Vag Exams on Preterm Patients??

  1. Ok, so just started a new job and on my Second day of work was asked to go do a vag exam and FFN on a preterm patient to determine if she would be admitted SROMed or go home.

    When I said that it wasn't in my nursing scope of pratice it caused a bit of an uproar. There is No MD on site..small rural hospital. No residents either.

    So then the managing MD went off and so did the administration of the hospital.
    I am not comfortable doing exams on preterm women with the possibility of accidently rupturing them. Was I wrong to refuse?
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    About jodyangel

    Joined: Aug '04; Posts: 642; Likes: 66
    Specialty: L&D


  3. by   babyktchr
    What is your hospital policy on examining preterm patients. There SHOULD be something written as far as a gestation that nurses are allowed to check. At the very least, if I am asked to check a very preterm patient, I always write an order that states just that and document that I was told to do it per MD. It is not out of your scope of practice, you just need to know what your facilities written policies are regarding this issue. Are you trained to do FFN? Was there competency for the nursing staff to do it? If not, then no, you should not be doing FFN.

    On a side note,...why FFN for r/oSROM?
  4. by   anggelRN
    How preterm was she? Also, I second the question about the FFN test. I have checked a patient who was 35 weeks gestation.
  5. by   Fyreflie
    In my rural job we often checked preterm patients (as preterm as late 20s) after communicating with the physician, doing a sterile spec to rule out SRM and collecting a FFN. Our orders from the MD were usually "gentle VE" meaning if we could not reach or find the cervix, there was no screwing around--we would communicate with them afterwards, usually when we called with the results of the FFN. I think it may be hospital or state/province policy that determines action. Of course if you are uncomfortable checking I think you are well within your right to decline to do it, especially being new to the facility (and OBs?). I might have said it something like "I'm really new and have never examined a preterm patient before. Can we check together so that I can safely learn this skill, and increase my comfort level with these types of patients?"
  6. by   knufflebunny
    How is it not in your scope of practice?
  7. by   jodyangel
    Ok well I will tell you that this didn't.actually happen to me. I just started at with another orientee. I asked her now her day went and she I wanted input because I always worked with residents so I don't know whats right n wrong.Pt was 34 weeks..the md office had checked her and she had wouldn't an FFN be wrong?Apparently this nurse saying um no made.them search for.their policy..which said an MD had to check preterm? Argument ensued..both the physician and CEO said that was stupid..
  8. by   jodyangel
    I don't know if checking a pt less than 35 weeks is IN my scope. Never have been allowed before.
  9. by   Fyreflie
    Yeah FFN after sex in the past 24 hours is pointless. As for scope you'd have to check with your regulating body, but as I understand it changes state by state for you guys? So it might be the hospital policy that tells you more.
  10. by   jodyangel
    Well I spoke with this nurse and she said the MD was mad because the nurses have always done it there. But there was no policy..weird huh?I don't know what the RNs role is...because I've always worked with residents on site.
  11. by   jodyangel
    Oh and the patient was 33 weeks.
  12. by   Fyreflie
    I would go straight to your regulating body but if they don't have a problem with it, and you're rural and the hospital and MD want you doing it then it'd be a good idea to ask for guidance in learning!
  13. by   jodyangel
    What do I do...just email my board of nursing??
  14. by   babyktchr
    Really you need to check your policy. Vaginal exams are not prohibited by nurses (only if it is written into the bylaws of the hospital). As a nurse you are considered a qualified medical professional who acts on behalf of the physician. The physician has the ultimate decision as to how to proceed based the assessment given to him. As I said before, your hospital SHOULD have a policy on what the cutoff is for gestational age and exams. If at all possible you shouldn't check preterm patients unless imminent delivery is possible. I have examined patients of all gestations on request of a physician based on specific circumstances (mostly because the patient appeared to be imminently delivering.

    Some things are fuzzy for me still. FFN and recent sex and vag exam excludes is pointless. This should definitely be reflected in your policy and is a directly identified by the manufacturer. Your nurse buddy is wrong. mentioned SROM and FFN. Why? I could see amnisure, but not FFN.

    While I understand that you came from a facility that utilized residents, vaginal exams are a part of life in community hospitals. You are just going to have to get used to doing that. Its really not a scope of practice issue. Having never worked with residents myself, I don't know if I would be comfortable in the reverse and never have to do them :-)