites to diagnose foot problems fills me with horror, I'm strongly opposed!!! It's bad enough diagnosing a foot complaint face to face let alone using what I believe to be attempting to use a crystal ball? But if I where living in the USA., I could, however, suspect that I could be wrong about this as it appears everyone in the USA are doing it?

    Regards,

    Colin.

    No P.S. Here, I could be sueded!
     
  19. ehresources

    ehresources Member

    Yikes!

    It was an interesting debate to read until the rant near the end. May I clarify a few things?
    First, Nursing has "lost" many tasks as the need for a practitioner with more highly specialized training became evident. It was not because nurses were not doing a good job!!!!! The needs of the client changed and a new specialty developed in order to fill the need. Just as the role of the podiatrist has changed and evolved, so has the role of the foot care nurse. We are a nursing specialty where extra training is required.
    Nursing foot care is not new. I have been doing it for over 10 years and it was being done long before I started.
    I also have reservations/concerns about what is happening in nursing foot care. there is a huge movement amongst foot care nurses to standardize. The WOCNB (? - I always get it wrong) exam concerns me as well. For example, the education requirements are low even to me. I am going to write the exam to see what it's all about. I'll get back to you about it if you're interested...
    I work as a professor for a nursing foot care course. Might I suggest that when discussing the role of another health care provider, you actually speak with some and look at what they learn? Again, I would be more than happy to accommodate...
    I rememeber when I was in nursing school how shocked the medical students were are what we were studying and what we were required to know in order to become RNs. This has led to more mutual understanding and respect. Lesson to be learned here????
    We are not trying to be podiatrists. We have no desire to be podiatrists. We are not trying to replace or fill a shortage of podiatrists. We have a role to play and function well as a member of the team. I work quite well with all the podiatrists in my city. I know my limits and refer up to the podiatrist or seek their opinions as necessary. They send clients to me. Team work...
    J
     
  20. Foot Care Nurses

    :) Sooo delighted to read your common sense appraisal of our foot care role, am in total agreement. I have set up my clinic in my home (home business) with a Shire permit and backed by NEIS for the first yearto fill an obvious gap in the market and my mobile, elderly clients are flocking to the door to have their nails cut 4-6 weekly, any problems I refer to the local Pod. Part of my service includes B/P and diagnostic diabetic test. I love my work, and will continue. I was taught primary nursing care (nail cutting) in my degree for nursing and use it! Good Luck to all involved with preserving mobility!!!--Anita
     
  21. achilles

    achilles Well-Known Member

    It would seem to me that this is simply about allocation of resources.
    Does it require a degree educated podiatrist to adequately assess a patient ??
    Does it require a degree educated podiatrist to provide the technical elements of routine foot care??

    The fact is that within the NHS in the UK, the initiation of the assistant practitioner role is to allocate technical work to Grade 4 , whilst being clinically supervised by Podiatrists.
    Is this not a better form of resource allocation?

    Tony
     
  22. Mark Russell

    Mark Russell Well-Known Member

    Tony

    There are merits with introducing an assistant practitioner role in podiatry, but there are dangers too, especially if they can practice unsupervised and if the regulatory mechanisms allow independent practice in the private marketplace. We could end up in the uneviable position of the previous forty years with a regulated podiatric workforce and an unregulated foot health professional workforce, which will severely undermine the market potential for graduate practitioners. Provided assistant practitioners work under direct supervision both within the NHS and in private practice and have their scope of practice strictly defined, I don't have a problem with their introduction.

    Mark
     
  23. C Bain

    C Bain Well-Known Member

    NHS. Ward Nurses Treatment of Feet!

    ________________________________________________________
    Hi Tony,

    Sounds interesting, my experience from the outside looking in is that Nurses on the Wards are being offered short courses in Nail cutting and general Chiropody as expected now that nail cutting appears to have been downgraded out of NHS. Podiatry?

    I have new patients who are prepared to pay to have their toe nails and corns cut and treated mainly because some of them need a doctor's letter locally everytime they seek a new appointment! Of course the toe could have fallen off before they get one? (Only joking, I think!).

    The hospital seems to be working well with the odd nurse on the Ward taking the course and using it! The next generation of Podiatrists perhaps, (Nursing Degree standard always a good start for the next step into Podiatry?). But where have all the NHS. Podiatrists gone? Flown south for the winter perhaps and haven't returned?

    Is there a drop in NHS. Podiatrists numbers or is it just my imagination?

    Yours,

    Colin.

