Sterile Speculum Exams by Nurses

NorthernRN · Aug 15, 2000

Having worked in 4 OB units, one being a High Risk unit, the standard of care was for the MD to perform the sterile spec exam.

maikranz · Aug 16, 2000

Originally posted by Pamela67:
In the facilty I work for, the physicians are wanting the registered nurses to perform sterile speculum exams for ferning and ect.. I am wanting to know if this is a standard practice in other facilties for nurses.

Why?

Just curious.

Pamela67 · Aug 17, 2000

The physicians would like for us to perform this procedure so they don't have to come in, especially at night, to determine the next course of action. I am concerned about the liability of this. I am curious to know if other facilties have RN's performing this procedure.

maikranz · Aug 17, 2000

Originally posted by Pamela67:
The physicians would like for us to perform this procedure so they don't have to come in, especially at night, to determine the next course of action. I am concerned about the liability of this. I am curious to know if other facilties have RN's performing this procedure.

Greetings!

Not at all to sound trite, but too bad about them. If you're calling them in the middle of the night, it assuredly is not a social or trivia call.

My area of expertise is med-surg, but I agree that there may be a big liability question.

The BON or whatever agency governs the practice of nursing in your state very likely has a practice standard that would address this issue. I would call your state's practice consultant. Good luck.

bbnurse · Aug 20, 2000

Our physicians also have asked for nursing to perform sterile speculum exams for ferning or fetal fibronectin. I have found no tertiary centers who allow anyone except APN, midwives, residents or physicians to do this. I spoke with AWHONN and ACOG who do not have a position statement. State Nurse Practice Act does not delineate whose role it is. Armed with all this info' I was asked to research the "national standard of practice". I will tell you these also limit it to physicians or APN: John Hopkins, U of Pa., Mayo Clinics, Duke University, and others. AWHONN told me that some states allow "trained" nurses to do pelvics but that in Washington, DC, no hospitals allow it. This report to the Chrm. of the Dept. brought this response "well keep looking for someone who does this."

So I too ask, what is the practice in your hospitals? Please feel free to utilize the above information for your ammunition too.

And I hope it works better for your staff than it did for us. Thanks....

HazeK · Aug 21, 2000

I work in a high-risk, busy unit (450+/mo) in Nevada; Our amnicator/nitrazine supplier instructions require a speculum for use, soooooo we took "Sterile Speculum Exams by RNs" to the state board of nursing for approval... it is now SOC for us to do them, w/ MD order. This is VERY helpful to us in our Triage/evaluation area for all those pt's who come in with the "I think my water broke" situation, as we can concretely document +ferning/+amnicator/+nitrazine or not... & if not, send them on their way. Also, if preterm ROM, can use sterile spec to obtain lady partsl pool sample for fetal lung maturity studies.

It was easy to learn how & a very simple procedure for us, as we use disposable speculums w/ the light built right in it, so visibility is optimal.

Hope this helps! HK