Point‐of‐Care Ultrasound by Nurses: A Niche Skill or a Global Core Competence?

Point-of-care ultrasound (POCUS) has moved in less than two decades from a niche physician-operated technology to a ubiquitous bedside tool that has reshaped how clinicians assess, monitor and treat patients across the continuum of care (Knutsen and Solbakken 2025). At the same time, nurses are increasingly using ultrasound at the bedside (Totenhofer et al. 2021). Responses from the various health systems and professions, locally and internationally, to nursing-POCUS reflect the challenges of achieving effective practice change in nursing. In many health systems, nurses utilise POCUS every day without being formally trained or recognised as independent users, and despite accumulating evidence that registered nurses and nurse practitioners can acquire, interpret and act on POCUS findings with accuracy comparable to other clinician groups, when appropriately trained (Brunhoeber et al. 2018; Enrici Baion et al. 2025). The success story of nurse-performed POCUS for bladder volume assessment for suspected urinary retention is well-established and studies show very strong correlation between ultrasound-estimated bladder volume and urine drained in postoperative and neurologically impaired patients (Ho-Gotshall et al. 2024). Prospective studies comparing handheld bladder ultrasound, the standard nursing bladder scan and catheterisation as a gold standard confirm high diagnostic agreement and highlight the convenience of portable devices at the bedside (Fuzaro et al. 2025; Liptrott et al. 2025). The practice can reduce unnecessary indwelling catheters and catheter-associated urinary tract infections in adults (Johansson et al. 2013), reduce ‘dry’ catheterization in children and improve caregiver satisfaction without delaying care (Ng et al. 2025), aiding selection of the least traumatic and most appropriate urinary catheter for each situation, thereby minimising tissue trauma. The question, then, is not simply whether nurses can acquire POCUS skills but whether we are yet prepared to accept that bladder scanning is not an exception and ensure that nurse-performed POCUS shifts from sporadic, self-initiated or emergency use to being recognised, managed and resourced as a core component of care. In nursing, POCUS is utilised across diverse populations and at various levels of healthcare, ranging from primary care to critical and emergency care, as well as pre- or intra-hospital settings (Santos et al. 2024). In trauma care, nurse-performed Focused Assessment with Sonography for Trauma (FAST) in adult patients demonstrates sensitivity and specificity for intra-abdominal free fluid comparable to physician FAST studies with scan times compatible with resuscitation workflows (Varndell et al. 2018). Systematic and validation studies concur that, after structured training and supervised practice, nurses' FAST interpretations are highly concordant with those of physicians (Bowra et al. 2010). Evaluation of the feasibility of adding nurse-performed POCUS—extended FAST, basic lung ultrasound and lower-limb compression ultrasound—to standard ED triage for selected adult presentations shows it adds a median of about 90 s to triage, is feasible in most eligible patients and may improve detection of otherwise occult deep vein thrombosis, urgency classification and early risk stratification (Enrici Baion et al. 2025). In sepsis and undifferentiated shock, preliminary studies in emergency departments (ED) and Intensive Care Units (ICU) indicate that nurses can integrate serial ultrasound scans of the inferior vena cava (IVC) and lung early in treatment, obtaining useful information regarding fluid response. Scans performed by ED nurses at predefined time points during the first hours of care showed IVC collapsibility decreasing over time, lung patterns remaining relatively stable, with nurses recommending progressively less fluid as ultrasound information accumulated, with high agreement from emergency physicians (Kalam et al. 2023). Effects on mortality or ICU admission have yet to be demonstrated but data show nurse-performed POCUS can shape real-time haemodynamic decision-making in ED practice. Similarly, in out-patient clinic settings, ultrasound examinations of the pleural cavity and IVC performed by nurses may enhance diagnostics and patient care for patients with heart failure and on haemodialysis, producing high-quality scans for assessing fluid volumes (Gundersen et al. 2016; Steinwandel et al. 2018). Benefit has also been demonstrated for patients with difficult intravenous access (DIVA). Associated with multiple failed cannulation attempts, delays to time-critical therapies and avoidable central venous catheters (Nickel et al. 2024), studies show that for adult DIVA patients ultrasound-guided peripheral IV insertion by nurses increases first-attempt success, reduces the overall number of punctures and lowers the need for central access without increasing complications (Álvarez-Morales et al. 2024). A similar picture is emerging in paediatrics, where ultrasound-guided peripheral access in children with DIVA has improved first-attempt success and