Managing Complex Foot Care Clients Without the Overwhelm

 New Episode Alert! 

Empower Her Entrepreneur is back with another powerful episode made just for YOU, the dedicated and driven foot care nurse entrepreneur! 

This week, we’re diving into a topic that so many of us face daily:

 “Managing Complex Footcare Clients Without the Overwhelm” 

Feeling drained or second-guessing your approach when working with high-risk clients? You’re not alone — but you can feel confident, equipped, and in control.

In this episode, we’ll cover:

 Practical tools to assess and plan care efficiently How to stay calm and organized under pressure Tips to protect your time, energy, and mental wellness Real-world stories and solutions from the field

This one is for every nurse who’s ever said, “I love what I do, but some days feel like too much.” 

 Tune in now on your favorite podcast platform and don’t forget to share with a fellow nurse boss who needs to hear this today!

#EmpowerHerEntrepreneur #FootCareNurseLife #ComplexClientsMadeSimple #NurseBoss #FootCareWithoutBurnout #AFCN #NurseLifeCanada

Transcript

SPEAKER_00: 0:35

Well, welcome back to the Empower Her Entrepreneur Podcast, the space for bold and brilliant footcare nurses who are building thriving businesses with heart, hustle, and a whole lot of purpose. And I'm your host, Janice Boudreaux, CEO, footcare nurse, educator, and mentor, and entrepreneur woman in the footcare space. Of course, on the side, I'm also a wife and a mom, and definitely a boater, definitely a million other things on my plate, just like everyone else. So that's why today's topic is one I know many of you have asked about because I've been there myself, and how do we manage complex foot care clients while or without getting completely overwhelmed? Um, besides the fact that we have all these rules that we follow in our lives, you know, we're also trying to build a business, um, sustain growth, um, offer excellent services to our clients. And we have to find a way to, you know, get through and have some accomplishment when we are dealing with um complex foot care clients. So clients with multiple conditions like severe fungal infection, diabetes, dementia, um, they might have mobility challenges. I'm not gonna lie, they may have all of them all together. You know, you've seen that client. Um, and you love them. You you love all your clients. You can have the one who's completely cognitive, um, but and could it actually just be as challenging? Anyway, um, but these can all be intimidating. And when you're running a business and providing care, the stress can really build up. Um, but here's some good news uh with the right mindset, a solid plan, and smart boundaries, you can confidently manage even the most complex clients without getting burned out. Uh, you should be able to go home, you should be able to close that chapter on what you did that day, whether it be in clinic, home visit, or facility, and you should be able to relax and come home to your family, your pets, um, sisters, brothers, uh, you know, whatever your situation is. So let's dive in. So let's reframe what complex really means. Let's start by shifting the mindset. When we say a client is complex, what we often mean is they take more time, they have multiple diagnoses, or their needs go beyond the standard routine care. But complexity does not mean chaos. It does not have to be. And all those things I just mentioned about the taking more time, multiple issues, and going beyond the standard routine could be all of the things above. It could even be behavior of the client, attitude of the client, um, so many things. Um, also additive onto that. It doesn't mean that the client is difficult. It doesn't mean you're unqualified. What it means is that this client needs you to step into your professional expertise and maybe even upgrade your systems to support them better. The first key, be prepared and not panicked. Often we have that first visit with our client, which tells the tale of what their needs are, um, what their tone is with you. You can have clients that are really quiet. You can have clients that they nonstop talk during the whole visit, um, they like the the chit-chat back and forth. Um they, you know, you you see what's going on with their feet, their lower limbs from generally the knee down, you're obsessing everything. That is a big part. Um, but the other thing is the power of the pre-visit planning. One of the biggest causes of overwhelm is walking into a client visit without a clear plan. So here's a strategy. Chart review. Always review your client's file before the visit. Whether you're in clinic or mobile, look for red flags like uncontrolled diabetes, open wounds, history of infection, poor circulation, cognitive impairments. So the power of pre-visit planning. So, well, how do I do that? They're, you know, Barb and John are coming in and they're brand new clients. Well, we are using, and I know there's a million systems out there, but we use Clinico, which is fabulous. And do you know the moment somebody books with us, we have a um consent that goes out to them that they can take the time to read it, they can sign it when they're in front of us. So that way they're they're getting a lot of the pre-stuff. But also we send a very well-crafted health intake form. Both our consent and intake form were