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Keywords:

  • childbirth;
  • delivery mode;
  • cesarean;
  • quality improvement;
  • negotiation;
  • interprofessional communication;
  • shared decision making

ABSTRACT

Objective

To examine the role of the labor and delivery nurse in a nurse-managed practice model and nurses’ perceived ability to influence decisions about mode of delivery and outcomes.

Design

Cross-sectional, descriptive, qualitative study.

Setting

One nurse-managed labor and delivery unit in a community-based hospital near a major metropolitan area.

Participants

A purposeful sample of 13 registered nurses with intrapartum experience.

Methods

Qualitative, in-depth interview data were subjected to content analysis.

Results

Experienced labor and delivery nurses perceived their role to be influential in decisions about mode of delivery. Negotiating for more time was integral to the way nurses exerted their influence, allowing for the time needed to implement practices that promote vaginal delivery. Knowledge of labor and physician practice patterns shaped the specific communication strategies used by nurses in their roles as negotiators.

Conclusions

The responses of experienced, intrapartum nurses to actual and perceived time pressures and the subsequent impact on nurse–physician communication patterns and delivery mode outcomes are significant. Findings indicate the need to further explore how individual nursing practice may function as an independent predictor of delivery mode and how shared decision making among physicians, laboring women, and nurses affects rates of cesarean delivery.