principles and practice

Educating New Labor and Delivery Room Nurses CAROL POOLE, CRN, MN

Nurses who are new to the labor and delivery area need a foundation in maternal-newborn theory before beginning clinical practice. A model for a two-week, theory course for nurses orienting to the labor and delivery area is presented.

Traditionally, when nurses with no previous experience were hired for labor and delivery units, they learned the specialized skills nec- essary for that area by observing the practice of other nurses and through trial and error. Hospitals now usually use a formal or infor- mal preceptor method of providing the needed orientation. At times, new nurses attend special classes on fetal monitoring, but very little other formal instruction is avail- able. Most new labor and delivery nurses have had no obstetric the- ory courses since their basic nurs- ing education that, for many, was years ago. This type of orientation leaves a trainee dependent on the skill of the preceptors. The infor- mation they are given is usually fragmented and often conflicting.

The belief of the Swedish Hos- pital Medical Center (SHMC) Nursing Department is that nurses employed in the labor and delivery room suite should begin with a solid base in maternal-newborn

Accepted: December 1983.

November/December 1985 JOCNN

theory. In 1980, the first, two-week workshop was offered to new labor and delivery nurses. At this time, the course consisted of approxi- mately 40 hours of theory presen- tations and 40 hours of clinical ex- perience. Instructors were primar- ily hospital employees; however, instructors from the University of Washington and consultants from the Washington State Regional Perinatal Care Program also were involved.

About this time, Swedish Hos- pital, which has a secondary level obstetric service, began receiving requests from primary level hos- pitals for help in educating their new obstetric nurses. As a result, in the second workshop, the deci- sion was made to include five nurses from SHMC and two nurses from the Olympic Peninsula. Sev- eral changes were made in the workshop following this experi- ence. First, the department de- cided that 40 hours was not suffi- cient time to cover all of the theory believed to be essential. Second, as more nurses came from the com- munity, the clinical experience segment became impractical. The

workshop now contains approxi- mately 70 hours of theory presen- tations over a two-week period. Nurses are expected to arrange clinical experience in their own fa- cilities following the workshop.

PARTICIPANTS

The workshop is offered twice a year. Nurses come from Washing- ton, Idaho, Montana, Canada, Alaska, and Oregon. Approxi- mately 35 participants attend each workshop. Participants in the course are almost exclusively reg- istered nurses. However, a few LPNs and childbirth educators have participated. Even though SHMC does not hire LPNs in its la- bor and delivery unit, other hos- pitals in the Northwest do. These LPNs, like the RNs, need at least a beginning theory base from which to practice. Likewise, childbirth educators need the opportunity to expand their knowledge base. Be- cause childbirth educators come with more obstetric knowledge than most medical-surgical nurses, the non-nurse childbirth educators are able to keep up with the pace

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of the course and contribute a great deal. Table 1. Summary of Course Outline

Topics Lecturer Format Length (min)

THE COURSE Day 1

Introduction and Overview Pretest The objectives of the workshop

are for each participant to be able,

Coordinator -

Lecture Test-76

multiple-choice questions

Film

30 60

60 at

1.

2.

3.

4.

5.

6.

7.

8.

the end of the workshop to

Discuss the physiology involved in the labor and delivery pro- cess; Describe nursing care required during the labor and delivery process; Recognize basic deviations from normal on a fetal heart monitor tracing; Describe methods of identifying and managing the high-risk patient during the antepartal, intrapartal, and postpartal periods; Describe appropriate tech- nique to be used for abdominal and perineal preps; Compute a newborn's Apgar score; Describe immediate care of the newborn and discuss physiol- ogy involved in the transitional period; and Describe components of a new- born surface appraisal and a gestational age assessment.

Movie-"The Child"-Overview of Menstruation, Ovulation, Fertilization, Pregnancy, and Birth

Anatomy and Physiology Review 06 Consultant

06 Consultant

Lecture, Overhead, Models

Overhead, Models

Lecture,

60

180 Physiology of Normal Labor, Delivery, and 4th Stage

Day 2 Family-centered Maternity Care 60 College

College

College

College

College

Instructor

Instructor

Instructor

Instructor

Instructor

Lecture,

Lecture Discussion

Nursing Care During Labor 150

60 Film Lecture Pain Relief During Labor

Nursing Care During Delivery

Nursing Care During 4th Stage

Lecture 120

Lecture 90

Day 3 Fetal Monitoring Theory Aseptic Technique

Clinical Specialist College

College Instructor

Instructor -

Lecture, Slides Lecture, Practice,

Demonstration Lecture, Practice,

Demonstration Modules

270 45

Abdominal and Skin Preparation 45

Newborn Modules: Apgar Thermoregulatiop Vital Signs Congenital

Defects Suctioning

Day 4 Newborn Theory

Transition to Life Immediate Care of the Newborn Identification of the High Risk

Surface Appraisal Gestational Age Assessment

Newborn

Resuscitation of the Newborn

90 (to be

finished at home) The course is taught entirely by

instructors with previous teaching experience: five master's-prepared nurses, a college instructor, two maternal-newborn clinical spe- cialists, the RN baccalaureate program coordinator, a doctoral student, two perinatologists, a maternal-newborn outpatient co- ordinator, a neonatal nurse con- sultant from the Washington State Regional Perinatal Care Program, an obstetric nurse consultant, a re- spiratory therapist, a biomedical engineer, and an IV nurse.