    PS. Two for the price of one a most definite improvement on management profitability perhaps? Always a good Element in the Industrial Revolution? Down grade skills. Semi-skilled much more numerous and cheaper to train and employ. Good for numbers of patients treated too. Much needed Jobs in the NHS. and a promotion for good management?

    PPS. Trouble is it is beginning to sound like a broken record all over again?
     
  24. achilles

    achilles Well-Known Member

    Couldn't agree more, Mark.
     
  25. Simon Spooner

    Simon Spooner Well-Known Member

    No.

    No.

    So why do we need Podiatrist's to be degree educated at all?
     
  26. C Bain

    C Bain Well-Known Member

    Hi All,

    It is the Guild-monopoly all over again. History does repeat itself. The perfect world for the expert! Control and keep the skill to oneself don't you think!

    Excuse or main argument, It will be safer for the patient! But can the expert in such as the NHS. give the time to justify their case? Only if they jettison work such as nail cutting.

    But just a minute, if they do that they will not see the feet until there is something dropping off perhaps. Which is more important, the Patient or the Practitioner bearing in mind the NHS. is now run as a business in part???

    Yours,

    Colin.
     
    Last edited: Jul 24, 2006
  27. martinharvey

    martinharvey Well-Known Member

    Who fixes your cars brakes? The mailman?

    Simon, I'm interested in your reasoning behind the first No. Also your definition of 'adequate'

    Perhaps one good reason could be that even when we are cutting nails we are using our eyes and noses and ears. However, none of the foregoing is any use at all without a personal knowledge base, I thought higher education was supposed to provide this. ........; look at that mole (but is it an MM?) What a funny shaped toe! (hold on. what about - empyema, pulmonary carcinoma?) That little lumpy thing (wait- synovial sarcoma?) and so on and so on.

    I'm sure that my Postman COULD change my cars brakes, but could I blame him if nobody had told him to check the brake hoses, personally I'll stick with a skilled mechanic, even for the simple jobs. If people choose to pay our charges to have us cut their nails (and keep our brains in gear while we do so), when I'm sure a pedicurist would be cheaper, then personally for me, thats fine.

    If you think our routine cases are boring, just ask a GP. Sometimes, the ones I work alongside come into the break room glassy eyed, from saying the same thing dozens of times a day, day in and day out. And I think they train just a little longer than we do. But, the very next 'routine' case they see may just end up owing their life to that Doctors knowledge.

    Perhaps they don't need degrees either?

    Regards,

    Martin
     
  28. Mark Russell

    Mark Russell Well-Known Member

    Not sure I agree with you Martin. Most graduates will tell you they are over-qualified for most of the work they do - especially in the NHS - where most practice these days is restricted to changing wound care dressings, something nurses used to do. The problem we have is that the present three year podiatry degree and scope of practice falls between something that is overqualified for general footcare and underqualified for a foot specialist. Personally I would like to see podiatry education extended to a five year doctorate course encompassing foot surgery at undergraduate level, but as the NHS still funds podiatry education, this may not be possible for some time yet. The big question is - are thirteen podiatry schools viable in the UK?
     
  29. Cameron

    Cameron Well-Known Member

    Netizens

    Always an interesting topic.

    I am working in chronic disease management at present and almost come to a cathartic conclusion that our profession works on two separate levels. The majority promote total patient dependence on podiatry and the rest encourage negociated care with their clients (empowerment) The former view nail care (pedicure) as either non essential housekeeping which frustratingly forms a large part of the workload; or a normal part of foot health care within their patient demographic. In truth more people seek help out with podiatry (including self-care) than go to podiatrists, so I think this makes it all the more essential practitioners acknowledge what they do for a living, and asimportant,what their limitations are asapractitioner. Alternatively, pinning for "greener grass' is not healthy and much cause for work related stress as has been seen in reported surveys on stress.

    As to how best to prepare a work force to meet these challenges.

    That is worth a bottle of good brandy, and an evening in by the fire (winter in Oz), or a BBQ in the Northern Hemisphere.

    Cameron
    Hey,what do I know ?
     
  30. Simon Spooner

    Simon Spooner Well-Known Member

    Martin what you should remember here is that up until 1990/1 degree's in podiatry didn't exist. I think I'm right in saying that my cohort at Eastbourne were the first to graduate (although I'm not sure whether the year above got retrospective degrees- hence the 90/1 thing above) so anyone qualifying before this time were diplomates. So in other words these people, many of whom may not have converted their diplomas to degrees, are still working in practice and are as capable as any degree bearing individual in performing said assessment of patient.

    Also, what if I trained an individual to do one task, lets say an ABPI. Are you telling me that with enough training this individual could not perofrm this single assessment and interpret the results?