created by a health law team, making sure that we are protected liability-wise. And I must say, our health intake form is fabulous. There isn't anything that we do not cover. We have these forms for purchase on the AFC and Learning Institute, but we also um we have them that the nurses can go to home visits or facilities and have a heart copy. But like I'm saying, if you do have clinic space, uh, we have them for clank or home visits that the moment they're booking the employment, that health intake form is giving you so much information. And some of that can be like underlying disease, things that have been happening in the past. Um, they have the time. A lot of it's just tick-off boxes. There are sections where, you know, paragraphs can be put in. Uh, we really, really do cover all the areas. And when my nurses get the opportunity to take a look at that, um, and I know myself as a practitioner, you're not walking in so blind. There's nothing worse than going to a home business. You have absolutely no idea what's going on. But you know, now Mary and Bob filled out the health intake form, and you can see, okay, well, Bob's, you know, an uncontrolled diabetic. Um, Mary's really good, but she's had a 20-year history of ingrown nails. You know, you are walking in and you are prepared. Not only that, sometimes it really helps you to make sure you have all the tools you need. And I have to say, I know even my nurses have gotten hold of me, or I've had to do it in the past. Sometimes they felt the health intake form. And I mean, I may have been a nurse for almost 30 years, but I'm like, what the heck is that? You ever do that? You're not even sure what disease process it is or what it even looks like. So it really gives you the power of the pre-visit to look up some of these conditions, diseases, concerns, um, to familiarize yourself with. You're going in a lot um, a lot more uh skilled and more comforter, right? So you're not feeling the rise of it. Um, but I just want to quickly intervene. Sometimes if they haven't filled it out and they tell you about it, never be afraid to say or utilize your health team that don't pretend to know what you're talking about. Say, you know what, I'm not all that familiar with it, but I do have, you know, our healthcare team that I can speak to some of them. I can either get you to the right person or I'm gonna learn and educate myself on this more. There is nothing wrong with following up. Yes, we want to go in strong like an expert, but there is nothing wrong with saying I'm going to confer with my health team. I've even had it where myself or my nurses have taken pictures with the permission. We I should tell you, we have um on our consent, we have a space that uh clients can can let us know. So all of this is really, really important. So, and you know, I'm talking foot care, but at the end of the day, it can also be for any business that you're doing. Um, you know, maybe I I don't know, you're in health, maybe you're a counselor. It's all about that pre-visit information coming in. Um, you know, it like I said, advanced helps you mentally and clinically prepare. Also, book more time. Complex clients uh often need the longer visit. That's not a problem. That's part of premium care. You can schedule accordingly and charge accordingly. So, what we do is that all of our clients or yourself, you can say, Is this the first time a client is seeing me? Well, we have a different amount of minutes and time we see for what's called an initial client. And then an ongoing client has less time. But wait a second, now you've got that client that is, you know, more challenged in what they need. So we have an advanced appointment. So that means they go from initial to advanced, they don't go into the ongoing slot, which is more um stable care. They may go there one day, but they're not there yet. So between these three appointment types, you're giving yourself or um your staff or your nurse, like I said, depending on what kind of treatments you're doing and what kind of business you're in, more time. They're going to feel more comfortable. There's going to be less stress. And you're charging appropriately. More time is more money. You don't have to feel bad about that. Um, the next thing would be, like I said, so the power of the pre-visit, your chart reviewing, or you're getting the information on your client, you're booking more time if needing. Well, the last one would be pack with purpose. Bring what you know you'll need. For example, for clients with thick fungal nails, don't forget extra burrs, a dust extraction drill, or even a headlamp for better visibility. Whatever you're doing and gathering in that pre-visit knowledge, um, it could be resources that you need to give your client, such as pamphlets, such as cards and information. This is just crucial. And you know what? It really shines your expertise when you have, you know, hi Mary and Bob, thank you so much for coming in today. Um, I see here on your health intake forum, you have this. I do have some information for you. You it's it's nice to always be sending clients away with homework, um, in essence, or information. Um, this makes you definitely a premier and a top provider. So, next thing I would say, moving on from the pre-visit, is streamline during your appointment or your visit. Confidence over perfection. So, know