"Not allowed" to perform vaginal exams

  1. I am a new grad in Labor & Delivery and I began working in a large teaching facility in August. I was informed that nurses here are "not allowed" to do vaginal exams. While on orientation on day shift, my preceptor told me that she has been working at this hospital for 27 years and has never learned to do a vaginal exam. I was told that this is their policy because they want the residents to be very involved in the patient's care and also to strengthen their skills. My preceptor also mentioned that nurses are "not allowed" to perform vaginal exams so that the number of exams are minimized to decrease the risk of infection.

    I started working on night shift this week and found out that a lot of the night shift nurses do vaginal exams when the residents are occupied. Friday night when I was working, one of the residents offered to let me do a couple of vaginal exams since, as he put it, "it's a skill you should learn and most other hospitals allow nurses to check their patients." Without thinking much about it, I decided to check the patient along with the resident. Now I am nervous about whether that was a good idea or not...

    To other nurses who work under similar circumstances... can I get in trouble for doing cervical checks if I'm "not allowed"? Should I continue to try to learn this skill or should I not do this anymore? I'm afraid that if I don't learn this skill it will make it more difficult to find a job at a different hospital later on. But I also don't want to risk getting in trouble with my current job because so far I have a good reputation.

    Any advice would be greatly appreciated.
  2. Visit Kayla.J.RN profile page

    About Kayla.J.RN

    Joined: Jun '12; Posts: 45; Likes: 27
    Registered Nurse; from US
    Specialty: Labor & Delivery


  3. by   Fyreflie
    Is it a policy or just a culture? I have to say, I can't imagine being competent in L&D and never doing an exam!! We do a great deal of teaching but it's the residents who check along with US and not the other way around. Heck, the first year we don't trust a single exam they do--what if they told us to push with a primip who wasn't quite fully?

    I would clarify the hospital expectation and policy and follow that, but do as much learning as you can and if you have a doc willing to teach you, try to grab those opportunities? I dunno, that's a toughie!
  4. by   Kayla.J.RN
    Thanks for your response Fyreflie. I honestly think it's more culture than policy... but I need to clarify this when I go in to work again. I'm going to see if there is any written policy on nurses performing vaginal exams and ask the other night nurses about what they do.
  5. by   monkeybug
    One of the many reasons I would NEVER again work in a teaching hospital! I did work in a teaching hospital very briefly, and the nurses did check, but very rarely. If the doctors are offering to let you learn, then do it! If you go to work for a non-teaching facility, you will be expected to do many of the vaginal exams. We had a nurse transfer to us after years of working at a teaching facility, and she couldn't hack it. She wanted to throw up her hands and call the doctor all the time, and they wanted her to act like the rest of us (deal with it and only when it was over our heads did we call the cavalry).
  6. by   cebuana_nurse
    I agree with Fyreflie. Ask your co-workers if there's any written policy regarding this. I think that as a nurse working in L&D, you should be ready for anything. Labor and Delivery is known to be very unexpected. God forbid if you get a patient that is screaming in agony and dropping F bombs in the room and who happens to be a multip and the doctor is not around and you don't check them, and they start pushing without a table, then your screwed. This would also limit paging doctors for unneccessary things. I've learned this the hard way when one of our new OB-GYNs just came out of residency from NY and she likes to do all exams on her own. Needless to say, I was able to prepare for a table and anticipate a delivery. When the doc came in, all she needed to do is gown up and put her boots and goggles. I work at a small community hospital that only averages 100 births per year and our OB-GYN's are not in house but on-call living 30 minutes away.
  7. by   NurseNora
    If a resident offers to teach you something that is within your state's scope of practice, take him/her up on it. Doctors like to teach,so encourage them to do so. If the rational for nurses not doing exams is to keep the docs closely involved with the patients, then having one teach you doesn't go against that. Ask them if you can check after them and compare findings, Especially patients with epidurals. so you don't cause unnecessary discomfort
  8. by   NurseNora
    oops not finished.Patients with intact membranes or ruptured and making good progress--don't want to cause iatrogenic infections.lNight shift nurses do tend to do more things than day shift. It's part of the cultural difference between the shifts. The bosses aren't around and even residents need a little sleep from time to time. As long as you aren't going beyond written policy and are with your scope of practice, you'll be OK.
  9. by   ColoradoBirthRN
    I think if a provider asks you to check, you should go ahead and take the opportunity. I work at a teaching hospital as well and often when there are new residents, they ask the nurses to check behind them to make sure and if you stay at this hospital this very well may happen to you too.
  10. by   anggelRN
    I couldn't imagine not being able to do vaginal exams. Are the docs just sitting around with nothing to do all day? I have very often checked after doctors and residents. I say if it's not a written policy and it won't get you into bad graces with your manager, learn the skill when you can. Even if it mean working a night shift or two.
  11. by   ndirishfanRNC
    I also work in a teaching hospital where nurses were discouraged from checking patients. Our attending physicians felt we were taking opportunity away from the residents. This is a skill that nursing staff needs to be competent in as well as the residents. Some of the upper level residents that came through have been very good at teaching nurses to check a cervix, but they are few and far between. There were no policies in place, so every time I had a labor patient with an epidural I would check her cervix q4 hrs when i would have to straight cath her and I eventually learned after being there over three years! Is there a nurse/physician council in place on your unit? I am a member of our council and one of this issues being discussed is how to collaborate with physicians to get nurses signed off on cervical checks as well as residents. Good luck!!
  12. by   Kayla.J.RN
    Thanks everyone for your responses. I agree with what everyone has been saying. I want to continue to learn this skill.. so I will take the opportunity to check with the residents and doctors that are willing to let me learn.

    ndirishfanRNC, I like what you mentioned about checking the cervix on pt's with epidurals q4 hrs and before straights caths. Thanks for sharing what you've learned from working under similar conditions.

    When I was first hired as a nurse extern on L&D the summer of 2011, I didn't know that nurses were expected to perform the vaginal exams in most other hospitals. This is because I was an extern in L&D before my obstetrics rotation in my nursing program. It wasn't until a fellow student mentioned to me that she performed cervical checks during her senior residency in L&D that I realized most places don't operate the same way. When she told me this I felt cheated of a good learning experience and the opportunity to learn a valuable skill.

    Now that I'm finally an RN in L&D I want to take every opportunity to learn and grow in this specialty. So far, I really love my job... even with all the challenges and anxiety I'm facing as a new grad.
  13. by   lovemyjoblandd
    I would be a nervous wreck if I had to take the word of someone else in order to manage my labors. While cervical checks alone are definitely not a determining factor on how I base my care, a baseline and changes are important to me. The strip nor the patient always gives away how close a patient is, and I personally don't like the liability when I have to deliver because the doc didn't get there in time lol
  14. by   RNLaborNurse4U
    What about if the doc is not readily available and you have deep, repetitive decels? You need to check for a cord prolapse immediately. Learning cervical exams are a basic assessment skill that all L&D nurses need to have. Double check with your state nursing scope of practice, but I'm sure it's within all states nursing scope. (Speculum exams are a different story though.)