Model policy: Registered nurse performance of medical screening examinations in the obstetrical department
(Must be approved by the hospital’s governing board)
1. Registered nurses with demonstrated clinical competency in obstetrics may perform medical screening examinations on persons requesting or requiring this type of emergency medical services.
2. The specific tasks that registered nurses may perform as part of the medical screening examination include, but are not limited to assessing: fetal heart tones, the regularity and duration of uterine contractions, fetal position and station, cervical dilation/effacement, and status of uterine membranes, (i.e., ruptured, leaking, intact).
3. "Demonstrated clinical competency" means the ability to conduct the tasks listed in Section (2) as demonstrated by: [successful completion of the hospital’s skill validation process and departmental orientation at the time of the nurse’s hire, successful completion of an advanced fetal monitoring course; successful completion of a neonatal resuscitation program; other]. The registered nurse’s personnel file should reflect documentation of the nurse’s continued competency.
4. Registered nurses who perform medical screening examinations must consult with a physician at an appropriate time before the patient’s disposition. The physician is responsible for obtaining pertinent information from the nurse, ordering appropriate diagnostic tests, analyzing the results of those tests and determining the appropriate disposition of the patient; and countersigning the [EMTALA certification for transfer form] within a reasonable time after the transfer.
When a patient requires diagnostic or treatment services that are beyond the registered nurse’s scope of practice, demonstrated competency, or comfort level, the registered nurse will:
- request that the patient’s attending physician or on-call physician come to the hospital to further evaluate and treat the patient; or
- refer the patient to another appropriate area within the hospital for further screening, evaluation, or treatment; or
- transfer the patient to another facility, at the direction of a physician, when (s)he determines that the benefits outweigh the risks.
The physician is responsible to come to the hospital or send an appropriately credentialed practitioner with hospital privileges if the nurse performing the medical screening examinations determines that the physician’s presence is necessary. When the attending or on-call physician refuses to come to the hospital when requested by the nurse, or the nurse has concerns about the physician’s medical management of the patient which cannot be resolved with the physician, the nurse will contact [his or her supervisor, risk management, hospital administrator, department chair, other].
A registered nurse may not discharge or transfer a patient from the hospital until he or she has:
- performed a medical screening examination;
- consulted with a physician who has authorized the discharge or transfer of the patient;
- completed and signed the appropriate EMTALA certification for transfer form, if applicable; and
- documented the screening examination, interventions, physician orders, disposition of the patient, and if applicable, discharge instructions.
The hospital’s quality assurance process will include random and periodic reviews of OB records to evaluate the appropriateness of screening examinations, interventions, and patient dispositions.
Source: Arizona Hospital and Healthcare Association, Phoenix, AZ, and Coppersmith Gordon Schermer Owens and Nelson, PLC, both of Phoenix.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content