Purpose for the Program
Nursing leaders and staff identified nursing practice in the labor and delivery unit as complex with many variables influencing workload and productivity. Observation of clinical practice reinforced the dynamic nature of the unit with high-risk patient presentations and comorbidities requiring multitasking, critical thinking, and expert care. Staff nurses described inefficiencies and discrepancies that added to nursing workload and interfered with clinical care. Themes and patterns emerged in their observations, which represented eight areas for improvement.
Eight staff performance improvement groups were formed to address the issues.
Implementation, Outcomes, and Evaluation
Eight groups were constructed with two to three staff nurse members, a staff nurse as chair, a leadership resource, and a facilitator. Each group was given a charge, data and drivers for their work, education and support for performance improvement processes, and a time line. The course for each group was complicated and took longer than planned. Motivation and commitment prevailed to produce a recommendation for pilot implementation of practice change in six of the groups and ongoing progress toward the goals for the other two. The workload and allocation of resources group developed a nurse-driven patient acuity/complexity scoring system for pilot and integration with the institution's QuadraMed patient classification system.
The postdelivery length of stay group validated activities that occur between the delivery and the transfer to the postpartum unit for vaginal and cesarean births and proposed improvements. The induction group collected and analyzed data to describe utilization patterns and proposed redistribution of work and resources. The communication and collaboration group conducted extensive on-unit analysis of communication behaviors and designed an intervention for daily interdisciplinary rounds. The environment of care group identified labor and delivery room readiness as a problem, collected data, and worked with support departments to construct a reliable system for equipment and supplies. The professional growth and development group assessed staff needs and designed an education, mentoring, and accountability program using expertise and resources from within the staff. The work of the documentation group and outcomes group is ongoing. The documentation group is evaluating elements of nursing documentation that influence perinatal outcomes, including those in the new electronic medical record. The outcomes group is identifying evaluation methods for perinatal outcomes, patient and staff satisfaction, regulatory compliance, and financial indicators.
Implications for Nursing Practice
Best practice innovations come from the clinicians. Staff performance improvement groups will continue to monitor the results of their implementations and look for opportunities for other practice improvements. We will move toward identifying strategies that strengthen interdisciplinary, collegial, and collaborative practice. The work of the eight performance improvement groups has built a foundation for continuing development of clinician-driven practice improvements to ensure successful outcomes for mother, infant, and family.