Table 1 contains a list of the top- ics covered during the course, the type of lecturer, the format, and the

Doctoral Student Doctoral Student Doctoral Student

Lecture, Slides Lecture Lecture, Slides

60 60 60

Doctoral Student Doctoral Student Neonatal

Consultant and Respiratory Therapist

Lecture, Slides Lecture, Film Lecture, Film,

Practice

60 60

120

Day 5 Fetal Monitoring-Theory and

Mother-Infant Interaction Instruction

195

60

Clinical Specialist Lecture, Slides

Lecture, Film Doctoral Student

460 November/December 1985 JOCNN

their clinical orientation. Once they return to their facilities, the nurses a r e bet ter ab le to grasp techniques because of their in- creased understanding of the the- ory and rationale for the proce- dures.

One of the benefits of the course is the contact between nurses from different locales. Approximately half of the participants come from primary-level hospitals, where nurses a re responsible for labor and delivery, nursery, and post- partum areas. Many are the only R N s on the unit. This is far different from the urban obstetr ic units where nursing staffs a re much larger. Much sharing occurs during the two-week period, and nurses gain an increased respect for each other.

Since clinical experience is not provided in this workshop, each hospital sending nurses to the course must make arrangements for providing clinical orientation. This is of some benefit to the in- stitutions because the student has not spent a lot of time learning a set of policies and procedures ihat is different from their local hos- pital’s policies and procedures. With a solid base of theory behind them, new labor and delivery nurses a re able to learn clinical skills much faster than they would otherwise.

One weakness of the course is the method of the presentation. Sitting in lectures for seven hours a day, for two weeks, is not the best way of learning. Ideally, the classes should be spread over a greater length of time to increase retention of knowledge. However, nurses from the variety of states would not be able to participate in a work- shop that has not been condensed. It is also more feasible for hospitals to release employees for a two- week period than to release them for a few days a week over a pro-

Table 1. (Continued)

Tooics Lecturer Format Lertath (min)

Prenatal Complications College Instructor

Lecture, Film 120

120

60 90

435

60 60

270

240

120

60

60

90 90 60

60

Day 6 Prenatal Complications (continued) Monitoring the High-Risk Fetus

Through Laboratory Testing Induction of Labor Fetal Monitor Strip Interpretation

Perinatologist Lecture

Lecture Practice

Clinical Specialist Clinical Specialist

RNB Coordinator

Day 7 Complications of Labor College

Instructor Lecture, Films

Day 8 Management of Breech Delivery Repeat Cesarean vefsus Trial of

Delivery Complications Labor

Perinatologist Perinatologist

Lecture Lecture

College Instructor

Lecture, Films

Day 9 Caring for the Family With Loss

IV Practice

Outpatient

IV Nurse Coordinator

Lecture,

Lecture, Discussion

Discussion and Practice

Demonstration Lecture,

Practice

Fetal Monitor Troubleshooting Biomedical Engineer

Clinical Specialist RNB Coordinator

Fetal Monitor Strip Interpretation

Day 10 Caring for the Pregnant Teenager Teenage Father Posttest

RNB Coordinator RNB Coordinator

-

Lecture, Slides Film. Discussion Test (same as

posttest) Discussion and

Evaluation Form

Coordinator Evaluation and Discussion

amount of t ime allotted to each topic.

Pretests and posttests are used to measure the knowledge gained during the workshop. The results ol the test are used in planning fur- ther education experiences for new employees. Nurses coming from other areas of the Northwest take their tests home with them and are responsible for making their own arrangements for improving areas of identified weakness.

EVALUATION

The course makes i t possible to ensu re that nurses a t Swedish Hospital Medical Center a r e re- ceiving quality education before beginning their labor and delivery clinical experience. The course also provides the Northwest Re- gion with an invaluable community service. Nurses are able to receive a broad theory base before starting

46 1

longed period. Even though nurses may not be able to retain every- thing that is presented, they at least know how to use the re- sources to find needed informa- tion.

SUMMARY

An extended period of time is needed for clinical orientation of new labor and delivery nurses. The

skills are very specialized and need time to be learned well. At Swedish Hospital Medical Center, once the nurses finish the course, they begin a three-month, clinical orientation. During this time, the nurses take on new responsibilities as they are ready. At the end of the three- month period, the nurses transfer to their assigned shift and are able to function relatively indepen- dently.

Address for correspondence: Carol Poole, R N , Coordinator, R N Baccalau- reate Program, Swedish Hospital Med- ical Center, 747 Summit Ave., Seattle, WA 98104.

Carol Poole is coordinator of the RN Bacca- laureate Program at Swedish Hospital Medical Center in Seattle, Washington. Ms. Poole is a member of Sigma Theta Tau, and ANA.

JOGNN SUPPLEMENTS FOR SALE

Copies of the following Journal of Obstetric, Gynecologic, and Neonatal

Obstetric and Gynecologic Nurse Practitioner Supplement (1 24 pp.,

Neonatal Intensive Care Nursing (95 pp., published May/June 1983).

The supplements sell for $5.00 each, plus 50 cents postage and handling per copy. A maximum postage fee of $2.00 will be assessed. Supplement orders should be mailed to NAACOG Publications, 600 Maryland Ave., S.W., Suite 200 East, Washington, DC 20024. Please specify the titles and quantities of the supplements being ordered. All orders must be prepaid.

Nursing supplements can be purchased from NAACOG:

published March/April 1984)

RESEARCH CONFERENCE SCHEDULED

NAACOG, the organization for obstetric, gynecologic, and neonatal nurses, is sponsoring a conference on OGN nursing research August 8- 10, 1986, in Minneapolis, Minnesota. The conference is entitled “Excellence in Perinatal and Women’s Health Research” and will focus on methods of conducting and using research. For information, contact Denise Savage, NAACOG, 600 Maryland Ave., S.W., Suite 200 East, Washington, DC 20024; (202) 638-0026.

462 Novernber/Decernber 1985 JOGNN