Who’s Protecting Pregnant Nurses? A $2.4M Study Is Asking That Question

University of Arizona researchers will follow 250 pregnant hospital nurses to better understand how workplace demands affect stress, mental health, and cardiovascular health, with the goal of making nursing safer during pregnancy.

We spend our entire careers taking care of other people. But what happens when the nurse is the one who needs a little extra protection? For pregnant nurses working at the bedside, that question can get complicated. We’re talking about 12-hour shifts, lifting patients, handling hazardous medications, responding to emergencies, and sometimes barely finding time to eat or use the bathroom. And let’s be real, nurses aren’t exactly known for putting themselves first.

In interviews conducted by University of Arizona researchers, one nurse described performing CPR on a patient while 20 weeks pregnant, even though she knew she shouldn’t have been the one doing compressions. Other nurses shared experiences of administering potentially harmful chemotherapy drugs, caring for patients experiencing pregnancy loss, and facing threats from patients. Now, those researchers have received $2.4 million in federal funding to study what these workplace demands mean for pregnant nurses and how hospitals can better protect them.

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The National Institute for Occupational Safety and Health (NIOSH) awarded a four-year, $2.4 million grant to researchers at the University of Arizona. The study is led by Jessica Rainbow, an associate professor in the College of Nursing, and Leslie Farland, an associate professor of epidemiology and biostatistics in the Mel and Enid Zuckerman College of Public Health. They plan to enroll 250 hospital nurses during their first trimester and follow them through delivery.

Participating nurses will:

• Wear a health-tracking ring.
• Measure their blood pressure twice weekly.
• Complete brief daily surveys about stress and workplace experiences.
• Participate in a follow-up survey six weeks after delivery, with researchers also reviewing medical records.
• In some cases, participate in interviews about ways hospitals could improve workplace safety during pregnancy.

Researchers want to understand how the demands of hospital nursing interact with available workplace resources, and how an imbalance between the two may affect nurses’ stress, mental health, and cardiovascular health. The study is observational, meaning it can identify patterns and associations but cannot, on its own, prove that specific workplace exposures cause pregnancy complications.

The findings could help hospitals improve working conditions, strengthen support for pregnant nurses, and develop workplace policies that better address their needs.

When researchers spoke with pregnant nurses about their experiences, several concerns came up repeatedly.

• Hazardous medications: Some nurses described administering chemotherapy drugs even when they were concerned about the potential risks to their pregnancies.
• Physical demands: Lifting and repositioning patients, responding to emergencies, and spending long hours on their feet can make an already physically demanding job even harder.
• Workplace violence: Nurses reported facing threatening situations involving patients while pregnant.
• Emotional stress: Caring for patients experiencing miscarriages and stillbirths while managing fears about their own pregnancies created additional emotional strain.
• Chemical and infectious exposures: Hospital nurses may encounter cleaning products, hazardous medications, infectious diseases, and potentially harmful chemicals used in healthcare environments.

But here’s what stood out to me. Researchers also found that pregnant nurses often receive limited guidance from their employers, or even their own healthcare providers, about which workplace exposures deserve special attention and what modifications might be appropriate. We spend years learning how to protect our patients, but how much education do we actually receive about protecting ourselves during pregnancy?

According to the University of Arizona, potential solutions could include adjusting patient assignments, pairing nurses for physically demanding tasks, and identifying medications that warrant additional precautions or temporary reassignment.

While the new University of Arizona study will examine pregnant nurses’ workplace experiences and health, earlier research has identified associations between certain healthcare exposures and pregnancy loss.

A 2012 study published in the American Journal of Obstetrics and Gynecology analyzed occupational exposures and pregnancy outcomes among 7,482 nurses. After adjusting for several other factors, researchers found that nurses who reported exposure to antineoplastic drugs had approximately twice the odds of miscarriage compared with nurses who did not report that exposure. Exposure to sterilizing agents was also associated with increased odds of miscarriage at 12 to 20 weeks of pregnancy, but not earlier miscarriage. These findings show associations and do not establish that the exposures caused the pregnancy losses. A 2021 Nurses’ Health Study 3 analysis of prepregnancy antineoplastic drug handling found only a suggestive association with miscarriage in the more recent cohort, likely reflecting improved PPE and handling practices since the 2012 data were collected.

A separate study, published in the American Journal of Nursing in 2019, examined protective-equipment use among nurses in the Nurses’ Health Study 3 who administered antineoplastic drugs. Among pregnant nurses who gave these medications during the first 20 weeks of pregnancy, 9% reported never wearing protective gloves and 38% reported never wearing a protective gown.

NIOSH states that safe levels of occupational exposure to antineoplastic drugs are not known and recommends limiting exposure as much as possible. Potential exposure is not limited to preparing or administering chemotherapy. It can also occur during other patient-care activities, including contact with bodily fluids from patients receiving these drugs.

Research on high-level disinfectants, the chemicals used to sterilize reusable medical and dental instruments, has produced less definitive findings. A separate 2021 Nurses’ Health Study 3 analysis found no overall association between occupational high-level disinfectant exposure and miscarriage. In an analysis restricted to pregnancies occurring within 12 months of the initial exposure assessment, reported exposure to unspecified types of high-level disinfectants was associated with increased miscarriage risk. The researchers cautioned that the observational design and limited subgroup sample size required careful interpretation.

