Open Forum

Does anyone work in an organization where LPNs can hook patients up for prenatal NSTs? I am aware of AWOHNNs position statement on EFM, but it seems very inpatient driven and clinical staff would only set up the NST and print the strip, the provider will interpret. Thoughts?

------------------------------
Quiere Robinson MSN, RN, AMB-BC
Ambulatory Nurse Clinician
VCU Health
Richmond VA
(804)773-9273
------------------------------

Hello Quiere,

I know this is old, but have a similar question.  We have been having the same conversation, but mine centers around MAs running the NST with Provider oversight.

Christi

------------------------------
Christine Conran
Director
Metro Health - University of Michigan Health
Grand Rapids MI
(616)634-6441
------------------------------

Unless you have a machine that has built in logic and assessment(does that exist?); it is out of scope. EFM requires continuous assessment of the patients and interventions. Would the clinicians be ok with learning about decels 20 minutes after they occur? Would they want to know there was an unreactive baby 20 minutes later and then order the admin of juice or crackers and wait another 20-40 minutes? This is a significant patient safety issue. It is also a delay of care when an earlier intervention could’ve prevented a poor outcome.

Thanks,
Amy

Sent from my iPhone


Original Message:
Sent: 3/5/2024 1:03:00 PM
From: Christine Conran
Subject: RE: Fetal NSTs

Hello Quiere,

I know this is old, but have a similar question.  We have been having the same conversation, but mine centers around MAs running the NST with Provider oversight.

Christi

------------------------------
Christine Conran
Director
Metro Health - University of Michigan Health
Grand Rapids MI
(616)634-6441
------------------------------

Original Message:
Sent: 3/5/2024 1:03:00 PM
From: Christine Conran
Subject: RE: Fetal NSTs

Hello Quiere,

I know this is old, but have a similar question.  We have been having the same conversation, but mine centers around MAs running the NST with Provider oversight.

Christi

------------------------------
Christine Conran
Director
Metro Health - University of Michigan Health
Grand Rapids MI
(616)634-6441
------------------------------

Hi Tanya,

I am also director of an out patient hospital clinic . What is you staffing mix? I would imagine you justify having RNs for this reason. We are hiring CMAs for the first time and I am looking for ways to justify having at least a couple of RNs. We will be doing NST soon in our OB clinic, I am not sure what the regs are in NJ. Glad I read this. 

Thanks,

Janette 

------------------------------
Janette Morgan, MSN,RN,AMB-BC,HN-BC
Director Community Care,
The Valley Hospital,
Ridgewood, New Jersey,
973 427 7676
------------------------------

Original Message:
Sent: 03-06-2024 10:31
From: Tanya Moore-Murray
Subject: Fetal NSTs

Good morning,

 

We are an outpatient clinic within a hospital.  Only RN's in New York City.

Only RN's can perform these duties.

 

Regards,

 

Tanya Moore-Murray MPH, MSN, RNC-OB, C-EFM

 

Assistant Director of Nursing

Ambulatory Children's & Women's Health Services

Office-(718) 918-5447

Cell – (646) 526-2152

Fax – (718) 918-6787

 

Visit www.nychealthandhospitals.org

CONFIDENTIALITY NOTICE: The information in this E-Mail may be confidential and may be legally privileged. It is intended solely for the addressee(s). If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on this e-mail, is prohibited and may be unlawful. If you have received this E-Mail message in error, notify the sender by reply E-Mail and delete the message.

Original Message:
Sent: 3/5/2024 1:03:00 PM
From: Christine Conran
Subject: RE: Fetal NSTs

Hello Quiere,

I know this is old, but have a similar question.  We have been having the same conversation, but mine centers around MAs running the NST with Provider oversight.

Christi

------------------------------
Christine Conran
Director
Metro Health - University of Michigan Health
Grand Rapids MI
(616)634-6441
------------------------------

Hi Janette,

My staffing mix is RN's, LPN's, PCA's & Sono techs.

Regards,

------------------------------
Tanya Moore-Murray MPH, MSN RNC-OB, C-EFM, CLC
Jacobi Medical Center
Teaneck NJ
------------------------------

Original Message:
Sent: 03-21-2024 20:49
From: Janette Morgan
Subject: Fetal NSTs

Hi Tanya,

I am also director of an out patient hospital clinic . What is you staffing mix? I would imagine you justify having RNs for this reason. We are hiring CMAs for the first time and I am looking for ways to justify having at least a couple of RNs. We will be doing NST soon in our OB clinic, I am not sure what the regs are in NJ. Glad I read this. 

