Nails and the New Scope of Practice

Foot and nail care is needed for patients who are healthy but cannot perform normal foot care due to vision, orthopedic or neurologic deficiencies as well as for those who may have co-morbid conditions that lead to vascular, neurologic or dermatologic disorders and are therefore at high risk of trauma or infection from inadequate foot care.

The question of who is allowed to trim toenails has come up from time to time.  Most agencies in New Hampshire seem to take the conservative route and rarely allow LNAs to do it.  However, changes to the Board of Nursing scope of practice document may encouage some changes to home care practice.

In June 2019, the New Hampshire Board of Nursing released a LNA scope of practice document which included a section on “Foot Care” and “Nails.”  According to the Nursing Scope of Practice nail clipping or dreyer tool use must be ordered by a physician for our patients with compromised circulation.

Nail clipping is a nursing task delegated by a RN or LPN, and your agency has to have a policy in place. In your policy discuss which patients would be appropriate for nail care by an LNA.  It is important that the RNs follow the “delegation” rules.

See section 404 for Delegation.