Nurse-physician communication during labor and birth: implications for patient safety.

OBJECTIVE: To describe communication between nurses and physicians during labor within the context of the nurse-managed labor model in community hospitals and its relationship to teamwork and patient safety.

DESIGN: Multicenter qualitative study involving focus groups and in-depth interviews.

SETTING: Labor and birth units in 4 Midwestern community hospitals.

PARTICIPANTS: 54 labor nurses and 38 obstetricians.

METHODS: Focus groups and in-depth interviews were conducted using open-ended questions. Data were analyzed using inductive coding methods to gain understanding from the perspective of those directly involved.

MAIN OUTCOME MEASURES: Description of interdisciplinary interactions during labor.

RESULTS: Nurses and physicians shared the common goal of a healthy mother and baby but did not always agree on methods to achieve that goal. Two clinical situations critical to patient safety (fetal assessment and oxytocin administration) were frequent areas of disagreement and sources of mutual frustration, often leading to less than optimal teamwork. Minimal communication occurred when the mother and fetus are doing well, and this seemed to be purposeful and considered normal. Physicians and nurses had distinct opinions concerning desirable traits of members of the other discipline.

CONCLUSIONS: Interdisciplinary communication and teamwork could be improved to promote a safer care environment during labor and birth.