A recent Public Advisory by the College of Nurses & Midwives (BCCNM) warned that someone on Salt Spring Island has been advertising and offering Nursing Foot Care without the mandatory licensing to do so.

Because of the many questions received there are some answers provided below.

In Canada, professional standards and licensing for Foot Care are not achieved through central certification but in the following way:

Licensed nurses are trained in professional development courses to do Foot Care. Although a certificate to have passed such courses is mandatory, this is not a license or certification for Foot Care.

Only Foot Care Nurses in good standing are allowed to practise. Like other health professionals, nurses are expected to meet professional standards, continuing professional education, and other requirements for renewing their authorization to practise on an annual basis.

Additional certification is possible through the American Foot Care Nurses Association (AFCNA). Some Canadian Foot Care Nurses make this extra effort. Nurses with this US standard have the title of Certified Foot Care Specialist (CFCS). Some also call a nurse with this certification a Podiatric Nurse.

To ensure public safety, the BC Health Professions Act of 1996 requires that each designated profession providing health services such as doctors, dentists, nurses, pharmacists, and a number of other professions in this field, are regulated by an institution called college.

Only individuals registered with a college are allowed to practise and use titles of designated health professions. Contraventions are an offence under the BC Offence Act and can be punishable by fine or imprisonment.

The public advisory was not issued by a 'group', 'association', or 'union' suddenly concerned about 'ownership rights' of professional titles - as had been suggested. The advisory was issued for public safety by a regulatory college. The legal mandate of the BC College of Nurses & Midwives (BCCNM) is to protect the public through the regulation of nursing professionals (LPNs, NPs, RNs, and RPNs), setting standards of practice, assessing nursing education programs in B.C., and addressing complaints.

In order to be authorised to practise, members of a health profession need to prove their credentials, learn about professional standards in BC, engage in ongoing education, have professional insurance, and meet certain other professional requirements, usually on an annual basis.

Retired health professionals are not allowed to practise even as volunteers.

The public can verify the current licensing status of each member online and if necessary can make complaints about each member's professional conduct. This system is mandatory by law. It is vital to maintain high standards for health professionals to ensure safe practises for the public.

Nurses provide care for a wide range of health conditions. Foot Care Nurses are primarily caring towards healthy feet. Health conditions can be injuries, minor to more serious deformations of nails, skin or bones. Some illnesses can affect feet. For example, diabetes can cause nerve damage and poor blood flow, which can lead to serious foot problems that require specific treatment.

Modern Nursing Foot Care is evolving rapidly. In BC, foot care is provided by nurses that are required to take a course and are obligated to engage in ongoing learning and training in new developments both in nursing and foot care.

For example, current professional standards require tools that are packaged and sterilized under controlled conditions and not to be opened until treatment just as in hospital care, to avoid that a disease is transmitted from one client to the next. Comprehensive assessments and tests are used to identify potential health problems at an early stage. Healing progress is monitored with medical charts. New equipment consists of rotary or podiatry burs. Older techniques such as foot soaks before treatments are prohibited because of risks identified recently. As in any designated health profession, it is essential for public safety that practising members adhere to current standards.

Improperly trained individuals could cause unnecessary risks, pain, or harm to clients.

Foot Care Nurses network with other professionals.

Family Doctors diagnose medical problems and they direct care. Podiatrists are medical doctors specializing in feet and ankles, including surgery. Pedorthists are educated and trained in how to assess, modify, design and fit custom-made orthotics, footwear modifications, and orthopedic footwear.

Estheticians, Cosmetologists and Make-up Artists are beauty professionals who work on hair, skin, and nails to keep them attractive or improve their appearance. They refer issues related to health to professionals working in this field.

For more information see also here.

The goal is to provide appropriate services to clients according to their needs. Talk to a health provider such as your medical doctor and find out more about professional services to meet your needs. Compare service providers and make informed choices.

Where health aspects are concerned, the public has to be kept safe with high professional standards and professional conduct according to the laws and processes that were established for this purpose.

People who are trying to provide Foot Care services without licensing may offer low pricing because effort and costs are lower when shortcuts are taken in professional health standards. Be informed and be aware of the risks involved.

Some individuals may try to provide Foot Care without proper licensing and professional regulation. They may not be trained or updated on professional standards for the quality and safety of services.

Improper treatment can cause unnecessary pain. This is particularly harmful for clients already suffering from an illness or progressing stages of dementia. Foot Care should not be painful.

Inadequately sterilized instruments may harbour micro-organisms leading to bacterial, fungal, or viral infections. Diseases can be transmitted from one client to another.

Some infections cause furuncules, scars, warts, or fungal nails.

Paronychia is an infection of the nail bed forming tender, red skin, and pus-filled blisters. It can be painful and requires medical attention.

Nail scissors and foot baths have been identified as a risk factor in the transmission of the virus Hepatitis B and C.

Mycobacteria transmitted by contaminated tools have led to very serious infections that can take weeks to be diagnosed, can spread to bone tissue or lymph nodes, and can take months of aggressive treatment with antibiotics or surgery. Some cases require amputation of limbs as a last resort.

Foot soaks have been identified as high risk in transmitting disease because tubs cannot be sterilized to required standards. They are not part of professional foot care treatments.

Some outdated tools and techniques particularly regarding cutting cuticles and thickened skin have been associated with a high risk of infection, and can be unnecessarily painful. Revised techniques and modern rotary tools with sterilized or replacable bits are the new standard.

Clients with Diabetes are at particular high risk of developing infections or losing a limb if exposed to inadequate foot care or poor hygienic standards.

Unlicensed individuals may undercut regular pricing for foot care services because they fly below the radar of professional standards, don't carry professional insurance, and are not regulated as a health profession.

Is it worth taking the risk?

There is a cost and value to hire a licensed professional because it means benefit and safety by using approved sterilization of tools, applying modern equipment and products, continuing training and education, maintaining health records, and being part of professional regulation and oversight.

Some Further Reading (includes studies on the cosmetic industry):

Pedicure-associated infections

Nontuberculous Mycobacterial Musculoskeletal Infection Cases

Cosmetically Induced Disorders of the Nail

Necrosis, gangrene, amputation: All from a manicure?

Nail scissors as reservoirs of hepatitis B virus DNA

What's REALLY Lurking In Those Pedicure Tubs?

Registered Nurses (RN, 4 yrs with Bachelors Degree) or Licensed Practical Nurses (LPN, 2 yrs training) need to be in good standing and require additional training for Foot Care in order to work in this capacity.

Verify the current annual licensing status of a RN or of a LPN at the British Columbia College of Nurses & Midwives (BCCNM).

The relevant organizations for professional standards are the BC College of Nursing Professionals and the Canadian Association of Foot Care Nurses. 

Serving the area of:
Salt Spring Island, BC