Audrey Lyndon

Faculty

Audrey Lyndon Headshot

Audrey Lyndon

FAAN PhD RNC

Vernice D. Ferguson Professor in Health Equity
Assistant Dean for Clinical Research

1 212 922 5940
Accepting PhD students

Audrey Lyndon's additional information

Dr. Lyndon is the Vernice D. Ferguson Professor in Health Equity and assistant dean for clinical research at NYU Rory Meyers College of Nursing. Her equity work is focused in two areas: maternal health equity and diversifying the nursing science and healthcare workforce. Dr. Lyndon’s maternal health work has focused on patient safety and quality in maternity and neonatal care, including improving communication and teamwork among clinicians; identifying parents’ perspectives on safety during labor, birth, and neonatal care; developing nurse-sensitive outcomes for labor and birth; and research on severe maternal morbidity and maternal mortality. Her team has conducted groundbreaking research on differences in clinicians’ and parents’ perspective on speaking up about safety concerns and developing an understanding of how women and parents conceptualize safety during childbirth and neonatal intensive care. Dr. Lyndon co-chaired the development of the CMQCC Obstetric Hemorrhage Toolkit, which became a national and international model for maternal safety bundles and collaborative quality improvement. Dr. Lyndon recently completed a study funded by the Agency for Healthcare Research and Quality examining relationships between nursing care during labor and patient outcomes. She is currently focused on understanding the experiences of Black and Latinx survivors of severe maternal morbidity to better identify their support needs, research priorities, and community-driven prevention targets for severe maternal morbidity. Dr. Lyndon’s work on diversifying the nursing science and healthcare workforce includes mentoring and sponsorship of historically excluded clinicians and scientists and efforts to build effective pathways programs for historically excluded individuals into nursing, nursing science, and clinical specialties.

PhD - University of California, San Francisco
MS - University of California, San Francisco
BA - University of California, Santa Cruz

Women's health
Health Services Research

American Academy of Nursing
American College of Obstetricians and Gynecologists (ACOG), Educational Affiliate
American Nurses Association
Association of Women’s Health Obstetric and Neonatal Nurses
International Family Nursing Association

Faculty Honors Awards

Reviewer of the Year, Journal of Obstetric, Gynecologic, and Neonatal Nursing (2017)
Irving Harris Visiting Professor, University of Illinois, Chicago College of Nursing (2015)
Distinguished Professional Service Award, Association of Women's Health, Obstetric and Neonatal Nurses (2013)
Fellow, American Academy of Nursing (2012)
Award of Excellence in Research, Association of Women's Health, Obstetric and Neonatal Nurses (2011)

Publications

Nurses' Perceptions of Critical Issues Requiring Consideration in the Development of Guidelines for Professional Registered Nurse Staffing for Perinatal Units

Simpson, K. R., Lyndon, A., Wilson, J., & Ruhl, C. (2012). JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing, 41(4), 474-482. 10.1111/j.1552-6909.2012.01383.x
Abstract
Abstract
Objective: To solicit input from registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) on critical considerations for review and revision of existing nurse staffing guidelines. Design: Thematic analysis of responses to a cross-sectional on-line survey question: "Please give the staffing task force your input on what they should consider in the development of recommendations for staffing of perinatal units." Participants: Members of AWHONN (N = 884). Results: Descriptions of staffing concerns that should be considered when evaluating and revising existing perinatal nurse staffing guidelines. Consistent themes identified included the need for revision of nurse staffing guidelines due to requirements for safe care, increases in patient acuity and complexity, invisibility of the fetus and newborn as separate and distinct patients, difficulties in providing comprehensive care during labor and for mother-baby couplets under current conditions, challenges in staffing small volume units, and the negative effect of inadequate staffing on nurse satisfaction and retention. Conclusion: Participants overwhelmingly indicated current nurse staffing guidelines were inadequate to meet the needs of contemporary perinatal clinical practice and required revision based on significant changes that had occurred since 1983 when the original staffing guidelines were published.

