Professional Practice, Patient Safety, and Issues and Trends
This domain asks how you practice, communicate, and improve care, not just what you know clinically.
Standards and safety infrastructure
Know the bodies behind practice standards, including AWHONN for staffing and fetal monitoring, ACOG for obstetric practice, and ACNM for midwifery care. A sentinel event is an unexpected death or serious injury; a root cause analysis follows an event, while failure mode and effects analysis anticipates one. Universal protocol and time-out apply before procedures. Under just culture, human error is consoled, at-risk behavior is coached, and reckless behavior is disciplined.
Communication and teamwork
SBAR structures escalation. Closed-loop communication confirms that a message was received, the two-challenge rule lets any team member stop an unsafe action, and CUS signals concern. Know the chain of command and use structured handoffs and debriefs.
Quality and bundles
The AIM bundles for hemorrhage, severe hypertension, and sepsis rely on standardized protocols and quantitative blood loss. Maternal early warning criteria and maternal mortality review committees identify preventable harm.
Ethics, law, and equity
Informed consent requires indication, risks, benefits, alternatives, and consequences of refusal, and the patient must have capacity. Protect confidentiality, report as mandated, and document objectively. Interpreters and plain-language teaching address health literacy. Recognize that implicit bias drives disparities in maternal outcomes and that respectful, shared decision-making care is a safety practice.
Worked example
An SBAR call might sound like this: Situation, this is the nurse in room 6, she is 6 cm with recurrent late decelerations. Background, oxytocin at 12 mU/min and an epidural in place. Assessment, I believe this is uteroplacental insufficiency. Recommendation, I have stopped the oxytocin and given a fluid bolus; please come evaluate now.