Thanks,

Janette 

------------------------------
Janette Morgan, MSN,RN,AMB-BC,HN-BC
Director Community Care,
The Valley Hospital,
Ridgewood, New Jersey,
973 427 7676
------------------------------


Original Message:
Sent: 03-06-2024 10:31
From: Tanya Moore-Murray
Subject: Fetal NSTs

Good morning,

 

We are an outpatient clinic within a hospital.  Only RN's in New York City.

Only RN's can perform these duties.

 

Regards,

 

Tanya Moore-Murray MPH, MSN, RNC-OB, C-EFM

 

Assistant Director of Nursing

Ambulatory Children's & Women's Health Services

Office-(718) 918-5447

Cell – (646) 526-2152

Fax – (718) 918-6787

 

Visit www.nychealthandhospitals.org

CONFIDENTIALITY NOTICE: The information in this E-Mail may be confidential and may be legally privileged. It is intended solely for the addressee(s). If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on this e-mail, is prohibited and may be unlawful. If you have received this E-Mail message in error, notify the sender by reply E-Mail and delete the message.

Original Message:
Sent: 3/5/2024 1:03:00 PM
From: Christine Conran
Subject: RE: Fetal NSTs

Hello Quiere,

I know this is old, but have a similar question.  We have been having the same conversation, but mine centers around MAs running the NST with Provider oversight.

Christi

------------------------------
Christine Conran
Director
Metro Health - University of Michigan Health
Grand Rapids MI
(616)634-6441

We have RN’s, LPNs, and CMAs. The CMAs are rooming patients and chaperoning/assisting with visits, LPNS are doing med refills, medication administration outside of CMa scope, and RNs are triaging, educating, and doing NSTs due to assessment requirement and intervention per protocol.

Amy
Sent from my iPhone


Original Message:
Sent: 11/2/2024 8:58:00 AM
From: Tanya Moore-Murray
Subject: RE: Fetal NSTs

Hi Janette,

My staffing mix is RN's, LPN's, PCA's & Sono techs.

Regards,

------------------------------
Tanya Moore-Murray MPH, MSN RNC-OB, C-EFM, CLC
Jacobi Medical Center
Teaneck NJ
------------------------------


Original Message:
Sent: 03-21-2024 20:49
From: Janette Morgan
Subject: Fetal NSTs

Hi Tanya,

I am also director of an out patient hospital clinic . What is you staffing mix? I would imagine you justify having RNs for this reason. We are hiring CMAs for the first time and I am looking for ways to justify having at least a couple of RNs. We will be doing NST soon in our OB clinic, I am not sure what the regs are in NJ. Glad I read this. 

Thanks,

Janette 

------------------------------
Janette Morgan, MSN,RN,AMB-BC,HN-BC
Director Community Care,
The Valley Hospital,
Ridgewood, New Jersey,
973 427 7676
------------------------------


Original Message:
Sent: 03-06-2024 10:31
From: Tanya Moore-Murray
Subject: Fetal NSTs

Good morning,

 

We are an outpatient clinic within a hospital.  Only RN's in New York City.

Only RN's can perform these duties.

 

Regards,

 

Tanya Moore-Murray MPH, MSN, RNC-OB, C-EFM

 

Assistant Director of Nursing

Ambulatory Children's & Women's Health Services

Office-(718) 918-5447

Cell – (646) 526-2152

Fax – (718) 918-6787

 

Visit www.nychealthandhospitals.org

CONFIDENTIALITY NOTICE: The information in this E-Mail may be confidential and may be legally privileged. It is intended solely for the addressee(s). If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on this e-mail, is prohibited and may be unlawful. If you have received this E-Mail message in error, notify the sender by reply E-Mail and delete the message.

Hi Amy,

I would love to connect with you. I am working on a large OB project to standardize OB care across all of our outpatient OB offices. Scope or practice, practicing at top of scope as well as NST's and OB Intake's are a major consideration. Wondering if you have any policies (especially pertaining to NST's) that you would be willing to share. 

Thanks!

Original Message:
Sent: 11-02-2024 17:01
From: Amy Cadoret
Subject: Fetal NSTs

We have RN's, LPNs, and CMAs. The CMAs are rooming patients and chaperoning/assisting with visits, LPNS are doing med refills, medication administration outside of CMa scope, and RNs are triaging, educating, and doing NSTs due to assessment requirement and intervention per protocol.

Amy
Sent from my iPhone



Original Message:
Sent: 11/2/2024 8:58:00 AM
From: Tanya Moore-Murray
Subject: RE: Fetal NSTs

Hi Janette,

My staffing mix is RN's, LPN's, PCA's & Sono techs.

