ED nurses report radio silence when it comes to guidance for care of pregnant patients in states with abortion bans

Expressing frustration, anger and moral distress, emergency department (ED) nurses interviewed in states with abortion bans say they are getting no information or guidance from nursing leaders or hospital administrators on how to provide care to obstetric patients, according to new, multidisciplinary research by the University of Massachusetts Amherst.

“Basically, the nurses felt like they were set adrift with no guidance, no support, no backup, and they were concerned for their patients,” says Lisa Wolf, associate professor at the Elaine Marieb College of Nursing and lead author of the paper published in the Journal of Nursing Administration.

The new research is expected to inform discussion at the American Organization for Nursing Leadership 2025 annual conference in Boston, which runs through April 2.

The lack of communication impacts the quality of care – even whether pregnant patients get care at all – and represents a stark contrast from the usual protocols in an ED, adds Wolf, a longtime ED nurse whose research focuses on making the emergency environment safer for patients and nurses. “In an emergency department, if we change how we do EKGs or how we do stroke care, there’s like 150 ways that that information is communicated – and immediately,” Wolf says.

Wolf and co-author Lynnette Arnold, a linguistic anthropologist at UMass Amherst, found that confusion reigns over the wording and interpretation of legislation in the 12 states with total bans on abortion, seven states with bans under 18 weeks, and 22 with bans after 18 weeks. All the states provide an exception if the life of the pregnant patient is in danger, and some of the states also allow medical intervention for the “health” of the pregnant person, in the case of rape or incest, or a fatal fetal condition.  

Nurses told the researchers that some ED doctors refuse to provide even clearly legal reproductive health care for patients, such as prescribing Plan B, a contraceptive pill that remains legal in all states. “The nurses were talking about calling around to three different emergency departments to try to get Plan B for patients who are sexual assault victims because the physicians in their hospital won’t write the prescription, even though it’s legal and not an abortion,” Wolf says. “So there’s a lot of moral distress.”

What struck Arnold was the virtual silence even among the nurses, due to the political nature of the issue and the potential for legal and professional repercussions. “The overwhelming takeaway for me was the communicative isolation that nurses faced. They were essentially operating in the same kind of informational vacuum that all the rest of us are. And there wasn’t a lot of that kind of horizontal communication among nurses that can sometimes fill the gap of institutional communication.” Some of the more experienced nurses used “work-arounds.” One strategy was what Arnold called “reading the room for allies” to try to figure out who is safe to talk to about reproductive care. “So they’re reading things like who has a rainbow pin, or who’s wearing Chuck Taylors [sneakers] and pearls to signal that they’re going to vote for Kamala Harris,” Arnold says. 

One nurse in the study put it this way: “It’s political, it’s religious. It just kind of stems on a bunch of issues you don’t really want to talk about at work.”

The lack of protocol and communication leaves pregnant patients in a precarious situation. “They’re not coming in for elective abortions,” Wolf emphasizes. “What is showing up in emergency departments are pregnancy complications – cardiomyopathy, preeclampsia, miscarriage, fetal demise, sepsis.”

Living in “obstetric deserts” has led to more pregnant patients showing up in EDs – where nurses are not necessarily trained in obstetric emergencies – because it’s often the only place they can seek health care. “There are more people who are pregnant because they can’t get abortions,” Wolf says. “And there are more pregnant people who are having complications, and the only place that they can go, at least prior to the second trimester, is an emergency department, because a lot of OB practices in those states will not see you in the first trimester because they don’t want to get tangled up in any accusations of causing an abortion or a miscarriage.”

Arnold and Wolf recruited nurses for the study over social media. In one-hour Zoom sessions between March and May in 2024, they interviewed 22 ED nurses – 19 of whom worked in a state with care-limiting legislation. More than 45% of the ED nurses worked in the Southwest; 41% in the Southeast; 9% in the Northeast; and 5% in the Midwest.

This is the third study Wolf, who is also director of Emergency Nursing Research at the Emergency Nurses Association, has undertaken about the ED nurse experience since the Supreme Court’s Dobbs decision overturned Roe v Wade in 2022. The first study, published in 2023 in the Journal of Emergency Nursing, explored the impact of a post-Roe environment on how ED nurses cared for people in obstetrical emergencies. The second one, published in Nursing Ethics in 2024, examined the question of moral courage among ED nurses caring for patients amid bans on abortion and gender-affirming care.

Wolf says the current study shows ED nurses have grown more confused, wary and angry. “We’re pretty sure that what we’ve said here is accurate and representative, although maybe not 100% generalizable,” Wolf says. “We had interdisciplinary triangulation. We had subject matter triangulation. We had geographic triangulation.”