Predictors of likelihood of speaking up about safety concerns in labour and delivery

Lyndon, A., Sexton, J. B., Simpson, K. R., Rosenstein, A., Lee, K. A., & Wachter, R. M. (2012). BMJ Quality and Safety, 21(9), 791-799. 10.1136/bmjqs-2010-050211
Abstract
Abstract
Background: Despite widespread emphasis on promoting 'assertive communication' by care givers as essential to patient-safety-improvement efforts, little is known about when and how clinicians speak up to address safety concerns. In this cross-sectional study, the authors use a new measure of speaking up to begin exploring this issue in maternity care. Methods: The authors developed a scenario-based measure of clinician's assessment of potential harm and likelihood of speaking up in response to perceived harm. The authors embedded this scale in a survey with measures of safety climate, teamwork climate, disruptive behaviour, work stress, and personality traits of bravery and assertiveness. The survey was distributed to all registered nurses and obstetricians practising in two US Labour & Delivery units. Results: The response rate was 54% (125 of 230 potential respondents). Respondents were experienced clinicians (13.7611 years in specialty). A higher perception of harm, respondent role, specialty experience and site predicted the likelihood of speaking up when controlling for bravery and assertiveness. Physicians rated potential harm in common clinical scenarios lower than nurses did (7.5 vs 8.4 on 2-10 scale; p<0.001). Some participants (12%) indicated they were unlikely to speak up, despite perceiving a high potential for harm in certain situations. Discussion: This exploratory study found that nurses and physicians differed in their harm ratings, and harm rating was a predictor of speaking up. This may partially explain persistent discrepancies between physicians and nurses in teamwork climate scores. Differing assessments of potential harms inherent in everyday practice may be a target for teamwork intervention in maternity care.

Quality patient care in labor and delivery: A call to action

Lawrence, H. C., Copel, J. A., O’Keeffe, D. F., Bradford, W. C., Scarrow, P. K., Kennedy, H. P., Grobman, W., Johnson, M. C., Simpson, K. R., Lyndon, A., Wade, K., Peddicord, K., Bingham, D., & Olden, C. R. (2012). American Journal of Obstetrics and Gynecology, 207(3), 147-148. 10.1016/j.ajog.2012.07.018

Antenatal steroid administration for premature neonates in California

Lee, H. C., Lyndon, A., Blumenfeld, Y. J., Dudley, R. A., & Gould, J. B. (2011). Obstetrics and Gynecology, 117(3), 603-609. 10.1097/AOG.0b013e31820c3c9b
Abstract
Abstract
OBJECTIVES: To estimate risk factors for premature neonates not receiving antenatal steroids in a population-based cohort and to determine whether the gains of a quality-improvement collaborative project on antenatal steroid administration were sustained long-term. METHODS: Clinical data for premature neonates born in 2005-2007 were obtained from the California Perinatal Quality Care Collaborative, which collects data on more than 90% of neonatal admissions in California. Eligible neonates had a birth weight of less than 1,500 g or gestational age less than 34 weeks and were born at a Collaborative hospital. These data were linked to administrative data from California Vital Statistics. Sociodemographic and medical risk factors for not receiving antenatal steroids were determined. We also examined the effect of birth hospital participation in a previous quality-improvement collaborative project. A random effects logistic regression model was used to determine independent risk factors. RESULTS: Of 15,343 eligible neonates, 23.1% did not receive antenatal steroids in 2005-2007. Hispanic mothers (25.6%), mothers younger than age 20 (27.6%), and those without prenatal care (52.2%) were less likely to receive antenatal steroids. Mothers giving birth vaginally (26.8%) and mothers with a diagnosis of fetal distress (26.5%) were also less likely to receive antenatal steroids. Rupture of membranes before delivery and multiple gestations were associated with higher likelihood of antenatal steroid administration. Hospitals that participated in a quality-improvement collaborative in 1999-2000 had higher rates of antenatal steroid administration (85% compared with 69%, P<.001). CONCLUSION: A number of eligible mothers do not receive antenatal steroids. Quality-improvement initiatives to improve antenatal steroid administration could target specific high-risk groups.

