Implementing the Neonatal Assessment Nurse Role in the LDR: Improving Neonatal Outcomes While Supporting Family-Centered Care


Paper Presentation

Purpose for the Program

Knowing the stabilization and bonding benefits of minimizing the separation of the mother–baby dyad at delivery, a nurse-driven task force integrated the role of a neonatal assessment nurse (NAN) into the care delivery process. The task force discovered that inconsistent care practices, anecdotally reported by the medical providers, affected the quality of neonatal care and maternal satisfaction. The purpose of this project was to establish an innovative role designed to consistently provide transitional care at the mother's bedside for eligible newborns. Without funding to hire additional nurses into this position, a core group of nurses from all maternal child health units volunteered.

Proposed Change

Introduction of the NAN, as a dedicated clinical assignment, would positively facilitate the transition of life from fetus to neonate, decrease mother–neonate separation, increase rate of skin-to-skin contact, improve nurses’ perspective of neonatal care, decrease neonatal intensive care unit admissions, and improve maternal satisfaction. The NAN provides transitional care at the mother's bedside, thus changing the current practice of separating the infant from the mother to conveniently transfer the infant to where the work can be accomplished.

Implementation, Outcomes, and Evaluation

Hospital Institutional Review Board approval was obtained. Strategies for NAN success included detailed role description; patient care priorities; expectations when the labor and delivery room (LDR) had no neonatal patients; and a decisive evaluation plan for those infants requiring nonintensive yet supportive care and monitoring. A comprehensive process of didactic education and clinical orientation was individualized based on the nurse's expertise along the spectrum of neonatal care. Simulation scenarios served as teaching adjuncts and reinforced evidence-based practices.

The enthusiasm of the NAN-identified nurses and creative staffing models developed by the maternal–child health units’ charge nurses ensured coverage for every shift, 7 days a week.

The Caring Behaviors Inventory by Wu, Larrabee, and Putman (2006) was used before and after NAN to gain clinical nurses’ perspective about the care delivered to neonates who were less than 4 hours of age. This tool and survey, which focused on maternal perspective, were chosen because both aligned with the hospital's choice of Watson Caring Theory, which is the framework that currently guides our nursing practice.

Implications for Nursing Practice

The NAN role in the LDR presents an extended benefit of having a dedicated nurse to provide neonatal care in situations when transition time requires pulse oximeter monitoring and/or additional poststabilization assessments. With no literature available on this topic, publication of the positive results of this implementation plan will help others adopt similar roles specific to their settings.