The Role of Neonatal Nurses in Mechanical Ventilation Management.

Background: 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.

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

Study design: 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.

Results: 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.

Conclusion: 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.

Relevance to clinical practice: 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.