once you're in the visit, one, stay calm and go step by step. Don't rush. Break the visit into simple stages: assessment, cleanse and soften, nail and skin care recommendations and documentation. If you work through this four-step flow and do it every single time the same way, assessment, cleanse and soften, nail and skin care, recommendations and documentation. You're gonna focus on what you can address today and save the rest for a follow-up. You're not here to fix 10 years of problems in one visit. So that's why you want to stay calm and you're doing your steps. I can often see clients that have come in and yeah, they could have like four years of issues. Well, what we often will say is that you know what, we have this time allotted today, and you know, this didn't build up in one month. We're going, and you may want to shorten the next time you're going to see that client. So instead of booking them in six weeks, maybe bring them back in four. I think a big thing to know too is it's a lot for a client, especially if they're, you know, it's a complicated case. Um, I I can also say, even if their nails were perfect, and maybe their skin's perfect, you're not even dealing with calluses, but we have a lot of um mentally challenged, um, disabled, um, we have certain um mental health conditions uh for clients that are coming in. So imagine that the knee down really is not hard, but you have to take breaks every five minutes because the person has such bad anxiety. So we need to accept and learn and not get in overwhelm. You can only do if you have scheduled 45 minutes for that client, you can only do what you're gonna do in 45. Bring them back sooner, let them know the first three appointments are gonna be space four weeks apart. You cannot undo or um, you know, fix things all at once. Always, always, like I said, when you're after your assessment, you always pick the things that are crucial. I mean, if they're coming with an ingrown nail, you're going to be doing that. You're that's a 100% priority. You're looking at things that can cause issues. But I mean, if that means you can only reduce a nail down half, don't worry about it. You're gonna get it the next time. And if you schedule them a bit sooner, you in a couple appointments will have absolutely everything cleaned up. But there are so many things that go around a challenging client, not just the conditions. Like I said, it could be at um a mental level. So we need to accept we're only doing the best we can do. We are absolutely only human. Uh, so streamlining your visits, so be direct but compassionate. Clients with complex needs may also carry fear, shame. We know we have all seen it. Speak with kindness, but be clear about what you're doing and why it matters. You know why that kind of trust and confidence you can build with your client. I had actually a client in there. Um, oh gosh, she stayed with me for so many years. She could not have nippers, she had a fear of nippers. So that meant I had to reduce all her nails by just using a burr. Absolutely, we work together. Um, and still she would almost like scream in between every few minutes. Um, this this was a this is something absolutely not controllable by this person. But we worked together, and even after a couple visits, like she told me, she was she's like, I have never been able to go to anyone. You took the time. If I needed to take breaks, but guess what? She came back. I'll never forget it because we could only get a few toes done at a time, because the amount of breaks. We need to accept where they're at, and they need to accept and put the boundaries in that that's great that you need to take a break, but we're not here for three hours to do all your toes. We're gonna do four toes, you're gonna come back in three weeks. There are things that you can put in place. Um, like I said, being direct, but being compassionate. Another thing is always too, when you are uh streamlining, is to document like a boss, chart clearly and professionally. Complex can be lead to a lot more liability. So your notes are your protection. We use our online software. We got away from gosh, remember all the files we used to have on clients so far, so far ago. But we do love the online because we have it set up through Clinico that we can just like tick off a lot of the stuff, but then again, paragraph sections. But I think it's most important that you're documenting for sure everything they're telling you. It's those conversations, and I I think the biggest scare for all of us, and that is to document well, is and I know I've had it, I've unfortunately had it, um, where a client is almost I think they're just so angry with the way their health has gone, maybe their legs, their feet, what's going on. But yet they've had it for 20 years, and then they're like, Well, I don't know, this was since the last visit, and no, it was not. Um, I've even had a client who's like, I've never had this before, now my toes are I'm like, really? Because we've got a documented 20-year history of a problem with an area. But you know what? I I always have a lot of compassion and empathy that I think that person is just is in so much overwhelm over their health. Um, they look to blame people, so you got to be very, very careful. And yes, you've got to chart like a champ. You've got to, if they say it, it goes in there. You