Labor and delivery care teams have the unique challenge of considering the outcome of two lives at once; and for infants, negative outcomes can lead to a lifetime of additional healthcare needs. Meanwhile, staff shortages in hospitals and outpatient settings have been front and center in hospital leaders' minds over the last three years. It is imperative that enough well-trained nurses are present, both physically and mentally, to meet the needs of a bustling neonatal care unit.
What Is Causing the Nursing Shortage?
Nursing shortages have been predicted to coincide with the expected retirement of the baby boom generation of nurses, but the current shortage stems from a variety of causes. For instance, Dr. Peter Buerhaus cites the move of younger or mid-career nurses from hospital-based care to either outpatient care or nurse practitioner roles.1 The number of people following this path has increased over the years, according to Health Affairs.2 The COVID-19 pandemic has worsened the shortage.3 Exhausted clinicians are choosing early retirement, left unable to work after their own or a family member's case of COVID-19, or simply burnt out from long hours and difficult working conditions during the worst of the pandemic.
While organizations are addressing shortages through strategies such as hiring traveling nursing staff or instituting mandatory overtime, it's important to consider the relationship between nurse-to-patient ratios and outcomes, says research from the journal PeriAnesthesia Nursing.4 Particularly in labor and delivery and the NICU, patient needs can change drastically from moment to moment. It can be challenging to ensure adequate staff and flexibility for what may happen during any given shift. Nurses must juggle unplanned admissions, families needing support, and any number of other setbacks.
How Nurse Education Can Help
Given these factors and the need for specialty training, education and orientation are constant efforts in postnatal care. Whether it's maintaining competency, learning the intricacies of new equipment, or onboarding new graduates or nurses from another care area, every generation of nurses has their own educational needs and relationship with technology, reports research from the Journal of Perinatal and Neonatal Nursing.5 Baby Boomers, Generation Xers, and millennials all may benefit from different learning strategies.
Here are four key areas to focus on in labor and delivery and neonatal nursing education.
New Hire Orientation
For the specialty areas of labor and delivery and neonatal intensive care, extensive orientation is necessary to accomplish the appropriate level of competency. Lynn Arenson, a labor and delivery nurse educator, and Kelly Potter, a nurse educator for neonatal intensive care, describe a model for new hire orientation in cooperation with several area hospitals. Having training and education provided by multiple educators in multiple locations is "a more cost-efficient way to train new folks with up to 100 people in each class," Arenson says. In addition, individual educators can focus on certain areas that fit with their particular expertise rather than taking on their whole education alone.
Training was handled remotely during the worst of the pandemic, given the local restrictions. That said, Arenson and Potter found that "virtual training was very difficult due to the intensity and length of the training days." Hands-on experiences are an important component in the new hire orientation, they add.
Implementing New Programs
Hospital leaders have several options when it comes to training staff on new protocols. Arenson describes one scenario in which she was able to use the online meeting program Microsoft Teams for a new practice that needed to go live quickly.
"I scheduled about 25 sessions in the morning, around mid-day, and at night. I got really good feedback because people could log in from anywhere and could pick what time worked best for them," she says.
These sessions could be provided as a pre-recorded video with periodic feedback from the learner, a module with a test at the end, or a variety of other methods to validate attendance and learning. In some cases, real-time instruction may be preferable to allow attendees to ask questions.
Equipment Training
Equipment-specific training, either as a refresher or with the purchase of new equipment, is important to ensure staff members are comfortable using the available tools.
"It was a huge help to have the clinical application educators physically available to service folks by actually assisting nurses to place and use the Monica Novii II after it was purchased," Arenson says.
Clinical application educators often bring a depth of clinical experience with them, as well as in-depth knowledge of the equipment being trialed or purchased. Potter reinforces the value of this sort of support, particularly for high-risk, low-volume procedures. Seeing as equipment may not be used as often, she says she "definitely want[s] the company representative/educator there so people can get their hands on the machine and see how it works." Utilizing manufacturer clinical application educators also leaves nurse educators more time for other unit needs.
Potter follows a tried-and-true process for effective team training on low-volume equipment. "I really try to get a core group of people who feel really comfortable with this piece of equipment, both days and nights, so that there are resources available until everybody is comfortable," she says.