    We all like to think that what we do is really technically challenging, in isolation each task is not. It is the whole which is worthy of degree- but this wasn't the question. Moreover, the degree is just the indicator of the level of learning BTW. In my years of teaching I came across an number of first class students who I wouldn't have trusted to sit the right way around on a toilet seat, let alone look after my feet. They could however play the academic game. Equally, I worked with a number of students who ended up with pretty crappy degrees but were excellent clinicians.
     
  31. martinharvey

    martinharvey Well-Known Member

    level of practice

    Hi, Mark, Cameron, Simon.

    Mark, I certainly understand the frustration of practitioners in the NHS, after all, you probably can't choose your caseload. But equally, in private practice, I can't afford to turn away 'boring' pedicures either(if I did how would I buy the Laphroig, and other essentials). Sure, wall to wall nail and skin surgery, and daily challenging gait pathologies etc might be nice - but be careful what you wish for ..and so on. What makes it easier for me of course is that I dont suffer from the same time constraints, I can give them 30 minutes plus, and if something piques my curiosity I can go galloping off on a tangent without having to justify it to an administrator wearing money - goggles. You are right about different levels of practice, thats why IMHO everbody who works on the foot from FHP to Pod Surg' should be regulated by the HPC (or something better), with UK wide defined common training syllabii and legally defined scopes of practice, common infection control policies, and work as a TEAM referring cases to where they need to go, upwards, sideways, downwards. But of course it would mean that we would actually have to have professional discourses with each other instead of some of the "I'm a proper Pod but your'e not" slanging matches that we have seen on this site over the years. Anyway another man, well known to this forum, and far more highly qualified than I will ever be, suggested that, and said it far better than I could, quite a while ago. And got pilloried for it by his peers. Good idea about that Doctorate - but as you say, who pays?

    Cameron, apt and seductive suggestion (about the BBQ and Brandy I mean)

    Simon, I take your point, I was using the degree as a simple label for a high level of theoretical knowledge and clinical skill, - I should have said degree - standard perhaps. However, granting the highly trained ABPI technician is mustard at ABPI's, how will they react to that odd lesion, that ?mole, that little erythematous rash running up the leg etc, etc. They need a catholic knowledge base in order to mentally flag something as 'suspicious' and take appropriate action, whatever is 'appropriate' in each case.


    Regards,

    Martin
     
  32. Cameron

    Cameron Well-Known Member

    Netizens

    Degree level education relates more to the way the content is processeed by the learner rather than the level or volume of content within the subject. In the taxonomy of cognition, analysis, synthesis and evaluation are stressed in graduate education whereas recall, comprehension and application are skills which related more to training. Vocational degree contain both elements (because of the job) and often some components are favoured over others by participants. "I liked the practical component of my time at university/ college, the essays were always a struggle." This is not uncommonly heard in the pub.

    Cameron
     
  33. martinharvey

    martinharvey Well-Known Member

    I see you took your advice

    ;) Cameron, Must be good brandy that!
    let me have the recipe!!
     
  34. Cameron

    Cameron Well-Known Member

    Netizens

    I can finish my post now I have dropped "she who must be obeyed" at her place of work.

    The move to graduate education in the UK and Australasia was not borne out by a need to change podiatry practice, quite the reverse, it was a move by the polytechnic universities to gather together non university programs to forge a non medical faculty which would consist of nursing and allied health. These professions had potential to be moved from diploma status to degree with the intention that one day the paramedical faculties could compete for research monies alongside the traditional medical faculties. A lot has happened in the last 20 years or so with the bigger disciplines such as nursing becoming centres by themself. Ironically there is now a -major move to incoporporate allied health into their faculties which is being encouraged by the UK government. Graduate entry courses also support career development and retraining. Mark suggested a five year undergraduate program for podiatry, this is more likely to be achieved by graduate entry i. e. a nursing degree followed by two year graduate entry podiatry program based on accelerated learning (or other combinations) .

    The pattern is already established in the states and now across the rest of the globe. Concerns have been expressed as to the potential for academic creep in these programs (graduate entry) which sometimes leave students to process volumes of content with no real attempt by the providers to use appropriate intellectual processing. At worst this type of cross over course has been criticised as income generation for universities ill prepared or unwilling to invest in appropriate teaching and learning technologies. However the program remain popular and are likely to remain becuase they do offer bridges and ladders to graduates keen to change their vocation.

