question re: nurses doing vaginal/cervical exams

[ljb]

Hello all,

I'm an L&D nurse looking to get into travel nursing, but have run into some problems in regards to my experience. I wondered what any of you might be able to offer in terms of advice or your personal experience, especially anyone who has been in my particular position.

I have 18 months of L&D experience, just shy of 4 years total nursing experience (my first job was in a SICU--good experience, but not for me). I work at HUP in Philadelphia, a large teaching facility. The nurses here (except for a handful, cross trained for our triage area), DO NOT do cervical exams. My first choice of location to move to has been San Francisco. Large teaching facilities there, as I'm told, do not want to hire first time travelers. So I've expanded my search to outlying areas, other small towns. This is where I've discovered (as many are community hospitals), that all the nurses do cervical exams (and place FSEs and IUPCs), leaving me unqualified!

So basically I'm stuck with the catch-22 situation of: can't get a job at a large teaching facility in the city (as a first timer), but can't get a job at a smaller or community hospital b/c of my sheltered existence at a large teaching facility! It's kind of funny really.

Is my hospital as outside of the norm as it seems in that we (the RNs) don't do vag exams? (or place internal monitoring instruments)

Just wondering if any of you has had this same combination of situations, and if they were ever successful in finding a travel job?

I realize this may be more of a "travel nursing forum" question (and I did post there as well), but I wanted insight from L&D nurses in general as to where my facility stood on the spectrum.

Thanks for any input!

[crissrn27, RN]

I don't know of any hospitals around here that don't allow nurses to do lady partsl exams in L and D (NC)--our nurses don't place IUPC but can do FSE

[DebblesRN, ASN, BSN, RN]

Where I work, we do all vag exams and fetal scalp electrodes (if mom is ruptured), but only the doctors put in the IUPC's.

We never really had a problem with Travelers who had never done a vag exam before because they had worked at a teaching hospital. We were happy to have them, and anytime they needed a second opinion, we were happy to come in and check behind them. You have to learn somehow.

Can you talk to someone at both types of facilities and feel them out?? Maybe it is not as a big a problem as you think. They may have you at either one. Rather an experienced nurse that needs a little direction, than no nurse at all, KWIM??

Good luck to you.

[HappyNurse2005, RN]

i am also at a decent sized teaching hospital (with private ob docs as well). nurses do not do the iupc/fse's. we do vag exams, though, the residents prefer to do them on their own patients (cuz they need the practice). the private ob docs, we do the check in triage, we often are the ones checking them during the night, etc.

[htrn]

I work straight nocs at a small hospital with 4 OBs and a couple of FPs that do the occasional delivery. We do SVEs all the time, but I worked a day shift with a pit induction and found out that some docs almost insist on doing their own SVEs on their pit patients. OK, fine, whatever.... I can understand why RNs would do fewer if any at a teaching hospital.

We do not do FECGs, IUPCs, fernings, or GBS cultures though. I wish we would, would save the docs from having to come in the middle of the noc to R/O SROM, etc... but, oh well.

Good Luck, it's just takes a little time and practice to learn.

[seanymph]

I just finished traveling for almost 4yrs. and had 10yrs OB eperience when I started. I could do my own SVEs, but have never done FSE or IUPCs and when asked in interviews for the travel position I just told the mgr that I was not trained to do them and they were all fine with it.

[mitchsmom]

If the community hospitals need people bad enough, and they probably do if they are using travelers, they will probably be willing to let you learn it.

[DEB52]

I worked L&D 16 yrs and now I work a High Risk Pregnancy unit. I have always done vag exams. We do the cervidil and cytotec insertions on our unit. In our L&D we (the RN's) do insert IUPC's and apply FSE's.I work in a teaching hospital. We did 6841 deliveries last year. So on both units the RN's do alot of V/E's.

[NPinWCH]

I work in a small community hospital. We do vag exams, as we don't have any docs around to do them. I have friends who work at the big teaching hospitals, including the big university hospital and they also do vag exams.

We don't do FSE or IUPCs, mostly because our docs don't like them, but RNs in all the big hospitals do them. Funny thing, they do the internal monitors we don't, but we do all our own ferns, FFNs, GC/Chlamydia, GBS and wet mounts and they don't.

[SmilingBluEyes]

In my experience, mostly in smaller community hospitals, nurses are a bit more autonomous and do a lot of the exams, etc. Like said above, OB docs are simply not inhouse 24/7......so....We do SVE, IUPC, FSE, fern testing, culture swabbing/testing, etc. We also place cytotec ourselves.

Some docs like internal monitors; others do not. So we place them for the docs who want them.

In the larger teaching hospitals, the residents tend make these calls and do them themselves.

[Calzonan RN]

I work in a smaller hospital in a big city, as an extern. I know our RN's do ferning, FSE's, VE's, IUPC's etc. I had three baby's in two other hospitals in town and the nurses did everything in those hospitals as well.

Keli class of Dec '07

[ljb]

from the OP:

thanks to everyone for your replies. All I can say is...I feel so inexperienced! We don't do VEs, FSEs, cultures, etc, and have residents around 24/7. Essentially, we are assistants to the docs and we chart alot. I hate to describe my job that way, but in comparison to most LD nurses, it sounds like it's the truth.

We do have RNs on the floor who work in our triage area who do all of these things (ie the VEs, cultures, spec exams, etc.) but you don';t usually cross train in that area until about 2 years.

I'm anxious to get the experience in these areas, but leary of having my experience be under the pressure of a travel position where I'd be forced to learn on my feet but at the risk of being seen as incompetent, or worse, making a big mistake/judgement error.

thanks again for your responses.