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4. Guidelines for the Role of RN in Exam of OB Patients

 Guidelines for the Role of a Registered Nurse
in the Examination of Obstetrical Patients

The Federal Emergency Medical Treatment and Labor Act (EMTALA) regulations at 42 CFR 489.24(a)(1)(i) require hospitals with emergency departments to provide an appropriate medical screening examination (MSE) to individuals who come to the emergency department to determine whether or not an emergency medical condition exists.  The examination must be conducted by an individual who is determined qualified by hospital bylaws or rules and regulations.

The North Dakota Administrative Code Licensing Rules for Hospitals Emergency Services Section at 33-07-01.1-25(1)(d) require a licensed health care practitioner to determine the nature, level, and urgency of care required of all persons seeking treatment. North Dakota Administrative Code 33-07-01.1-01 General provisions – Definitions define a licensed health care practitioner as an individual who is licensed or certified to provide medical, medically related, or advanced registered nursing care to individuals in North Dakota. 

The following guidelines apply to obstetrical patients, with a pregnancy greater than 20 weeks gestation, who present to the hospital with obstetrical (pregnancy) related medical conditions:

• Emergency departments may direct pregnant women over 20 weeks gestation with pregnancy related medical conditions to the facility’s staffed labor and delivery department.  All patients with the same medical condition (pregnancy greater than 20 weeks gestation with pregnancy related medical conditions) must be directed in such circumstances.
• A registered nurse, trained and qualified in the care of obstetrical patients, may conduct an examination on an obstetrical patient, with a pregnancy greater than 20 weeks gestation, if a registered nurse is determined qualified by hospital bylaws or rules and regulations.
• A licensed healthcare practitioner must be immediately available by telephone and available on site within 30 minutes. 
• Obstetrical patients presenting to the emergency department or hospital property with a pregnancy less than 20 weeks gestation or for a non-obstetrical emergency medical condition must have an MSE conducted by a trained and qualified licensed healthcare practitioner.
• If the patient or staff are unable to determine how many weeks gestation or what condition the patient is seeking treatment for, the MSE must be performed by a licensed healthcare practitioner.
• If the hospital does not have an obstetrical service staffed with a registered nurse trained and qualified in the care of obstetrical patients, a MSE must be performed by a licensed healthcare practitioner.
• The hospital must develop and implement policies and procedures for the role of a registered nurse in the examination of obstetrical patients over 20 weeks gestation.

These Guidelines were developed in conjunction with a workgroup comprised of the North Dakota Department of Health, North Dakota Board of Nursing, North Dakota Healthcare Association, PPS and Critical Access Hospital (CAH) Administrators, PPS Hospital and CAH Medical Doctors, and Registered Nurses.

If you have questions related to these guidelines, please contact ND Department of Health at 701-328-2352 or the ND Board of Nursing at 701-328-9784.

Adopted:  07/10
Reviewed/Revised: 12/14