Can a Nurse Perform a Medical Screening Exam? Understanding Roles and Scope

September 30, 2025 •

5 min read

Under federal law, specifically the Emergency Medical Treatment and Labor Act (EMTALA), a medical screening exam (MSE) must be conducted by a "qualified medical person," and for certain conditions, this can include a trained and authorized Registered Nurse (RN). The question of can a nurse perform a medical screening exam? depends on their level of licensure, specialized training, and the policies of their employing hospital or clinic. While an RN can perform a screening assessment under the right conditions, a Licensed Practical Nurse (LPN) generally cannot perform the initial comprehensive exam, and an Advanced Practice Registered Nurse (APRN) has a much broader scope, including the authority to diagnose.

Quick Summary

This article explores the different roles nurses play in patient assessment, from the initial triage conducted by a Registered Nurse to the comprehensive examinations performed by Advanced Practice Nurses. It clarifies the legal and regulatory framework that determines if and when a nurse can conduct a medical screening exam, emphasizing the distinctions between assessment, screening, and medical diagnosis.

Key Points

RNs vs. APRNs: A Registered Nurse performs initial assessments and triage, collecting data to inform a diagnosis, while an Advanced Practice Nurse (e.g., Nurse Practitioner) is licensed to diagnose and perform full medical exams.
EMTALA's QMP Role: Under the federal law EMTALA, a medical screening exam (MSE) must be conducted by a Qualified Medical Person (QMP), which can be an RN if they are trained, competent, and authorized by the hospital.
State Law is Key: A nurse's scope of practice, including what constitutes a medical screening exam, is defined by their state's specific Nurse Practice Act.
LPN Limitations: Licensed Practical Nurses (LPNs) are not permitted to perform the initial comprehensive assessment, but can perform focused assessments and assist with care under supervision.
Institutional Authorization: For an RN to perform an EMTALA medical screening exam, they must not only meet state requirements but also be formally approved by their hospital's governing board.
Assessment vs. Diagnosis: A crucial distinction exists between a nurse's assessment (collecting data) and a medical provider's diagnosis (interpreting data to name a condition).

The Role of the Registered Nurse (RN) in Medical Screening

When a patient arrives in an emergency department or clinic, the first healthcare professional they encounter is often a Registered Nurse (RN). The RN's initial assessment is a crucial first step in prioritizing a patient's care. However, it's important to distinguish this initial assessment or triage from a full medical diagnosis. The RN's role is to collect data, assess a patient's condition, take vital signs, and use clinical judgment to determine the urgency of their medical needs. Based on this, they can initiate emergency interventions or prioritize the patient for further evaluation.

Triage Assessment: In a triage setting, an RN performs a focused evaluation of a patient's symptoms and medical history. This helps prioritize patients, ensuring that those with life-threatening conditions are seen immediately.
Data Collection: RNs are trained to gather comprehensive patient histories and perform physical examinations to collect data, but they do not make a medical diagnosis. This information is then used by a physician, nurse practitioner, or physician's assistant to form a medical diagnosis and treatment plan.
EMTALA Compliance: As per EMTALA regulations, some hospitals may designate specially trained RNs as a Qualified Medical Person (QMP) for certain types of medical screening exams, provided it is within their state's scope of practice and authorized by hospital bylaws. For example, in obstetrics, experienced labor and delivery nurses have long been authorized to perform medical screening exams to determine if a woman is in active labor.

How State and Federal Laws Define a Nurse's Authority

The ability for a nurse to perform a medical screening exam is governed by a combination of state Nurse Practice Acts and federal regulations like EMTALA. These legal frameworks establish the boundaries of what is permissible.

State Nurse Practice Acts: These laws are created by each state and outline the specific duties and responsibilities of licensed nurses, including RNs, LPNs, and APRNs. They define the legal scope of practice for nurses and are the primary authority on what a nurse can or cannot do. For example, the law in most states explicitly states that nurses (other than APRNs) cannot diagnose medical conditions.
Emergency Medical Treatment and Labor Act (EMTALA): This federal law applies to Medicare-participating hospitals that offer emergency services. It mandates that anyone requesting treatment for a medical condition in the emergency department receive an appropriate medical screening exam (MSE) to determine if an emergency medical condition exists. The law requires a QMP to perform the MSE, and in many cases, hospitals have the authority to designate qualified RNs for this role under specific circumstances.

The Broader Scope of Advanced Practice Nurses (APRNs)

Advanced Practice Registered Nurses (APRNs) operate with a significantly broader scope of practice than RNs, allowing them to perform comprehensive medical examinations, diagnose conditions, and prescribe treatment. APRN roles include Nurse Practitioners (NPs), Certified Nurse-Midwives (CNMs), and Clinical Nurse Specialists (CNSs).

