Ultrasound Age Statement

Institute in Limited Obstetric Ultrasound


The Impact of Age upon Attaining Competency in Limited Ultrasound

Training a nurse (or other qualified medical professional) to perform limited obstetric ultrasound is a big investment of time and financial resources. Performing ultrasounds is a complex and multifaceted skill requiring the use of advanced technology, diligence, study, and practice.

After training thousands of nurses, NIFLA has become painfully aware that the older a person gets, the challenges of learning sonography greatly increase and being able to pass competency assessments become more difficult, even with extended training. NIFLA believes it is our duty to make you aware of this sensitive issue, as there have been numerous instances where some medical professionals who have been practicing for years have not been able to master this complex new skill to a level of competency acceptable under national guidelines established by AWHONN and AIUM.

NIFLA is not making a blanket statement that all medical professionals approaching a specific age are not able to gain competency in limited obstetric ultrasound. However, we are saying that it is an issue that needs to be addressed by the PMC prior to investing thousands of dollars. Even nurses who have had successful careers with years of experience have had great difficulty mastering the many essential sonography skills, thus resulting in great disappointment for all involved.

Your PMC needs to make educated financial decisions in seeking medical professionals to provide sonograms. Prior to offering employment and training in sonography, please review the following:


NIFLA’s didactic course Institute in Limited Obstetric Ultrasound, which follows national guidelines, is the best foundational classroom education for beginning sonography.

Following this course, the trainee needs to perform a minimum of 50-75 supervised training scans to establish competency. Performing less than 50-75 scans is insufficient.

Upon completion of such supervised training scans, skills must be assessed and documented for competency. “Scope of practice” directives in most states require documented competency before performing new procedures, such as sonograms. To overlook this critical issue of documented competency puts the PMC patients at medical risk, as well as the organization at legal risk.

Each person considered for providing sonograms should be carefully vetted to determine if they possess the following:

  • Medical professionals currently credentialed or licensed as an RDMS, RN, PA, NP, MD, or DO
  • Solid computer skills: comfortable with technology, track ball/mouse, uploading digital images
  • Working knowledge of OB anatomy/physiology, willingness to perform both abdominal and transvaginal scans (necessary in early pregnancy)
  • Good vision with visual discrimination to differentiate between subtle differences in shades of gray scale tissue, recognizing anatomical landmarks, with attention to fine detail
  • Steady hands, with good hand and eye coordination: able to use the right hand to manipulate the probe with very fine motor movements, eyes continually observing the screen, while using the left hand to adjust controls on the computer based console
  • Spatial ability: a category of reasoning skills refers to the capacity to think about objects in three dimensions and to draw conclusions about those objects from limited information. This skill is highly critical for the diagnostic purposes of sonography, as one must be able to view a two-dimensional black and white image on the screen (comprised of 256 shades of gray) while mentally correlating anatomy of the patient’s body and transducer movements necessary to obtain diagnostic quality images.
  • Ability to multi-task, being observant of many things at one time
  • Able to stand for long periods, to reach, grasp and apply pressure with the probe
  • Ability to recall information: consistently remember numerous steps necessary in following a scanning protocol and obtaining fetal heart rates
  • Commitment to ongoing study, growth and availability on a weekly basis. To maintain scanning skills it is recommended that one perform approximately 100 scans per year after initial training

The above describes why ultrasound is a complex and multifaceted skill, which is difficult to learn. We have observed that some nurses approaching and beyond retirement age are unable to master these skills. If a PMC believes that a person of or near retirement age is the right candidate for sonography, they should be aware of the above concerns and realize this most likely will necessitate more training days, thus increasing the expense and number of scans most likely needed to achieve competency. PMCs should also realize there is a higher risk that competency may not ever be achieved.

If it is determined that performing limited ultrasound is not achievable for a retired nurse, they can still be a wonderful asset to your medical team. There are numerous vital roles he/she can perform, such as pregnancy testing, medical intake forms, chaperoning the ultrasound exam, STI testing, and health education, etc.

Please contact Audrey Stout, VP of Medical Services at: [email protected], if you would like to discuss this matter or have further questions.