Performing vaginal exams

[perfexion, ASN, RN]

I work in a teaching hospital so the residents perform all the lady partsl exams. I don't even think it's even in our scope of practice in my state to be honest. However I'm looking into traveling and I know in some states, the nurses are expected to do the exams and the doctors just show up when it's time to deliver the baby. So how do I learn this skill? I can't just perform a VE on a patient without training (although I have been watching a few Youtube videos on the subject). And since most of the nurses have been working on the unit so long, they never learned how to perform VEs either so I have no one to teach me. How would I even go about learning this skill?

[klone, MSN, RN]

I'm sure it is in your scope of practice.

The only way to learn this skill is by doing. You could ask one of the residents/attendings if you could try (after obtaining the patient's permission, of course) and let them know you're hoping to learn, and they may be willing to work with you. Start with women who have epidurals.

Also, to get an idea of what it feels like, I would recommend starting with your own cervix. Even in non-pregnant women, your cervix will go from firm/closed to soft/fingertip, depending on where you are in your cycle.

[Katie71275]

I agree that the only way to learn is by doing. I worked in a teaching facility my first year, and the residents did the lady partsl exams also. However, it was FINE for nurses to do them also. So I did them as well. I needed to learn them and the residents were fine with that. The only thing I didn't have alot of experience in was checking for dilation in the earlier stages, so 1-4 for the most part. We didn't admit until 4-6.

[pearlsrwisdom]

I have the opposite experience..i was privte for 16ys then had to go to a teaching hospital..the main enjoyment in my job was my 1:1 time laboring my pts,checking them,knowing when the cx is changing..whetger that be dilating,thinning, or droppi g..also the way the head feels as it descends..knowing if caput is developing and which way to position them to help the baby turn.. and when to start pushing based on descent and parity and pubic arch..all facts of which im convinced the residents i work under have no clue! And i cant wven chart and exam until its "confirmed"by them! Pahlease! Im the expert compared to people doing this from none to 4 yrs!! And they only do the Ob portion for2 months out of each yr! So they get 8 months of checking compared to my now 17yr! This is truly the most frustrating part of my job! It takes like at least a yr working ft to become skilled in this!

[adpiRN]

My first L&D job was a large hospital with residents so we didn't do SVE.

At my new per diem job they're going to teach me on orientation.

I'm excited to learn!

And to work at a hospital where nurses, not residents, run the floor at night

[klone, MSN, RN]

And to work at a hospital where nurses, not residents, run the floor at night

It will challenge you and terrify you. It will hone your skills significantly, but it will also be frightening how much autonomy and clinical judgment you are expected to have. Good luck!

[cayenne06, MSN, CNM]

It will challenge you and terrify you. It will hone your skills significantly, but it will also be frightening how much autonomy and clinical judgment you are expected to have. Good luck!

Haha, this is true! I am a student CNM at a very large tertiary hospital, and I LOVE that the residents are there to have my back if the SHTF. I am also an RN at a teensy community hospital, and the buck stops with us most of the time. So of course we do SVE, and many other things that CNMs/MDs are responsible for at a larger hospital. Cervical exams definitely take some practice, but it isn't any harder than IV starts, foley caths, or any of the gazillion other skills we do every day. The HARDEST part is taking that information and using it along with other clinical information to make a full assessment.