Vag Exams on Preterm Patients??

[jodyangel]

Ok, so just started a new job and on my Second day of work was asked to go do a vag exam and FFN on a preterm patient to determine if she would be admitted SROMed or go home.

When I said that it wasn't in my nursing scope of pratice it caused a bit of an uproar. There is No MD on site..small rural hospital. No residents either.

So then the managing MD went off and so did the administration of the hospital.

I am not comfortable doing exams on preterm women with the possibility of accidently rupturing them. Was I wrong to refuse?

[babyktchr, BSN, RN]

Really you need to check your policy. lady partsl exams are not prohibited by nurses (only if it is written into the bylaws of the hospital). As a nurse you are considered a qualified medical professional who acts on behalf of the physician. The physician has the ultimate decision as to how to proceed based the assessment given to him. As I said before, your hospital SHOULD have a policy on what the cutoff is for gestational age and exams. If at all possible you shouldn't check preterm patients unless imminent delivery is possible. I have examined patients of all gestations on request of a physician based on specific circumstances (mostly because the patient appeared to be imminently delivering.

Some things are fuzzy for me still. FFN and recent sex and vag exam excludes is pointless. This should definitely be reflected in your policy and is a directly identified by the manufacturer. Your nurse buddy is wrong. Secondly...you mentioned SROM and FFN. Why? I could see amnisure, but not FFN.

While I understand that you came from a facility that utilized residents, lady partsl exams are a part of life in community hospitals. You are just going to have to get used to doing that. Its really not a scope of practice issue. Having never worked with residents myself, I don't know if I would be comfortable in the reverse and never have to do them :-)

[klone, MSN, RN]

Are you sure it was FFN, or was it ferning she was checking?

[jodyangel, RN]

Nooo I am Very competent in doing lady partsl checks. But on 37 weeks and above. It was the hospital policy in both hospitals I've done L&D was Not to do vag checks on pretermers. Of course if they appear to be quickly dilating you do what you have to do. But yeah never worked in a facility without any MD or residents on site. Apparently this doc they have here is extremely difficult too...doesn't like to come in..ugh. They have no policy..yet.

[jodyangel, RN]

Sorry but this is a new situation for me. The fear being that putting your fingers in a preterm patient and accidentally rupture her.

[jodyangel, RN]

Klone the nurse that was in the situation said that's what it was.

[T-Bird78]

I had sex at 31 weeks and started having contractions. They weren't too intense but lasted a few hours. I called my OB, they suggested changing positions and hydrating and go to the hospital if still going on another 2 hours. Well, I called on my way to the hospital. I was in L&D triage hooked to the monitors--intense contractions q 7 minutes, as close as q 2 minutes. The L&D triage nurse did a vag exam to see if I was dilated at all. Fortunately I wasn't so they gave me a shot of terbutaline to stop the contractions and was no sex until after the birth. (I'd also had contractions at 29 weeks due to dehydration; those took 2 shots of terbutaline to stop). I can understand why a vag exam would be ordered in a case like mine. I'd ask what the earliest gestational age is for RNs to perform vag exams. If you're just checking and not being forcible then there shouldn't be any harm.

[jodyangel, RN]

Yeah well ill want them to formulate a policy about this first : )

[kdot2003]

At my hospital in rural GA we check almost everybody regardless of gestation. ..unless they have absolutely zero risk of PTL or labor. We do sterile speculum exams and FFN when appropriate. We have policies for FFN and speculum exams etc. I usually make an order for SVE to cover me. There are no doctors on site unless its office hours. If any new nurse or old nurse for that matter is uncomfortable with her findings we get a second opinion from a coworker or just tell the MD exactly what our concerns are. Theres alot of trust involved but it does seem kind of scary now that I think about it.

[losbozos]

I have always done a VE but not on every preterm pt. Do the FFN first, & depending in what's going on do the VE IF appropriate. That's your job, right? To assess? If in doubt, call the provider & ask. I've had more than one preterm labor come in & near/at complete! Sometimes you just need to know now.

[jodyangel, RN]

Yep my job is to assess. I am just trying to clarify if its within my RN license. I have always worked with residents, who were the ones doing the preterm exams.

My fear is to accidentally rupture a pretermer .. and have her deliver .. and the baby have issues and the mother coming back with "Well that Nurse broke my water. If she hadnt dug around in me I wouldnt of had my baby early."

So not being difficult. Just wanting to not do anything I'm not licensed to do..