Purpose for the program: Creating a culture of safety on obstetrical units is paramount to preventing adverse events and improving staff satisfaction.  In a high census, level three Labor & Delivery unit, it was recognized that the Charge Nurse was spending an increasing amount of time on administrative tasks required to run the unit and there was a perception among the charge nurses that they were forced to focus on putting out clinical fires. 

Proposed change: They needed assistance from staff “resource nurses” to  address the clinical areas of need during their shift such as determining plans of care for patients with concerning fetal tracings, assuring that new graduate nurses were practicing safely, and assuring staffing ratios were appropriate for patient conditions. 

Implementation, outcomes and evaluation: A formal Resource Nurse position was created in Labor and Delivery, with clinical leads selecting  the nurses that had the knowledge,  communication and clinical skills to perform this role.  Feedback from staff alerted the leadership team that consistency in the expectations and qualifications was essential to the success of this role and perceptions of patient safety. A job description listing required nurse qualifications was developed and a plan for formalized training of staff selected to function in this role was instituted.  After implementation of the formalized Resource Nurse role, charge nurses, staff, and physicians were queried regarding their perceptions of the culture of safety in Labor and Delivery.  Evaluation of the formalized approach to the Resource Nurse role indicates a positive impact on staff perceptions toward both the value of having a Resource Nurse and the culture of safety on the unit, as indicated by increases in survey scores for all topics queried.  The most significant increase (56%) was in staff perception that there is consistently another qualified nurse ensuring accuracy of fetal monitor strip interpretation.  Additionally, our results mirrored information found in the literature that indicates job satisfaction increases with staff's perceived improvement in the culture of safety.

Implications for nursing practice: Application of this process could have positive implications for all areas of nursing, especially those where potential for adverse events is high or expertise is widely varied among staff.  The Resource Nurse role is designed to achieve an environment of professional excellence by removing the “fire-fighting” approach to managing a nursing unit, and creating a role where clinical issues are dealt with proactively, thus improving patient safety.

Keywords: obstetrics, resource nurse, culture of safety