Emergency Nurses' Training, Experience, and Confidence With Obstetrical Emergencies: A Cross-Sectional Survey in...

The United States has the highest maternal mortality rate among high-income countries, with rural states being disproportionately affected. In counties without birthing hospitals, emergency departments can serve as the first point of care for obstetrical complications. This study assessed emergency nurses' experience and confidence in managing obstetrical complications in the rural state of Arkansas.

Emergency nurses at Arkansas hospitals were invited to participate in a cross-sectional survey. The web-based survey asked nurses to report their experience in managing 15 obstetrical complications and their receipt of related training. Confidence in managing complications was assessed using a modified evidence-based practice confidence scale. Statistical analyses included descriptive statistics and multilevel ordinal regression modeling.

The sample included 164 emergency nurses employed across 42 Arkansas hospitals. Over two-thirds of all respondents (70.1%) had received training on at least 1 obstetrical emergency in the 2 years before the survey. Nurses most commonly reported training on pregnancy-related hypertension and seizures (36.6%), postpartum hemorrhage (31.1%), and stabilization of the newborn (27.4%). More than half of the nurses reported high interest in training on 13 obstetrical topics. Nurses' confidence in managing pregnancy-related hypertension was associated with receipt of training, previous case experience, and the presence of inpatient obstetrical services at their hospital.

This study demonstrates a need to better prepare emergency nurses in Arkansas to manage a range of obstetrical complications. Simulation-based education, which combines experiential learning with didactic instruction, may build the experience and confidence needed to manage obstetrical emergencies in areas with limited obstetrical care.