shortened procedure times compared with landmark techniques (Kleidon et al. 2025). In summary, studies in paediatric, ED, ICU and general care settings indicate that nurse-performed ultrasound-guided cannulation is feasible, effective and associated with acceptable complication rates (Kanaley et al. 2023; Mitchell et al. 2022). Taken together, these data strongly support viewing ultrasound-guided peripheral access in adult and paediatric DIVA patients as a foundational POCUS competency for nurses, not a niche interest for a small group of experts. Another emerging field is the use of POCUS to help confirm nasogastric tube (NGT) position—essential information but available assessments remain suboptimal (Fan et al. 2017). Misplacement of NGTs into the respiratory tract, though infrequent, can have serious consequences (Chiesa et al. 2025). Radiographic confirmation remains the reference standard but is time-consuming, exposes patients to ionising radiation and may be difficult to obtain promptly (Ong et al. 2025). Studies in ED and ICU populations have evaluated ultrasound techniques that visualise the tube in the oesophagus and stomach and use dynamic ‘fogging’ of the gastric lumen during air or fluid injection (Brotfain et al. 2022; Tai et al. 2016). Research indicates ultrasound has high sensitivity and specificity for confirming correct gastric placement compared to radiography (Chiesa et al. 2025) but is currently considered a valuable supplementary tool for high-risk patients or where radiography is delayed, rather than an alternative to X-ray confirmation. Overall, uptake and adoption of nurse-performed POCUS across hospital and community settings is currently patchy. If the clinical case is increasingly strong, its adoption as a universal competence is still far from achieved. The strongest evidence specific to nursing is focused on vascular access, whereas areas such as paediatric nursing-POCUS for respiratory and abdominal issues could be considered research priorities rather than standards of care. However, multiple implementation studies highlight the same barriers. First, training and competency pathways are often absent or inconsistent. Many nurses report that ultrasound courses, machines and mentorship are primarily geared towards physicians and that they rely on informal learning or local champions to develop skills (Knutsen and Solbakken 2025). Second, equipment and resource constraints restrict opportunities to use POCUS in daily work, whether because too few machines are available, devices are poorly located or maintenance and infection-prevention processes are inadequate (Bruant and Normand 2025). Third, time and workload pressures make ultrasound appear an ‘extra step’ in already overloaded shifts, particularly when retrieval, cleaning, image storage and reporting are not integrated into standard workflows (Enrici Baion et al. 2025; Kalam et al. 2023). Fourth, governance and medico-legal concerns are often unclear. In many services, policies do not clearly define which ultrasound examinations nurses are authorised to perform, how images should be archived and audited or how responsibility for interpretation is shared within the team (Totenhofer et al. 2021). Some nurses worry about overstepping into perceived medical territory or being held liable if a critical POCUS finding is missed, especially when their role is not formally recognised (Su et al. 2025). In many systems, the absence of explicit recognition of nurses as POCUS providers leaves their contributions invisible in documentation, quality metrics and resource allocation. Lastly, the lack of evidence—particularly in paediatric populations and low-resource settings—and the predominance of research conducted by physician operators create challenges for decision-makers when justifying investments in nursing POCUS programs. This situation reinforces a cycle where limited implementation leads to limited research and vice versa (Eppel et al. 2025; Kiepuszewska and Gałązka-Sobotka 2025). In conclusion, POCUS provides nurses with concrete, scientifically grounded opportunities to enact a broad, renewed vision of nursing: one that is technologically competent, deeply clinical and closely attuned to patients' immediate needs. Whether it becomes a true core component of nursing care worldwide will depend on whether health systems choose to see and support what nurses are manifestly capable of and already doing, and whether research gaps and structural, educational and cultural barriers are addressed systematically rather than left to chance. This scenario is an exemplar of decision challenges playing out repeatedly and ubiquitously in the evolution of nursing's scope of practice and perceived professional profile; as we strive to align what nursing could and does deliver, its potential with its actual practice. Daniele Privitera: conceptualisation, writing-original draft, writing-review and editing. Christian Nicole: writing-review and editing. Lin Perry: writing-review and editing, supervision. Davide Giustivi: writing-original draft, writing-review and editing. The authors have nothing to report. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.