    Meantime back to podiatry, practitioners now are presented with a vast range of information some genuine and the rest, less credible. To be a descerning practitioner is part of being a professional and the need to provide for the client requires modern practitioners must be congnisant with "the scientific method" Whether this is taught or self taught is of no consequence, if in the end we become more able to care for others.


    Have a good one

    Cameron
     
  35. One Foot In The Grave

    One Foot In The Grave Well-Known Member

    That's actually a really great idea.

    No doubt it would reduce profession attrition by reducing the number of students who select Podiatry because they can't think of anything else they want to do and increasing the numbers of those who choose it because it is really what they want.
     
  36. achilles

    achilles Well-Known Member


    I have to agree with Cameron in that the only way a 5 yr programme in the UK would exist is through graduate entry and an accelerated programme.
    The current proviso is to create a 2 + 2 model for foundation degree practitioners to step onto yr 2 of BSc (Hons) Podiatry programme.
    However,foot in the grave, you are mistaken in believing that there are large numbers of potential students who dash to undertake a 5 yr programme. Dentistry has been reduced to 4yrs via graduate entry and is far more lucrative, with greater professional kudos.
    I think you only need to look at how many Podiatry schools there are in the US, and the difficulties they have in recruitment.
    Let's also not forget the widening participation agenda and the issues surrounding recruitment and the Disability Discrimination act.
    Food for thought!!
    Cheers
    Tony
     
  37. gspod

    gspod New Member

    Hi - I am a (mature) podiatry student and, with my limited experience, have come to a couple of conclusions. There appears to be three types of student on my course.
    1 - Intelligent, young, dynamic A-level students who are genuinely interested in podiatry. I see them becoming specialists and/or surgeons.
    2 - Older students like myself (many who are mums with school age children) who are happy to become Chiropodists.
    3 - Young, not so accademic, students who drifted into podiatry for a variety of reasons.
    For group 1 the course is too easy and a few are disgruntled with at least 2 leaving last year. For groups 2 and 3 the course is either too long or too hard with many re-sits or people leaving due to other comitments.

    Would it be better to have a 2 tier system with a Chiropody Diploma of say a 2 year (1 and 1/2 with a 6 week summer holiday would be better) very practically based course, and a 5 year, American style Podiatric Doctorate. there could then be 2 titles - Chiropodist and Podiatist.
    This would, possibly, have a number of advantages.
    Firstly the public would come to know (eventually) and understand the differences between the proffessions. Secondly it would raise the profile and status of Podiatry, attracting not only more but higher quality graduates. thirdly it would attract and retain more people into the Chiropody spectrum: many of whom would have become foot care assistants, foot care proffesionals etc. And finally it might make it easier to regulate the profession where foot care professionals etc are concerned.
    Just a few thoughts, although I have no experience, for the forum
    Regards
    GS
     
  38. C Bain

    C Bain Well-Known Member

    Hi GS.,

    Now there is an original thought for you,

    1. Podiatrists with degrees, specializing!

    2. Chiropodists with Diploma's working!

    3. Some of us about to break out in hysterical laughter at your two suggestions!

    Regards,

    Colin.

    PS. No GS. not sarcasm regarding your common sense just amazed that somebody still reaches that conclusion of yours. Afraid not held by those in power and authority though! Lots of pensioners limping as a result in the very near future I suspect?
     
  39. 1stronglady

    1stronglady New Member

    Have some of you considered that the nurses who provide basic foot care do it for the good of their patients? We know our limits, we refer patients to their physician or podiatrist if they have infections, ingrown nails, etc. The reason they utilize foot care nurses is because Medicare does not pay for basic foot care, and doctors will not make house calls. Would you prefer these patients or their family members provide their own foot care (most of them can barely see or touch their feet), possible causing injury or infection? I think it is a better solution for them to have this care performed by a Certified Foot Care Nurse. These nurses have specialized training and have been certified to provide this care. If physicians work closely with these nurses they may find it helps all of us (patients and health care professionals). You may also find your patient load increases from referrals from these nurses.
     
  40. gaittec

    gaittec Active Member

    Before you decide if you want Nurses certified to preform services in your profession, consider Wal-green's Drug Stores, CVS Drug Stores, and even Kroger's Groceries who have all opened Offices in their stores with national chains of "Nurse Practitioners" directly competing with local primary care doctors. As a C.Ped myself, I thought it was ok for our organization to certify orthopedic shoe fitters who could assist in our practices. Then the certified fitters found they could list themselves as pedorthists; and, go into business on their own selling shoes to Medicare Diabetic patients. This, in turn, led to all of us C.Peds being required to have surety bonds, in addition to everything else, in order to do business with Medicare and other insurance payers.
     
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