Regards,

------------------------------
Tanya Moore-Murray MPH, MSN RNC-OB, C-EFM, CLC
Jacobi Medical Center
Teaneck NJ
------------------------------



Original Message:
Sent: 03-21-2024 20:49
From: Janette Morgan
Subject: Fetal NSTs

Hi Tanya,

I am also director of an out patient hospital clinic . What is you staffing mix? I would imagine you justify having RNs for this reason. We are hiring CMAs for the first time and I am looking for ways to justify having at least a couple of RNs. We will be doing NST soon in our OB clinic, I am not sure what the regs are in NJ. Glad I read this. 

Thanks,

Janette 

------------------------------
Janette Morgan, MSN,RN,AMB-BC,HN-BC
Director Community Care,
The Valley Hospital,
Ridgewood, New Jersey,
973 427 7676
------------------------------



Original Message:
Sent: 03-06-2024 10:31
From: Tanya Moore-Murray
Subject: Fetal NSTs

Good morning,

 

We are an outpatient clinic within a hospital.  Only RN's in New York City.

Only RN's can perform these duties.

 

Regards,

 

Tanya Moore-Murray MPH, MSN, RNC-OB, C-EFM

 

Assistant Director of Nursing

Ambulatory Children's & Women's Health Services

Office-(718) 918-5447

Cell – (646) 526-2152

Fax – (718) 918-6787

 

Visit www.nychealthandhospitals.org

CONFIDENTIALITY NOTICE: The information in this E-Mail may be confidential and may be legally privileged. It is intended solely for the addressee(s). If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on this e-mail, is prohibited and may be unlawful. If you have received this E-Mail message in error, notify the sender by reply E-Mail and delete the message.

Good morning,

in our organization, CMA's and LPN's can set up the monitoring, but an RN must be responsible for actually monitoring the patient and running the test.

Hope that helps!

------------------------------
Torie Bonnet MSN RN NE-BC
Clinical Nurse Edu Specialist-Ambulatory Care
UNC Health
Raleigh NC

torie.bonnet@unchealth.unc.edu
------------------------------

Thanks Torrie! To clarify, RNs in that area remain with the patient the entire time the test is occurring?

------------------------------
Quiere Robinson MSN RN AMB-BC
Ambulatory Nurse Clinician
VCU Health
Richmond VA
(804)420-2728
------------------------------

Original Message:
Sent: 03-06-2024 07:26
From: Torie Bonnet
Subject: Fetal NSTs

Good morning,

in our organization, CMA's and LPN's can set up the monitoring, but an RN must be responsible for actually monitoring the patient and running the test.

Hope that helps!

------------------------------
Torie Bonnet MSN RN NE-BC
Clinical Nurse Edu Specialist-Ambulatory Care
UNC Health
Raleigh NC

torie.bonnet@unchealth.unc.edu
------------------------------

Hi Torie,

I am working on a large OB project to standardize OB care across all of our ambulatory OBgyn offices. NST's is a big part of the conversation. Wondering if you have a policy around NST's and the CMA's ability to "set up" with the RN monitoring that you would be willing to share.

Thanks!

Original Message:
Sent: 03-06-2024 07:26
From: Torie Bonnet
Subject: Fetal NSTs

Good morning,

in our organization, CMA's and LPN's can set up the monitoring, but an RN must be responsible for actually monitoring the patient and running the test.

Hope that helps!

------------------------------
Torie Bonnet MSN RN NE-BC
Clinical Nurse Edu Specialist-Ambulatory Care
UNC Health
Raleigh NC

torie.bonnet@unchealth.unc.edu
------------------------------

Original Message:
Sent: 7/7/2026 12:50:00 PM
From: Lauren Grafton
Subject: RE: Fetal NSTs

Hi Torie,

I am working on a large OB project to standardize OB care across all of our ambulatory OBgyn offices. NST's is a big part of the conversation. Wondering if you have a policy around NST's and the CMA's ability to "set up" with the RN monitoring that you would be willing to share.

Thanks!

we allow MAs and LPNs to apply equipment, that is all. the provider or trained and validated competent RN would be verifying equipment placement and interpretation. we follow EBSCO/Dynamic Health's RN procedure for the RNs.

------------------------------
Carrie Lemke DNP RN NPD-S BC
Advocate Aurora Health
Denmark WI
(920)655-7795
------------------------------

Thanks Carrie! To clarify, do the RNs remain with the patient the entire time the test is occurring? Or do they just validate equipment placement and return after the 20 minutes for strip interpretation?

