The Wound, Ostomy, Continence Certification Board (WOCNCB) is an accredited organization that provides nurses with the opportunity for certification in wound, ostomy, continence, and, most recently, foot care nursing. The numbers of nurses certified in foot care nursing have grown steadily since the first examination was offered in 2005. This certification is currently the only examination offered by the WOCNCB that allows RNs with any level of educational preparation to sit for the certification examination.
Prior to being eligible for the examination in foot care nursing, individuals are required to complete a formal education program or they may opt to qualify through the experiential pathway. The experiential pathway toward certification in this specialty requires a minimum of 5 hours of formal continuing education that is directly related to foot and nail care plus 8 hours of supervised clinical time.
The following are representative samples of the types of questions seen on the examination.
1. In teaching a patient with diabetes how to best manage their foot care between professional appointments, the most important teaching point to be included is which of the following?
A. Inspection of both feet should be done on a daily basis.
B. Assessment for neuropathy should be done on a monthly basis.
C. Evaluation of hemoglobin A1C values should be done on a bimonthly basis.
D. Examination of footwear should be done on a weekly basis.
2. A patient presents with an acutely painful and swollen first metatarsophalangeal joint. The immediate area has taken on a deep reddish color. The patient reports that the onset of pain was sudden and occurred overnight. The most common cause of this condition is which of the following.
A. Psoriatic arthritis
B. Gout
C. Rheumatoid arthritis
D. Bone spur
3. In a healthy patient, how long will it take for a toenail to grow from the matrix to the free edge.
A. 1-6 months
B. 6-12 months
C. 12-18 months
D. 18-24 months
Answers
1. (A) This option is the basis of good foot hygiene for high-risk patients. It allows patients to become familiar with normal conditions so that they are able to recognize abnormal conditions and seek professional help promptly when needed. Options B, C, and D are all important components of a good foot management, but the time frames are inaccurate.
Reference
Bryant R, Nix D. Acute and Chronic Wounds: Current Management Concepts. 2nd ed. St Louis, MO: Mosby; 2000:313-314.
2. (B) Gout most often presents with these symptoms when uric acid fails to be eliminated properly. This results in the precipitation of uric acid crystals (tophi) that irritate the joint and soft tissue. All of the other options may be seen but none would present with this set of symptoms.
Reference
Mix G. The Salon Professionals Guide to Foot Care. Clifton Park, NY: Milady/SalonOvations Publishing; 1999:39.
3. (C) Toenails grow out much more slowly than fingernails. This is important when assessing nail morphology and in teaching patients so that they understand that healthy nails take time to grow and changes will be seen over an extended time frame.
Reference
Habif T. Nail diseases. Clinical Dermatology. 4th ed. St Louis, MO: Mosby; 2004:865.
Preparation is elemental to success and this is never truer than with new endeavors. Foot care nursing is an area of expertise that is very narrow in scope and yet complex with information coming from nursing, podiatry, dermatology, and even surgery. The current knowledge base is large and is continuing to grow. Success requires the proper combination of knowledge and experience. This preparation varies from one individual to the next and is dependant on a number of factors. The formal programs that are available offer similar content but each one varies slightly. The opportunities for continuing education also vary in content and the value of clinical time is dependent upon the setting, patients available, and the supervising healthcare provider.
One tool to balance these variables is the self-assessment examination that is available on the Web site, http://wocncb.org. This practice examination is available for a nominal charge and will allow examination candidates to test their readiness for it and direct further study. Sample questions are similar to those used in the actual examinations. They follow the outline of test content and are balanced like the examinations. This examination provides the test-taker with immediate feedback on whether or not they have selected correctly and clear rationale to support the correct answer and discount the distracters. This is a valuable tool for the candidate who is questioning his or her readiness and is a great confidence builder.
Nurses who have achieved the status of Certified Foot Care Nurse, CFCN, are using it in an unending variety of settings. For some, it is an extension of their professional wound care practice, others who do not have certification in wound care, use it as a solo specialty. Several have used this certification as the basis for forming their own businesses. For others it is the pathway to consulting opportunities and a way to control their own schedules and professional lives. Others apply their knowledge and experience in educating and inspiring others.
There are now certified foot care nurses practicing in all care settings providing safe, compassionate care for patients. Patients receive vital education that is critical in improving their lives along with their foot and nail care. For high-risk patients, such as those with diabetes, this education may be key in preventing devastating complications.