RN practicing out of scope?

[NellieRN10]

Just wanting your opinions:

I know an RN who has recently become a CNM, but she only works at her hospital in the capacity of a labor and delivery RN. Lately, she has been using the portable ultrasound on labor patients to check for breech positioning. She does this without first discussing with the doctors, basically of her own accord. Is this within her scope of practice as an RN because she is a CNM?

[HeartsOpenWide, RN]

You have to check with your states nurse practice act. Usually with training it's fine. I have considered taking a course to become certified myself, but I don't believe I will use it frequently enough to keep my practice accurate. ( same reason when we go to a code that requires we use ACLS we act as recorders). We have an out patient nurse that would probably make more use of an ultrasound certification. Our hospital has done classes, but just for ultrasound guided IV starts. It's like many things in nursing that require extra training and then you can do it, such as the nurses that insert PICC lines.

[klone, MSN, RN]

I imagine it would be up to your facility and their policies

[kirsnikity]

I think it depends on hospital policy. At my facility, ultrasound certified nurses can use ultrasound to check for position. Our policy states presentation will then be confirmed with a second u/s certified RN.

[elkpark]

Depends on the individual hospital's policies -- whether specially trained staff RNs can perform the function, and/or whether the hospital has given her permission to function within her CNM scope of practice while working in a staff nurse position.

[dariah]

I Imagine the MDs do their own sono upon admission? That's how we do it, an MD always checks for position on admissing, even for scheduled c-sections. RNs at my job use the ultrasound sometimes w/o "clearance" from MDs to help find the heartbeat on difficult babies (preemies, twins) to help with EFM. I'm pretty sure RNs can use the ultrasound in office settings too, with the right training. Not 100% sure though.