The Role of Neonatal Nurses in Mechanical Ventilation Management

Nurses have a critical role in managing mechanical ventilation (MV) in neonatal intensive care units (NICUs). Despite their critical role in day-to-day MV management, their role in key decisions, particularly extubating and weaning, remains limited.

To describe the role of neonatal nurses in MV management in neonatal intensive care units.

Descriptive survey design: Data were collected using the Survey of Mechanical Ventilation and Weaning Roles and Responsibilities questionnaire. Census sampling was used to select 108 nurses working in NICUs from two university-affiliated hospitals in Gauteng, South Africa. Descriptive and comparative statistics were applied to analyse the data.

This study achieved an 83.3% response rate, revealing that MV decisions were predominantly collaborative between nurses and doctors. While 90% of nurses were involved in patient evaluation and ventilator adjustments, their role in extubation decisions was limited (45.6%), with doctors making most extubation decisions (54.4%). Oxygen titration was the most frequently managed ventilator setting by neonatal nurses. Nurses' perceived autonomy and influence in MV decision-making had median scores of 6.0, with higher perceived nursing autonomy significantly linked to independent decision-making (OR = 1.55; 95% CI = 1.22-1.97; χ²(1) = 12.86; p < 0.001) and higher influence scores significantly predicting autonomous decisions (OR = 1.86; 95% CI = 1.40-2.47; χ²(1) = 18.34; p < 0.001). However, only 36% of ICUs had weaning protocols, and ongoing MV education was lacking.

The study underscores the need for enhanced education, structured training and standardised protocols to strengthen nurses' competency, perceived autonomy and confidence in MV management. While nurses actively participate in ventilation-related decisions, their autonomy remains limited, particularly in extubation decisions.

Optimising neonatal outcomes requires well-prepared nurses who can actively and confidently contribute to MV-related decisions. Enhancing nurses' autonomy through structured education and standardised protocols is crucial for improving neonatal outcomes and promoting safer, more effective care and strengthens collaboration in NICUs.