------------------------------
Quiere Robinson MSN RN AMB-BC
Ambulatory Nurse Clinician
VCU Health
Richmond VA
(804)420-2728
------------------------------

Original Message:
Sent: 03-06-2024 08:18
From: Carrie Lemke
Subject: Fetal NSTs

we allow MAs and LPNs to apply equipment, that is all. the provider or trained and validated competent RN would be verifying equipment placement and interpretation. we follow EBSCO/Dynamic Health's RN procedure for the RNs.

------------------------------
Carrie Lemke DNP RN NPD-S BC
Advocate Aurora Health
Denmark WI
(920)655-7795
------------------------------

Our RNs have monitors in their workroom to continuously monitor.

Amy

Sent from my iPhone


Original Message:
Sent: 3/6/2024 8:50:00 AM
From: Quiere Robinson
Subject: RE: Fetal NSTs

Thanks Carrie! To clarify, do the RNs remain with the patient the entire time the test is occurring? Or do they just validate equipment placement and return after the 20 minutes for strip interpretation?

------------------------------
Quiere Robinson MSN RN AMB-BC
Ambulatory Nurse Clinician
VCU Health
Richmond VA
(804)420-2728
------------------------------

Original Message:
Sent: 3/6/2024 11:29:00 AM
From: Amy Cadoret
Subject: RE: Fetal NSTs

Our RNs have monitors in their workroom to continuously monitor.

Amy

Sent from my iPhone



Original Message:
Sent: 3/6/2024 8:50:00 AM
From: Quiere Robinson
Subject: RE: Fetal NSTs

Thanks Carrie! To clarify, do the RNs remain with the patient the entire time the test is occurring? Or do they just validate equipment placement and return after the 20 minutes for strip interpretation?

------------------------------
Quiere Robinson MSN RN AMB-BC
Ambulatory Nurse Clinician
VCU Health
Richmond VA
(804)420-2728
------------------------------

Agreed---we only allow MAs and LPNs to place the monitor. RNs have to be specifically credentialed and privileged to monitor. In the situation that a clinic does not have an RN, the provider's must monitor the NST throughout the tracing. We also use ECRI training as this is required for all staff involved with caring for prenatal patients in the FQHC world. For the credentialing & privileging, we have the RN attend a training program at one of our local hospitals who offers NST monitoring training. They submit their certificate as proof of competency for the privilege.

ECRI training is free for all FQHC staff members, and I think look-a-likes...if you are not either of those (or do not know what I am talking about), then you can still access the training, but I think you have to pay for an account. ECRI is created in partnership with the FTCA (who provides the federal malpractice insurance for all FQHC providers). 

Hope that helps!

Mary

------------------------------
Mary Blankson DNP APRN FNP-C FAAN
Chief Nursing Officer
Community Health Center, Inc.
Middletown CT
(860)227-5432
------------------------------

Original Message:
Sent: 03-06-2024 08:18
From: Carrie Lemke
Subject: Fetal NSTs

we allow MAs and LPNs to apply equipment, that is all. the provider or trained and validated competent RN would be verifying equipment placement and interpretation. we follow EBSCO/Dynamic Health's RN procedure for the RNs.

------------------------------
Carrie Lemke DNP RN NPD-S BC
Advocate Aurora Health
Denmark WI
(920)655-7795
------------------------------

Hi there!

I am a newer educator at a FQHC organization. Could you give me some more info about these ECRI educational resources you list for FQHC staff? Thanks so much for any info you can provide!

Rachel Marcellus

-------------------------------------------

Original Message:
Sent: 03-13-2024 08:46
From: Mary Blankson
Subject: Fetal NSTs

Agreed---we only allow MAs and LPNs to place the monitor. RNs have to be specifically credentialed and privileged to monitor. In the situation that a clinic does not have an RN, the provider's must monitor the NST throughout the tracing. We also use ECRI training as this is required for all staff involved with caring for prenatal patients in the FQHC world. For the credentialing & privileging, we have the RN attend a training program at one of our local hospitals who offers NST monitoring training. They submit their certificate as proof of competency for the privilege.

ECRI training is free for all FQHC staff members, and I think look-a-likes...if you are not either of those (or do not know what I am talking about), then you can still access the training, but I think you have to pay for an account. ECRI is created in partnership with the FTCA (who provides the federal malpractice insurance for all FQHC providers). 

Hope that helps!

Mary

------------------------------
Mary Blankson DNP APRN FNP-C FAAN
Chief Nursing Officer
Community Health Center, Inc.
Middletown CT
(860)227-5432
------------------------------


Original Message:
Sent: 03-06-2024 08:18
From: Carrie Lemke
Subject: Fetal NSTs

we allow MAs and LPNs to apply equipment, that is all. the provider or trained and validated competent RN would be verifying equipment placement and interpretation. we follow EBSCO/Dynamic Health's RN procedure for the RNs.

