AROM- do you do it?

renerian, BSN, RN · Oct 20, 2002

A Dr. must need to do it in Ohio as the nurses never did for my babies..

renerian

nursenoelle · Oct 20, 2002

In this small hospital in arkansas....only the doc.

SmilingBluEyes · Oct 20, 2002

Where I WORK WE SURE DON'T.....it is considered a MEDICAL intervention out of the scope of nursing except for midwifery. It's fine by me...I do not wish to AROM anyone. ( I know in some places, they do from the perinatal listserve I subscribe to).

Had a nurse do that "accidentally"....she is known for this......and there washed the cord out the lady partsl introitus, making it an emergent situation whereby no doctor was present to deal with it. Guess she was not trained well enough? Just cause there is a bulgy bag there, does not mean we rupture it w/o serious thought as to presenting parts and where they are! NO THANK YOU, I am happy NOT to AROM !!!!!

spineCNOR · Oct 20, 2002

In Alabama the State Board of Nursing does not consider this to be within the scope of practice for nurses, with the exception of CNM's.

fergus51 · Oct 20, 2002

Not done by nurses up here either.

HazeK · Oct 20, 2002

AROM per RNs is the standard here in Las Vegas...

and is OK'd by our Board of Nursing & our Practice Act! :eek:

We have parameters like "vertex well applied to cervix", etc. too.

*** HOWEVER ***

I agree that AROM can be a very dangerous procedure for a nurse to be doing...and I say THAT after doing it for 20 years!

rationale: IF you arom and have a cord prolapse or have AROM'd a patient with a vellementous (sp?) insertion of the cord and the fetus is now exsanguinating, can YOU THE NURSE do the life-saving C/S required? Nope, not without an MD!

So............I make sure our OR & anesthesiologist aren't busy, and that the primary MD is prepared to come to the bedside immed if prolonged decles, prolapse, etc. !

SmilingBluEyes · Oct 21, 2002

yep yep Haze. I am personally GLAD not to be doing AROM at all. It is not that the procedure is difficult but I don't want that liability!

OB/GYN NP · Oct 21, 2002

In Indiana, Docs must perform AROM. Let's face it, certainly nurses can perform the skill of actually performing the AROM. It's not the skill that's difficult. We could probably all rupture someone if we needed to, but it's no credit to our skill to be able to rupture someone's membranes, but have to frantically call for a stat C/S, performed by SOMEONE ELSE WITH AN MD BEHIND THEIR NAME, when a cord prolapses. Fact is, it happens very infrequently, but if you ever have a cord rush out into your hand, you NEVER forget the panic. I, for one, will not. In my case, my patient ruptured while I was doing her vag exam (NOT one of those accidentally on purpose ruptures :) ). No Doc in house...you get the picture. I spent the next 30 minutes with my hand in this poor lady's lady parts, with my co-workers preparing my patient for a stat section, and rolling the patient down the hall with me in the bed with her. It was one of the scariest moments of my life. It taught me something, though. Nurses are in a powerful position, and sometimes we choose NOT to use that power for the sake of our patients. Just my opinion...

**canoehead, BSN, RN** · Oct 21, 2002

I believe we are able to per the BON but the nurses chose not to because the doc could be 45 min away, and sometimes there is just the one nurse on the floor, making it difficult to get help. Also some issues with MD's blaming RN's for poor outcomes, they didn't want to add ROM to the list.

anitame · Oct 21, 2002

RN's don't AROM in Oregon either.

Audreyfay · Oct 21, 2002

RNs in Michigan don't AROM. I worked in OB there...and no way. Saw the prolapsed cord with an emergency C-section with twins, when the MD AROM. Don't want to see it again. (The MD rode the bottom of the bed to the OR, with his fingers holding the head up, with the cord between his fingers. Both babies made it!)