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Fetal NSTs

  • 1.  Fetal NSTs

    Posted 06-15-2023 13:33

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


  • 2.  RE: Fetal NSTs

    Posted 03-05-2024 13:03

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



  • 3.  RE: Fetal NSTs

    Posted 03-06-2024 08:22
    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




  • 4.  RE: Fetal NSTs

    Posted 03-06-2024 10:32

    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.






  • 5.  RE: Fetal NSTs

    Posted 03-21-2024 20:50

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



  • 6.  RE: Fetal NSTs

    Posted 11-02-2024 08:58

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



  • 7.  RE: Fetal NSTs

    Posted 11-02-2024 17:01
    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




  • 8.  RE: Fetal NSTs

    Posted 03-06-2024 07:27

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



  • 9.  RE: Fetal NSTs

    Posted 03-06-2024 08:49

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



  • 10.  RE: Fetal NSTs

    Posted 03-06-2024 08:19

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



  • 11.  RE: Fetal NSTs

    Posted 03-06-2024 08:50

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



  • 12.  RE: Fetal NSTs

    Posted 03-06-2024 11:29
    Our RNs have monitors in their workroom to continuously monitor.

    Amy

    Sent from my iPhone




  • 13.  RE: Fetal NSTs

    Posted 03-10-2024 11:48
    The standard of care per the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) is that an RN places the fetal  and uterine monitors after performing Leopold's maneuvers.  The RN should be present for the testing to ensure a continuous tracing, ready to do interventions if necessary, and determine if the tracing is reassuring or non-reassuring.. Remember an NST is ordered during a high risk pregnancy.

    Tracy Weeber, CNS, RNC-OB, C-EFM, C-ONQS
    Ambulatory Operations CNS
    Enloe Health
    Chico, California





  • 14.  RE: Fetal NSTs

    Posted 03-13-2024 08:47

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



  • 15.  RE: Fetal NSTs

    Posted 03-12-2024 15:07

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



  • 16.  RE: Fetal NSTs

    Posted 03-13-2024 10:39

    We are using AWHONN's courses.

     

    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.






  • 17.  RE: Fetal NSTs

    Posted 03-14-2024 09:54

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



  • 18.  RE: Fetal NSTs

    Posted 03-19-2024 12:35

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