------------------------------
Carrie Lemke DNP RN NPD-S BC
Advocate Aurora Health
Denmark WI
(920)655-7795

Is anyone using AWOHNN's "Intro to FHM" program for training, or know which training would be most appropriate for ambulatory clinics? 

------------------------------
Andrea Kelly MSN RN NPD-BC
Director, Population Health
ECU Health Physicians (formerly Vidant Medical Group)
Greenville NC
(252)847-3930
------------------------------

Original Message:
Sent: 3/12/2024 3:07:00 PM
From: Andrea Kelly
Subject: RE: Fetal NSTs

Is anyone using AWOHNN's "Intro to FHM" program for training, or know which training would be most appropriate for ambulatory clinics? 

------------------------------
Andrea Kelly MSN RN NPD-BC
Director, Population Health
ECU Health Physicians (formerly Vidant Medical Group)
Greenville NC
(252)847-3930
------------------------------

Hi Quiere, 

At our organization we have both CMAs and LPNs who set up the NSTs. The nurses only assist if needed. The doctor's do all the interpretation. The strips are just printed and brought to the provider. We are an outpatient facility and clinic run office. I hope that helps!

Kimmie

------------------------------
Kimmie Vavra, MSN RN
Quality Assurance and Clinical Educator
Rush Copley Medical Group
1256 Waterford Drive, Suite 230
Aurora, IL 60504
Office: 630-499-6682
Cell: 630-456-3514
------------------------------

Hi Kimmie,

Thank you! Was this process vetted by any other departments, such as Regulatory or Risk Management?

------------------------------
Quiere Robinson MSN RN AMB-BC
Ambulatory Nurse Clinician
VCU Health
Richmond VA
(804)420-2728
------------------------------

Original Message:
Sent: 03-14-2024 09:53
From: Kimberly Schuda
Subject: Fetal NSTs

Hi Quiere, 

At our organization we have both CMAs and LPNs who set up the NSTs. The nurses only assist if needed. The doctor's do all the interpretation. The strips are just printed and brought to the provider. We are an outpatient facility and clinic run office. I hope that helps!

Kimmie

------------------------------
Kimmie Vavra, MSN RN
Quality Assurance and Clinical Educator
Rush Copley Medical Group
1256 Waterford Drive, Suite 230
Aurora, IL 60504
Office: 630-499-6682
Cell: 630-456-3514
------------------------------

I think it is important to mention that the parameters for who can perform and how often should a nurse be trained/certified may very from state-to-state and by hospital/clinic sites.  Additionally, I have been a nurse in high-risk OB for over 28 years and and previously only RNs were approved to initiate, interpret, and actively monitor OB patients.  However, some years later it was approved in WA state to have LPNs (but not Medical Assistants) who are trained to take part in Fetal Monitoring: 

Can the licensed practical nurse apply or remove an external or internal electronic fetal monitor?

"It is within the scope of an appropriately prepared and competent licensed practical nurse to apply or remove an external electronic fetal monitor under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. It is beyond the scope of the licensed practical nurse to apply or remove an internal electronic fetal monitor. The licensed practical nurse should use the Scope of Practice Decision Tree to determine if these activities are within the nurse's legal and individual scope of practice." https://nursing.wa.gov/practicing-nurses/frequently-asked-questions#LPN-FAQ

For training we have used ACOG, AWHONN and currently use OBIX https://www.obixpoet.com/local/intellicart/view.php?id=103

At our high-risk hospital/clinic in Seattle, we make it a requirement for RNs/providers to become ANCC or NCC certified. 

Sincerely, 

Leondra Weiss, MN, ARNP, RN, FNP-BC, C-EFM, AMB-BC

------------------------------
[Leondra Weiss MN, ARNP, FNP-BC, AMB-BC, C-EFM
Family Medicine ARNP
Vashon WA
(425) 870-0558
leondratw@gmail.com
------------------------------

Original Message:
Sent: 03-14-2024 09:53
From: Kimberly Schuda
Subject: Fetal NSTs

Hi Quiere, 

At our organization we have both CMAs and LPNs who set up the NSTs. The nurses only assist if needed. The doctor's do all the interpretation. The strips are just printed and brought to the provider. We are an outpatient facility and clinic run office. I hope that helps!

Kimmie

------------------------------
Kimmie Vavra, MSN RN
Quality Assurance and Clinical Educator
Rush Copley Medical Group
1256 Waterford Drive, Suite 230
Aurora, IL 60504
Office: 630-499-6682
Cell: 630-456-3514
------------------------------