Development of the Neonatal Resource Nurse Role in the Labor and Delivery Unit: Changing the Way We Support Mothers and Newborns During the Transition Period

Authors


Poster Presentation

Objectives

  1. Development of best practice outcomes for healthy and critical newborns during the transition period.
  2. Analysis and stabilization of the critical newborn from the labor and delivery unit to the neonatal intensive care unit.
  3. Increased recognition of signs and symptoms of postpartum complications by the labor and delivery nurse as a result of focusing solely on the mother.

Design

The Resource Nurse role was developed by evaluating the literature, discussing the current clinical concerns related to the stabilization, and transportation of critical newborns out of the labor and delivery unit to the neonatal intensive care unit, and care issues identified by the pediatric providers. Collaboration between neonatology, obstetrics, pediatrics, and nursing was utilized to ensure all newborn aspects of care during the transition period were considered and a priority of care was determined.

Patients/Participants

Neonatal and obstetric nurses were the primary clinicians who developed the Resource Nurse role.

Methods

Utilization of literature review, skills assessment and education for resuscitation techniques and normal transition care, collaborative discussions for process flow issues and case reviews were used to refine the care process.

Implementation Strategies

Weekly meetings were initiated during which key players were identified and a timeline was established. Separate taskforce meetings were utilized to create clear clinical pathways for newborn charting, room set up, breastfeeding support, and post-transition period handoff. One-on-one interviews were conducted at the 60-day mark after the role was implemented and will be conducted at the 6-month mark for evaluation of progression in nursing comfort and workflow.

Results

Results included the following improved patient outcomes related to increased collaboration between neonatology, obstetrics, and pediatric nurses, and providers; decreased rates of hypothermia, hypoglycemia, and inappropriate patient admission to the neonatal intensive care unit. Neonatal and obstetric nursing staff reported an increase in their clinical understanding of newborn physiology during the transition period and an increased comfort with initiating resuscitation for newborns based on neonatal resuscitation guidelines.

Conclusion/Implications for Nursing Practice

We saw an overall elevation in the level of care provided to newborns and mothers in the labor and delivery setting. We implemented fundamental changes in the clinical approach to the care of the newborn by providing the newborn his/her own nurse to monitor and evaluate the complex transition period. Increased communication and collaboration between two specialties resulted and allowed improved planning, implementing, and supporting best outcomes for newborns and mothers.

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