These studies do not establish that every hospital exposure poses a pregnancy risk. They identify potential occupational concerns and highlight questions that remain about nurses’ reproductive health. The new University of Arizona study will examine a related question: how workplace demands and available resources relate to pregnant nurses’ stress, mental health, and cardiovascular health.

Here’s something every nurse should know: you don’t have to wait for the results of this study to ask for workplace accommodations. The federal Pregnant Workers Fairness Act (PWFA) took effect June 27, 2023. The law generally requires covered employers with at least 15 employees to provide reasonable accommodations for qualified employees with known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship.

Depending on individual circumstances, accommodations may include:

• Additional breaks for water, food, rest, or bathroom use.
• Access to a stool or opportunities to sit.
• Assistance with lifting or other physically demanding tasks.
• Temporary changes to patient assignments or job responsibilities.
• Adjusted schedules or time off for prenatal appointments.
• Temporary reassignment or suspension of certain duties.
• Leave related to childbirth or recovery.

For nurses handling chemotherapy or other hazardous medications, NIOSH recommends talking with a supervisor or occupational safety officer about potential exposure and whether temporarily avoiding certain duties during pregnancy would be appropriate. NIOSH states that safe exposure levels for antineoplastic drugs are not known.

Pregnancy alone generally does not allow an employer to exclude a nurse from work based on assumptions about risks to the nurse or the pregnancy. However, that legal protection does not mean every clinical task is safe for every pregnant nurse. Decisions about accommodations should consider the specific workplace exposure, physical demands, and the nurse’s individual health needs.

You also don’t necessarily need a doctor’s note just to start the accommodation conversation. The Equal Employment Opportunity Commission (EEOC) explains that many requests can be handled through a discussion between an employee and employer. Supporting medical documentation may be appropriate in some situations, but it isn’t automatically required for every request. The PWFA also prohibits retaliation against workers for requesting or using protections under the law. Employers also cannot require a qualified employee to take leave when another reasonable accommodation can be provided. 

Certain provisions of the federal regulations have faced legal challenges, so nurses should review the latest EEOC guidance and any applicable state protections when requesting accommodations. This information is for educational purposes and is not legal advice.

I’ve spent more than two decades at the bedside, and I’ve watched plenty of coworkers push through pregnancy while taking care of everyone around them. Sometimes they’re exhausted, nauseated, uncomfortable, or worried, but they still show up and do their jobs. If we were sitting together giving report, here’s what I’d want you to know.

1. Tell your OB what your job actually involves. Don’t just say you’re a nurse. Explain your patient population, the medications you administer, your exposure risks, physical demands, and work schedule. Your provider can’t help you make informed decisions about workplace safety if they don’t know what your job looks like.
2. Ask for accommodations before you’re struggling. You don’t have to wait until something happens to start the conversation. Talk with your manager, employee health department, or occupational safety team about potential exposure risks and modifications. If you need an accommodation, consider putting your request in writing so you have a record.
3. Speak up about your assignments. If you’re concerned about administering a hazardous medication, lifting a patient, or caring for someone with a history of violence, talk with your charge nurse. Not every situation requires reassignment, but it absolutely deserves a conversation about appropriate precautions and available options.
4. Don’t cut corners with PPE. Follow your facility’s hazardous-drug handling policies and current safety recommendations. Appropriate gloves, gowns, engineering controls, and safe handling procedures matter. And remember, PPE isn’t always the only answer. Some exposures may require additional controls or temporary changes in duties.
5. Look out for your pregnant coworkers. If you’re the charge nurse, offer support without assuming that a pregnant coworker needs restrictions or asking them to disclose private medical information. If you’re working beside a pregnant coworker, offer help with a physically demanding task if you are able.
6. Take your mental health seriously, too. Pregnancy can already come with anxiety, stress, and uncertainty. Add critically ill patients, traumatic events, and long shifts, and that’s a lot for anyone to carry. There is nothing wrong with asking for emotional support, using employee assistance resources, or talking with a mental health professional.
7. Travel nurses, ask questions before accepting an assignment. If you’re pregnant or planning a pregnancy while traveling, talk with your recruiter about accommodation procedures, benefits, leave policies, and how accommodation requests are coordinated between the staffing agency and the facility. Your contract and assignment circumstances matter, and it’s better to understand the process before you need it.

I’ve watched nurses work through morning sickness, exhaustion, swollen feet, 12-hour shifts, and everything in between. We show up for our patients, even when we’re struggling ourselves. But pregnancy shouldn’t mean choosing between being a good nurse and protecting your own health.

This University of Arizona study could give hospitals something they’ve needed for a long time: better evidence about the unique challenges pregnant nurses face and practical ways to make their jobs safer. We advocate for our patients every single day. It’s time we make sure pregnant nurses get that same advocacy and support.

🤔 Nurses, what do you think hospitals should be doing differently to better support pregnant nurses?

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