What are the responsibilities of the nurse when observing a genital exam

Nurses General Nursing

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I know this may seem like a silly question and truthfully not one that I thought I would ever ask but here it is. I am currently an Lpn student and currently on a clinical rotation at a urology clinic. I am assigned to a female np and every time she does any kind of male genital exam which seems to be at least half of her patients everyday she wants me in the room to observe the exam. I've ask her what I'm suppose to do and all she says is just come in the room. My question is for any legal issue that may occur am I suppose to watch the exam or just be in there in case if some kind of legal action is filed and I can say I was a witness?

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Specializes in Healthcare risk management and liability.

Several times a year, I deal with allegations of inappropriate touching during an exam. I advocate the use of a chaperone in certain circumstances. I want the chaperone to actually observe the exam so that he/she can be a useful witness in case of such an allegation. Just being in the room and not watching the exam does not contribute as much in the way of witness potential.

The chart note by the NP should also document your presence or the presence of anyone else in the exam room during the exam: 'RiskManager in the exam room during GU exam' or 'Patient's spouse/parent/guardian (and their name) in the exam room during the visit'. Please don't just chart 'MA in the exam room during GU visit' without specifying the MA's name. When a complaint comes up several days or weeks after the exam, no one can remember which MA was on shift that day or which MA was in the exam room, which makes it impossible for me to locate the witness and ask them about the visit. Charting 'Sam Mendoza, MA was in the exam room during the GU exam' is much better and will make RiskManager smile.

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Thank you for your comment it is by far the most helpful advice I have received on this question. They don't cover this in the classroom nor does the clinical instructor discuss it. I just finished my second week at the clinic and I've found it a bit uncomfortable being in the room just to chaperone the np on the exam she is doing. Plus at times I have felt the male patient has felt uncomfortable for me being in there.

I guess this is a bit off topic but it does go along with it. In school we throughly go over everything for a pap. During this my instructor said numerous times if it is a male dr to closely watch the exam but she has never mentioned anything about watching, chaperoning a female dr and male patient.

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I would also recommend that you introduce yourself, ask the patient if he has been explained the purpose of your presence and if the patient has consented to you being there. If the NP, physician, etc. did not get consent for your presence, you can face potential problems (such as a lawsuit, alleged bullying, and accusations of assault or coercion).

Depending on the state that you practice in, there are laws (in some states) that require that the patient know your status as a student. In Pennsylvania, your position (profession) and status must be visibly displayed on your name tag.

Let me also say that they should be offering (NOT requiring)a chaperone to ALL patients and not just requiring them for males or when the patient and practitioner are of opposite genders. That can also open up a can of worms as in gender discrimination. Again, that is not a lawsuit that you want to be party to.

The Affordable Care Act (ACA) has added additional protections that require patients be treated in a dignified, respectful, and nondiscriminatory manner. Although this has been initially applied to the LGBT community, it will not be long until a lawyer applies this to heterosexual/cisgender patients.

Note that under ffordable Care Act's Section 1557, it requires:

Quote
Under the rule issued by the you.S. Department of Health and Human Services (HHS), all people are protected from discrimination in healthcare on the basis of race, color, national origin, age, disability and sex. This includes discrimination based on pregnancy, gender identity and sex stereotyping, which means expectations of heterosexuality“ that men should only marry women, for example“ or gender expression that conforms to a particular view, such as the idea that women should be feminine. Source: Obamacare's anti-discrimination protections fortified

Again, it is not much of a stretch for a lawyer to suggest that the fact that men always have a chaperone forced upon them is discriminatory AND that the fact that the chaperone is another female is an assault upon their dignity.

There will be many who are going to dispute my position, but ask yourself this: Would a malpractice lawyer make this claim?"

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RiskManager said:
Several times a year, I deal with allegations of inappropriate touching during an exam. I advocate the use of a chaperone in certain circumstances. I want the chaperone to actually observe the exam so that he/she can be a useful witness in case of such an allegation. Just being in the room and not watching the exam does not contribute as much in the way of witness potential.

The chart note by the NP should also document your presence or the presence of anyone else in the exam room during the exam: 'RiskManager in the exam room during GU exam' or 'Patient's spouse/parent/guardian (and their name) in the exam room during the visit'. Please don't just chart 'MA in the exam room during GU visit' without specifying the MA's name. When a complaint comes up several days or weeks after the exam, no one can remember which MA was on shift that day or which MA was in the exam room, which makes it impossible for me to locate the witness and ask them about the visit. Charting 'Sam Mendoza, MA was in the exam room during the GU exam' is much better and will make RiskManager smile.

Okay, on this same vein, should L&D nurses be charting that the patient's spouse was present for lady partsl exams during labor, for example? I have never been taught to do that, but now I'm paranoid....

ETA: I always introduce myself first, and ask permission before examining a patient, and explain what I'm doing as I'm doing it. That has always been my standard practice. I'm female.

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I have been a patient a few times now but go to another city for my care. It does not matter to me if I have a female physician or of she has an assistant in the room. Remember the nurses protect both the patient and the doctor. I was once spared injuries because the doc was doing a digital and nurse came in room and asked the doctor what he was doing. I knew it wasn't right and I was never so happy to see a nurse come back into room to stop the doctor from injuring me. So yes I say yes to chaperones even in me having to be exposed completely naked. They do their jobs correctly and know the routines.

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