Effective physician-nurse communication: A patient safety essential for labor and delivery

Lyndon, A., Zlatnik, M. G., & Wachter, R. M. (2011). American Journal of Obstetrics and Gynecology, 205(2), 91-96. 10.1016/j.ajog.2011.04.021
Abstract
Abstract
Effective communication is a hallmark of safe patient care. Challenges to effective interprofessional communication in maternity care include differing professional perspectives on clinical management, steep hierarchies, and lack of administrative support for change. We review principles of high reliability as they apply to communication in clinical care and discuss principles of effective communication and conflict management in maternity care. Effective clinical communication is respectful, clear, direct, and explicit. We use a clinical scenario to illustrate an historic style of nurse-physician communication and demonstrate how communication can be improved to promote trust and patient safety. Consistent execution of successful communication requires excellent listening skills, superb administrative support, and collective commitment to move past traditional hierarchy and professional stereotyping.

Letter to the editor

Lyndon, A. (2011, October 1). In Advances in Nursing Science (Vols. 34, Issues 4, p. 279). 10.1097/ANS.0b013e318231e2dc

Predicting Likelihood of Speaking Up in Labor &amp; Delivery

Lyndon, A., Sexton, J. B., Simpson, K. R., Rosenstein, A. H., Lee, K., & Wachter, R. M. (2011). JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing, 40, S117-S118. 10.1111/j.1552-6909.2011.01243_39.x

A state-wide obstetric hemorrhage quality improvement initiative

Bingham, D., Lyndon, A., Lagrew, D., & Main, E. K. (2011). MCN The American Journal of Maternal Child Nursing, 36(5), 297-304. 10.1097/NMC.0b013e318227c75f
Abstract
Abstract
Purpose: The mission of the California Maternal Quality Care Collaborative is to eliminate preventable maternal death and injury and to promote equitable maternity care in California. This article describes California Maternal Quality Care Collaborative's (CMQCC's) statewide multistakeholder quality improvement initiative to improve readiness, recognition, response, and reporting of maternal hemorrhage at birth and details the essential role of nurses in its success. Project Design and Approach: In partnership with the State Department of Maternal, Child, and Adolescent Health, CMQCC identified maternal hemorrhage as a significant quality improvement opportunity. CMQCC organized a multidisciplinary, multistakeholder task force to develop a strategy for addressing obstetric (OB) hemorrhage. Project Description: The OB Hemorrhage Task Force, co-chaired by nurse and physician team leaders, identified four priorities for action and developed a comprehensive hemorrhage guideline. CMQCC is using a multilevel strategy to disseminate the guideline, including an open access toolkit, a minimal support-mentoring model, a county partnership model, and a 30-hospital learning collaborative. Clinical Implications: In participating hospitals, nurses have been the primary drivers in developing both general and massive hemorrhage policies and procedures, ensuring the availability of critical supplies, organizing team debriefing after a stage 2 (or greater) hemorrhage, hosting skills stations for measuring blood loss, and running obstetric (OB) hemorrhage drills. Each of these activities requires effort and leadership skill, even in hospitals where clinicians are convinced that these changes are needed. In some hospitals, the burden to convince physicians of the value of these new practices has rested primarily upon nurses. Thus, the statewide initiative in which nurse and physician leaders work together models the value of teamwork and provides a real-time demonstration of the potential for effective interdisciplinary collaboration to make a difference in the quality of care that can be achieved. Nurses provide significant leadership in multidisciplinary, multistakeholder quality projects in California. Ensuring that nurses have the opportunity to participate in formal leadership of these teams and are represented at all workgroup levels is critical to the overall initiative. Nurses brought key understanding of operational issues within and across departments, mobilized engagement across the state through the regional perinatal programs, and developed innovative approaches to solving clinical problems during implementation. Nursing leadership and integrated participation was especially critical in considering the needs of lower-resource settings, and was essential to the toolkit's enthusiastic adoption at the unit/service level in facilities across the state.

Journal of Perinatal and Neonatal Nursing: From the editors

Lyndon, A., Simpson, K. R., & Bakewell-Sachs, S. (2010). Journal of Perinatal and Neonatal Nursing, 24(1), 1. 10.1097/JPN.0b013e3181cb9367

Perinatal safety: From concept to nursing practice

Lyndon, A., & Kennedy, H. P. (2010). Journal of Perinatal and Neonatal Nursing, 24(1), 22-31. 10.1097/JPN.0b013e3181cb9351
Abstract
Abstract
Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians' individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient's best interest can be viewed as their "agency for safety." However, collective agency for safety and commitment to support nurses in their role of advocacy is missing in many perinatal care settings. This article draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse's role in maintaining safety during labor and birth in acute care settings and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care.