Role of the Obstetric Clinical Nurse Coordinator

Abstract

<h2>Poster Presentation</h2><h3>Purpose for the Program</h3> The scheduling of procedures on the unit was formally an ad hoc process. This resulted in no true clinical oversight of the procedures being scheduled. The American College of Obstetricians and Gynecologists, The Joint Commission, and Centers for Medicare & Medicaid Services call for regulation surrounding the elective induction of labor of pregnancies before 39 weeks gestation. There also are controlled criteria for exclusions to these guidelines. Gaps in adhering to the guidelines as well as patient and physician dissatisfaction resulted in the vision of a single point of contact for all women entering the obstetric unit for planned procedures. <h3>Proposed Change</h3> To have the obstetric clinical nurse coordinator play the role of the clinical nurse expert to shepherd women through the final stages of their pregnancies, help guide their transition from outpatient to inpatient setting, and ensure adherence to guidelines of scheduled procedures. <h3>Implementation, Outcomes, and Evaluation</h3> Before initiation of the role, the hospital had a high nulliparous elective induction rate. This translated to a failed induction rate of 25%. This number proved to be staggering and bolstered support of a clinical expert to monitor scheduled procedures. Six‐months postimplementation of the role, the rate of failed inductions decreased dramatically to 2% with enforcement of cervical Bishop scoring and adherence to the guidelines related to medical versus elective inductions. This remarkable change in the model of care also resulted in fewer elective inductions scheduled overall from 15% to 8%. The clinical nurse coordinator also is a driver of family‐centered care. Women come to the unit already having established a relationship and point of contact in the inpatient units. This has resulted in high patient satisfaction scores with year‐to‐date overall inpatient satisfaction at 90.4% via Press Ganey. The number of delayed or cancelled inductions has decreased dramatically as well, and health care provider satisfaction has increased. <h3>Implications for Nursing Practice</h3> The role was not easily understood when first presented and resistance of the idea was met initially. The need for this change and desire to have a clinical nurse expert in the role, once occupied by a unit clerk, was met with skepticism. However, this model is now regarded as an exemplar of patient‐focused, quality care. The quantitative and qualitative positive results affirm the vision of this role.