A multi-ethnic group of nursing students are attending class together. They are seated at a long table in a classroom. The individuals are working in pairs on a project. The two women seated closest to the camera are being assisted by their female professor who is showing them something on a digital tablet.


Nurse Impact is a portfolio of projects that use data on the practices of labor and delivery nurses to inform quality improvement. The projects aim to strengthen and standardize nursing practice while improving the quality and equity of maternal care and delivery of outcomes across the US.

Because of the way data is collected in health services research, the impacts of nurses’ practices on childbirth outcomes are understudied. All Nurse Impact projects aim to close that gap by using labor and delivery nurse practice data to direct quality improvement. These projects are diverse in scope and spread across the US, including hospitals in Boston, MA, Seattle, WA, and Los Angeles, CA.

Areas of Focus

Defining the Influence of Nurses on the Likelihood of C-Section began in fall of 2018. The goal of this project is to explore the credibility of data used to evaluate rates of delivery mode for nurses, with the ultimate outcome of developing a valid and accurate method of attributing a cesarean delivery to an individual nurse. Analysis is currently underway to (1) examine the contribution of nurses to cesarean delivery in a predictive model and 2) explore whether patient assignment to nurses is at random. This project is funded by the RX Foundation. 

Understanding the Best Practices of L&D Nurse to Improve Patient Safety began in fall of 2019 and aims to improve patient safety by looking at the relationship between nurse attitudes, characteristics, and variation in nurse-level cesarean delivery rates. This project is funded by CRICO. 

Optimizing Nurse Practice to Improve Childbirth Outcomes began in January 2020. This project implements an Audit and Feedback intervention and empowers nurses to better understand data on their practice through feedback on their individual, nurse-level cesarean data. The project is funded by the Rita & Alex Hillman Foundation. 

The projects are led by Joyce Edmonds, PhD, MPH, RN, Associate Professor at Boston College Connell School of Nursing and Amber Weiseth, DNP, MSN, RN, Research Scientist at Harvard T.H. Chan School of Public Health and Interim Director of the Delivery Decisions Initiative at Ariadne Labs. Drs. Edmonds and Weiseth have collaborated on nurse-level innovation and research over the past three years, and their work together on this portfolio combines research expertise from Boston College Connell School of Nursing with the clinical intervention and implementation expertise of Ariadne Labs. We also partner with the Foundation for Heath Care Quality’s Obstetrical Care Outcomes Assessment Program.