Time and Effort by Labor Nurses to Achieve and Maintain a Continuous Recording of the Fetal Heart Rate via External Monitoring

Abstract

ObjectiveTo describe the time and effort of labor and delivery (L&D) nurses working to achieve a continuous recording of the fetal heart rate via external fetal monitoring, as well as the types of aids involved in that process. DesignDescriptive study using a cross-sectional survey methodology. Setting/Local ProblemNurses on our L&D units were frequently repositioning laboring women and fetal monitors, and utilizing various aids to achieve continuous monitoring. No evidence to support a best practice for achieving continuous fetal monitoring was identified. ParticipantsL&D nurses practicing in New Jersey. Intervention/MeasurementsAn online survey was used to collect data from labor nurses to identify if they used aids and what types of aids they used in their practice to achieve and maintain a continuous recording of the fetal heart rate via external fetal monitoring, as well as the amount of time that they spent doing so at the bedside. ResultsOf the 134 nurses who participated in the survey, 50% reported spending 1 to 2 hours repositioning an individual, and 48.9% reported spending 1 to 2 hours per 12-hour shift manipulating the ultrasound transducer. Thus, up to one third of the shift was spent working to achieve a continuous recording of the fetal heart rate via external fetal monitoring. More than 99% (n = 133) of participants reported the use of aids. The most popular aids included supplemental monitoring equipment such as extra fetal monitor straps or improvised aids such as washcloths. ConclusionL&D nurses spend at least some time at the bedside manipulating the ultrasound transducer to achieve and maintain a continuous recording of the fetal heart rate via external fetal monitoring. Various aids are used to do so. Understanding the amount of time nurses spend at the bedside and the aids used for this purpose may provide a better understanding of the work of L&D nurses.