Faculty Bibliography

OBJECTIVE:To identify processes affecting agency for safety among perinatal nurses, physicians, and certified nurse-midwives. DESIGN/METHODS:Grounded theory, as informed by Strauss and Schatzman. SETTING/METHODS:Two academic perinatal units in the western United States. PARTICIPANTS/METHODS:Purposive sample of 12 registered nurses, 5 physicians, and 2 certified nurse-midwives. FINDINGS/RESULTS:Agency for safety (the willingness to take a stand on an issue of concern) fluctuated for all types of providers depending on situational context and was strongly influenced by interpersonal relationships. While physicians and certified nurse-midwives believed that they valued nurses' contributions to care, their units had deeply embedded hierarchies. Nurses were structurally excluded from important sources of information exchange and from contributing to the plan of care. Nurses' confidence was a key driver for asserting their concerns. Confidence was undermined in novel or ambiguous situations and by poor interpersonal relationships, resulting in a process of redefining the situation as a problem of self. CONCLUSIONS:Women and babies should not be dependent on the interpersonal relationships of providers for their safety. Clinicians should be aware of the complex social pressures that can affect clinical decision making. Continued research is needed to fully articulate facilitators and barriers to perinatal safety.

OBJECTIVE:To identify evidence on the role of assertiveness and teamwork and the application of aviation industry techniques to improve patient safety for inpatient obstetric care. DATA SOURCES/METHODS:Studies limited to research with humans in English language retrieved from CINAHL, PubMed, Social Science Abstracts, and Social Sciences Citation Index, and references from reviewed articles. STUDY SELECTION/METHODS:A total of 13 studies were reviewed, including 5 studies of teamwork, communication, and safety attitudes in aviation; 2 studies comparing these factors in aviation and health care; and 6 studies of assertive behavior and decision making by nurses. Studies lacking methodological rigor or focusing on medication errors and deviant behavior were excluded. DATA SYNTHESIS/RESULTS:Pilot attitudes regarding interpersonal interaction on the flight deck predicted effective performance and were amenable to behavior-based training to improve team performance. Nursing knowledge was inconsistently accessed in decision making. Findings regarding nurse assertiveness were mixed. CONCLUSIONS:Adaptation of training concepts and safety methods from other fields will have limited impact on perinatal safety without an examination of the contextual experiences of nurses and other health care providers in working to prevent patient harm.

The Maryland Perinatal Education Consortium (MPEC), a 12-hospital education initiative, provides basic didactic education for perinatal nurses. The MPEC core curriculum integrates patient-specific cultural and age-related considerations for both the novice and experienced perinatal nurse. While the primary goal for developing the consortium was to maximize use of the nurse educator's time by pooling educational resources between participating hospitals, member hospitals have discovered that it also resulted in advantageous positioning for recruitment and retention of nursing staff. MPEC's pooled turnover rate of 14% is below the national average of 16%, resulting in important cost savings and additional staff for participating hospitals. This article describes the development of the MPEC and uses the Nursing Executive Center's model of turnover costs to describe the cost savings and retention impact for various-sized hospitals achieved through MPEC's multihospital collaboration in staff development.