Nurses Pioneer Practice in the Use of Nitrous Oxide for Labor Analgesia

Abstract

The purpose was to expand options for pain management by offering nitrous oxide analgesia to women through a process that allows nurses to implement and manage administration, independent from anesthesia oversight. We applied the Texas Board of Nursing Six-Step Decision-Making Model and found that the provision of nitrous oxide for patient self-administration after a provider order was within nursing scope of practice. Our goal was to develop a nurse-managed nitrous oxide policy and procedure guideline for self-administration by obstetric patients, thereby removing the “middle man” (i.e., the anesthesia department). All stakeholders agreed that research evidence and expert opinion supported implementation of a nurse-managed model after an order was obtained, with no necessity to consult or involve the anesthesia services department. After addressing self-administration issues, occupational hazards, and environmental risks, we proceeded with a nurse-led nitrous oxide protocol. It took 14 months to develop and guide the protocol throughout our health system committees to gain approval. Entity-specific professional competencies were developed and implemented within the obstetrics department. To date, 56% of our patients have used nitrous oxide as an analgesia option at some point between the antepartum and postpartum periods. The response by patients to nitrous oxide administration has been overwhelmingly positive in regard to meeting their expectations for pain management. There have been no safety concerns related to this analgesia option. Nitrous oxide was also used for its anxiolytic properties for bedside procedures, such as external cephalic versions, cervical ripening, intravenous catheter insertions, indwelling urinary catheter insertions, perineum repairs, and postpartum incisional care, as well as in cases of fetal demise. Babies born after nitrous oxide administration show less sedation and fewer potential respiratory issues compared with those born after intravenous narcotics have been administered during birth. A nurse-managed policy and procedure allows registered nurses to practice at the top of their licensure and to support the autonomy of their patients without delay; it also helps decrease health care costs by giving patients an expensive, noninvasive option for pain management.