Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians' individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient's best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support nurses in their role of advocacy is missing in many perinatal care settings. This article draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse's role in maintaining safety during labor and birth in acute care settings and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care.
Department of Family Healthcare Nursing, UCSF School of Nursing, San Francisco, California (Dr Lyndon); and Yale School of Nursing, New Haven, Connecticut (Dr Kennedy).
Corresponding Author: Audrey Lyndon, PhD, RNC, CNS, Department of Family Healthcare Nursing, UCSF School of Nursing, 2 Koret Way, PO Box 0606, San Francisco, CA 94143 (firstname.lastname@example.org).
This work was supported by the Nursing Initiative of the Gordon and Betty Moore Foundation and by NIH/NCRR/OD UCSF-CTSI grant KL2 RR024130. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Submitted for publication: August 26, 2009
Accepted for publication: November 18, 2009