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Variability in routine nursing involvement relating to labor epidurals- Does practice setting dictate nursing practice?
Abstract Number: T-39
Abstract Type: Original Research
OBJECTIVE: To understand the variability in routine nursing practice as it relates to labor epidurals across different practice settings, especially between academic and non-academic environments.
METHODS: All the U.S. members of the Society for Obstetric Anesthesia and Perinatology (SOAP) were sent a link to an anonymous 17-question survey relating to typical labor and delivery nursing practices observed by the SOAP members in their respective practice settings. The survey was administered via Qualtrics. A reminder was sent to the participants at the end of 4 weeks. At the end of the 8 weeks, the survey was closed and the results analyzed. The details of the questions answered in the survey are in Table 1.
RESULTS: Of the 795 members who were sent the survey, 237 began the survey and 223 finished it, for a completion rate of 28%. The survey focused on 12 areas in which nurses might be involved with respect to labor epidurals, and not surprisingly found that nurses did significantly more tasks (7.4/12 vs 4.1/12, p < 0.001) in non-academic settings compared to academic settings. These included obtaining epidural kits and drugs, administering boluses and changing infusion rates. In fact, every one of the 12 areas analyzed had higher nursing involvement in non-academic areas. Some of the differences were striking, for instance, in only 6.3% of academic settings, nurses give the initial dose of pressors; whereas nurses give the initial dose of pressors in 52% of non-academic settings. Along the same lines, the study found that nurses did significantly more in private hospital settings compared to public (6.2/12 vs 4.1/12, p = 0.001). The study also found that nurses were likely to do more tasks if the hospital had a policy on the extent of nursing involvement (p < 0.01).
CONCLUSION: Nursing practice varies significantly between academic and non-academic settings with respect to labor epidurals, with nurses in non-academic settings having a greater scope of practice. This may be due in part to the increased role of residents in academic settings and a greater reliance on nursing staff in the private practice environment.