Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients

Nurs Outlook. 2023 May-Jun;71(3):101960. doi: 10.1016/j.outlook.2023.101960. Epub 2023 Mar 31.


Background: Evidence is limited on nurse staffing in maternity units.

Purpose: To estimate the relationship between hospital characteristics and adherence with Association of Women's Health, Obstetric and Neonatal Nurses nurse staffing guidelines.

Methods: We enrolled 3,471 registered nurses in a cross-sectional survey and obtained hospital characteristics from the 2018 American Hospital Association Annual Survey. We used mixed-effects linear regression models to estimate associations between hospital characteristics and staffing guideline adherence.

Findings: Overall, nurses reported strong adherence to AWHONN staffing guidelines (rated frequently or always met by ≥80% of respondents) in their hospitals. Higher birth volume, having a neonatal intensive care unit, teaching status, and higher percentage of births paid by Medicaid were all associated with lower mean guideline adherence scores.

Discussion and conclusions: Important gaps in staffing were reported more frequently at hospitals serving patients more likely to have medical or obstetric complications, leaving the most vulnerable patients at risk.

Keywords: High risk; Hospital; Hospitals; Hospitals, Teaching; Inpatients; Nursing staff; Obstetric nursing; Personnel staffing; Pregnancy; Workforce.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Sectional Studies
  • Female
  • Hospitals
  • Humans
  • Infant, Newborn
  • Nursing Staff, Hospital*
  • Personnel Staffing and Scheduling*
  • Pregnancy
  • Workforce