Authorized to Diagnose: Unlike RNs, APRNs have completed extensive graduate-level education and training, which qualifies them to diagnose illnesses and create treatment plans, making them fully capable of performing medical screening exams in any context.
Primary Care Providers: In many states, APRNs, particularly NPs, serve as primary care providers, conducting routine physicals and screenings independently.

LPN/LVN Responsibilities in Patient Assessment

Licensed Practical Nurses (LPNs), also called Licensed Vocational Nurses (LVNs), have a different scope of practice from RNs and APRNs. A key distinction is that LPNs cannot perform the initial comprehensive assessment that establishes a patient's baseline.

Focused Assessments: LPNs are qualified to perform focused assessments to collect ongoing data and monitor a patient's health status.
Reporting Changes: If an LPN notes a change in a patient's condition, they must report their findings to an RN or other provider, who will then decide on the appropriate course of action.
No Initial Assessment: An LPN cannot perform the initial comprehensive assessment required to develop the initial nursing care plan.

Comparison: Nurse Roles in Patient Screening


Feature	Registered Nurse (RN)	Advanced Practice Nurse (APRN)	Licensed Practical Nurse (LPN/LVN)
Scope of Practice	Primarily assessment, triage, and care execution	Comprehensive diagnosis, treatment, and management	Focused assessment and care assistance, not initial assessment
Authority to Diagnose	No. Can identify and report abnormalities, but cannot medically diagnose.	Yes. Educated and licensed to perform medical diagnoses.	No. Cannot interpret clinical data or diagnose.
Primary Role in Screening	Triage and initial patient assessment, often in the ER or clinic.	Full medical screening exams, annual physicals, and specialized screenings.	Assists with data collection during focused assessments under RN supervision.
EMTALA Screening (QMP)	Can be designated as a Qualified Medical Person for certain conditions with hospital authorization.	Can serve as a Qualified Medical Person for all types of medical conditions within their scope.	Cannot serve as a Qualified Medical Person for initial MSEs under EMTALA.
Education/Licensing	RN license (Associates or Bachelors)	Master's or Doctorate degree plus APRN certification	LPN/LVN license (post-secondary program)

The Importance of Institutional Policy

Even when state laws permit an RN to perform certain medical screening exams, institutional policies and bylaws play a critical role. A hospital's governing body must formally authorize and credential specific nurses for these functions. This includes verifying their training, demonstrating clinical competency, and outlining clear consultation procedures with physicians. These policies are designed to ensure patient safety and legal compliance, adding another layer of regulation on top of state and federal guidelines.

Conclusion

While the scope of nursing practice has evolved, the legal and professional boundaries remain. A registered nurse can and does perform critical screening and triage assessments, determining the urgency of a patient's condition and collecting essential data. However, the ability to perform a comprehensive medical screening exam, particularly one that leads to a medical diagnosis, is a function reserved for Advanced Practice Registered Nurses and physicians. For an RN to be a designated QMP under EMTALA, they must have specific training and explicit authorization from their hospital, and the exam must fall within their state's legal scope of practice. These distinctions ensure that patient care is delivered safely and within the appropriate legal and professional boundaries across all healthcare settings.

EMTALA Basics: What Medical Professionals Need to Know

Frequently Asked Questions

A nurse's assessment is a systematic process of collecting health data and evaluating a patient's condition, often for triage or ongoing care. A medical screening exam (MSE) is a more specific evaluation, particularly under federal law like EMTALA, to determine if an emergency medical condition exists. For RNs, the MSE role is typically limited and requires specific authorization.

No, a Registered Nurse (RN) is not legally allowed to form a medical diagnosis. While they can perform a health history and physical examination to collect data, interpreting that data to make a medical diagnosis is outside their scope of practice.

An RN can perform an EMTALA medical screening exam (MSE) if they are trained to perform MSEs, are acting within the scope of their state practice act, and have been approved by the hospital's governing body to do so. The RN must also consult with a physician for disposition of the patient.

Yes, a Nurse Practitioner (NP), which is a type of Advanced Practice Registered Nurse (APRN), can perform a full medical examination. They have an advanced scope of practice that includes the authority to diagnose and treat medical conditions.

A Licensed Practical Nurse (LPN) cannot perform the initial, comprehensive assessment for a patient to establish their baseline. They can perform focused assessments and collect data to report to an RN or other provider, assisting with the patient's care plan under supervision.

No, the level and type of training vary based on the nurse's role. An RN designated as a QMP for EMTALA screenings requires specific, documented training and clinical competency. Advanced Practice Nurses require graduate-level education, while LPNs have a more limited training scope.

Hospital bylaws play a vital role by specifying which categories of personnel, including nurses, are authorized to perform specific types of medical screening exams. Authorization via these bylaws is a mandatory step for any nurse performing an EMTALA-required screening, in addition to meeting state requirements.