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Clinical Disagreements During Labor and Birth: How Does Real Life Compare to Best Practice?


MCN: The American Journal of Maternal/Child Nursing: January-February 2009 - Volume 34 - Issue 1 - p 31–39
doi: 10.1097/01.NMC.0000343863.72237.2b
Original Article

Purpose To describe how nurses would respond in common clinical situations involving disagreement with physician colleagues during labor and birth.

Study Design and Methods An electronic survey, consisting of five clinical disagreement case scenarios along with two open-ended questions regarding how to promote effective interdisciplinary communication and collaboration, was administered via a secure Web site. Seven hundred four obstetric nurses in a mid-size metropolitan area were invited to participate via mail. One hundred thirty-three nurses responded. Data were analyzed using descriptive statistics and thematic analysis of open-ended text responses.

Results Respondents were primarily aged ≥40, experienced in labor nursing, and held a BSN; 35% were members of the Association of Women's Health, Obstetric and Neonatal Nurses, 35% were certified in electronic fetal monitoring, and 33% were certified in inpatient obstetrics. In all five scenarios, most nurses were aware of current evidence and published standards of care (range 52%–86%). However, there was a wide discrepancy between current evidence/standards and what nurses indicated would occur in actual clinical practice.

Clinical Implications In this well-educated and knowledgeable sample of experienced labor nurses, reports of what would occur in clinical practice did not match current evidence or standards of care. Adequate nursing knowledge may not be an accurate predictor of appropriate clinical practice. Confidence in administrative support appears to be one of the key factors in empowering nurses to pursue resolution of disagreements in patients' best interests, whereas medical hierarchy, fear, and intimidation are significant barriers.

We've all been there. One provider thinks a treatment is necessary, and another disagrees. What's the best option for the nurse?

Kathleen Rice Simpson is a Perinatal Clinical Nurse Specialist, St. John's Mercy Medical Center, St. Louis, MO, and an Editorial Board Member of MCN. Dr. Simpson can be reached via e-mail at

Audrey Lyndon is an Assistant Professor, Department of Family Health Care Nursing, University of California San Francisco School of Nursing.

The authors have no conflict of interest or any financial relationship with any companies mentioned in the article.

© 2009 Lippincott Williams & Wilkins, Inc.