This "core group" concept is valuable for units with a high number of traveling or agency nurses. These staff members typically come and go about every six to 12 weeks. Although many are familiar with the most common equipment, if their help is needed in a high-risk, low-volume situation, the assistance of that core group of experienced and trained staff is invaluable.
Maintaining Competence
Most hospitals have required annual competencies based on quality improvement projects, Joint Commission guidelines, or internal policies. Various methods of delivery and review for these projects are utilized across the country. But, as Potter points out, "in order for someone to stay competent in multiple areas, they must spend time regularly in those areas." This can be challenging, as moving around usually depends on need and patient census rather than an individual nurse's needs. Even within the same clinical area, maintaining competency in all emergency situations can be difficult.
That's where virtual and simulated training come in. Potter and Arenson have used a state-of-the-art simulation lab to help nurses maintain competency across clinical areas without waiting for real-life scenarios to unfold. This training includes multidisciplinary cases and cases that cross over service lines. "We developed a simulation with the emergency department to include a hypertensive emergency and a baby born on arrival," says Potter. To help intensive care units (ICUs) that were caring for more maternity patients during the pandemic, Arenson developed simulations with ICU staff to practice addressing emergencies with antepartum and postpartum patients.
How Supportive Education Helps Retain Staff and Fight Shortages
It's essential to keep adult learning principles in mind while training nurses. "Everybody learns differently, and depending on what equipment, procedure, or policy you are teaching, how it is taught will vary," Potter says. Arenson adds that it's important to "give the whys" so trainees understand the reasoning behind a rule or procedure. Nurses are motivated to learn when there is a need to apply their new knowledge. "But we want to keep it fun and engaging, as well!" Potter adds. She and Arenson have used games such as Jeopardy and Family Feud—along with candy and snacks—to keep trainees engaged during long, detailed sessions.
These motivational tools are more than just tricks for engagement, however. A systematic review published in the British Journal of Nursing found that education and support at work are two key factors influencing nursing staff retention.6 Besides onboarding new staff, it's important to recognize the impact that education—and the improved experience that comes from working alongside a well-trained care team—can have on retention.
Well-structured, consistent training is critical to combat nursing shortages that are likely to persist for some time.7 The research from the Journal of PeriAnesthesia Nursing reports that instances of medical errors and hospital-associated infections are rising in conjunction with staffing shortages. Adequate labor and delivery nurse education and neonatal nurse training are key for both permanent and temporary staff. Utilizing available resources such as manufacturer-assisted education, online learning, and simulation-based instruction provides the necessary support for the nurse educator and addresses trainees' varied learning needs.
References:
- BiPartisian Policy Center. Help wanted: alleviating the nursing shortage. YouTube. https://www.youtube.com/watch?v=L_asyU0viSI. Accessed October 18, 2022.
- Auerbach DI, Buerhaus PI, Staiger DO. Implications of the rapid growth of the nurse practitioner workforce in the US. Health Affairs. 2020;39(2):273-279. doi:10.1377/hlthaff.2019.00686
- Bourgault A. The nursing shortage and work expectations are in critical condition: Is anyone listening? Critical Care Nurse. 2022;42(2):8-11. doi:10.4037/ccn2022909
- Ross J. Nursing shortage creating patient safety concerns. Journal of PeriAnesthesia Nursing. 2022;37(4):P565-567. doi:10.1016/j.jopan.2022.05.078
- Gallo AM. "Beyond the classroom: using technology to meet the educational needs of multigenerational perinatal nurses." The Journal of Perinatal & Neonatal Nursing. 2011;25(2):195-199. doi:10.1097/jpn.0b013e3182163993
- Marufu TC, Collins A, Vargas L, et al. Factors influencing retention among hospital nurses: systematic review. British Journal of Nursing. 2021;30(5):2052-2819. https://www.britishjournalofnursing.com/content/literature-review/factors-influencing-retention-among-hospital-nurses-systematic-review
- Baker DW. Addressing the nursing shortage in the United States: an interview with Dr. Peter Buerhaus. The Joint Commission Journal on Quality and Patient Safety. 2022;48(5):298-300. doi:10.1016/j.jcjq.2022.02.006