at the end of the day, um, liability-wise, it's so interesting to be able to look back at all the notes. And if you can say, Well, look at it, she told me she had pain in that toe 18 times. Um, God forbid that person ever sued you or came back to you saying, I had a problem with my toe. We're like, Well, you you came to us originally with a problem with the toe. We didn't cause a problem with the toe. Anyway, chart like a champ. So another section is to not be, like I said, in the overwhelm of it and manage these complex clients is to have boundaries, referrals, and follow-up. So let's talk boundaries. Number one, know when to refer. You're not responsible for fixing every medical issue. If something is beyond your scope, refer out. Have a referral sheet ready for podiatrists, wound care nurses, physicians, diabetic specialists. We absolutely have this. Do we feel we can do a lot of the things ourselves? Yeah, for sure. But you know, you know that gut feeling. And sometimes we refer out just when we find the client to be aggressive. Um, and it's not a client liability-wise, we want to take on. We feel that, okay, you know what? This would be a better person going with um somebody else, and we um just, you know, send them a referral sheet. Or sometimes it can be example of brittle diabetic. We love doing ingrown, but this is just say, like, okay, we can't get it. It's it's an ongoing issue, and even using brace and fix isn't working, which is like an ingrown toenail composite resin. Um, we've tried different things, we refer them out. You know what? There are some times they need the surgery, there are some issues that are just well beyond. In our practices, we don't do wound care, so that does move on to other people. Referring makes you look more professional, not less. So don't ever worry about that. Two, create follow-up plans. Complex clients should never be one and done. Explain this up front. Set up a care pan that includes regular visits, home care routines, progress check-ins. This keeps them accountable and makes your care effective. So this kind of ties in with the charting, too. Is I can't tell you how many times people come in and they're a complex case and they're like, yeah, I'll see you in six months. And we're like, no, no, no, no, Lord, no. And they do it. So in our um company, we bring them back to always an initial brand new client. Um, we don't like that. We don't think it's fair to the nurse having to, it's like a lot of work. Uh, we time sometimes find that um it we can we know that some people can't afford it, maybe they don't have insurance. I can absolutely respect that. In other cases, we know they can pay for it, they just don't want to. So they try to go like twice a year, um, which really is not great for a complex client. But in our charting, we have a section, it ticks off. It says client is choosing to rebook beyond what is sell is suggested for their complex or foot care issues. We make sure we tick that off when they are not. We also have a box that uh health resources have been given. We are protecting ourselves because we want them to come back in. I'll be honest, most come back in. We've got a great follow. Up plan. Um, sometimes that could be at four weeks. Um, like I said, getting I've had we've had clients even at two weeks. We're like, you know what? You got a lot going on here. Let's get you in for a short visit in two weeks. So this keeps everybody accountable. Um, absolutely for sure. And you know what? Another big thing is you've got to um protect your mental energy. You're a caregiver, yes, but you're also a business owner. You need recovery time, mental space, and support. After a heavy visit, take five minutes to decompress, journal, stretch, or have a glass of water in silence before jumping into the next client. These are all things that are absolutely so important when making sure that you are at your best, you're able to talk to your client, explain to your client, give them all the information that they need to be able to thrive. Um I'm just looking for something here because there was, I had a really good, a little bit more um information when I give about something, but we'll move on from it. Um, so to recap, complex clients aren't impossible. They're just more layered with preparation, clear systems, guys, and healthy boundaries, you can manage them with confidence. Know your role, refer when needed, set up follow-up systems and never try to do it all in one day. And don't feel bad about it. I know we want the fantastic, where we're like, oh, we just, you know, we it's a total transformation. Um, but baby steps, because they might not want that either. Toes and and uh lower limbs can get quite sore with the work being done on them. Sometimes separating it. Don't feel bad. And most importantly, give yourself grace, ladies. You are doing work that matters. Every thick toenail, every callus, every diabetic foot exam, you are improving lives. So take a deep breath, trust your training, and show up as the CEO foot care clinician you truly are. So if this episode hit home, please share it with a fellow foot care nurse. You can tag me and let me know your manage your how you're managing your complex client caseload. I'd love to hear your stories. Until next time, keep healing, keep leading, and keep building that business you were born to run.