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

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

Kathleen R Simpson  1 , Joanne Spetz  2 , Caryl L Gay  3 , Jason Fletcher  4 , Gay L Landstrom  5 , Audrey Lyndon  6
Affiliations

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

Kathleen R Simpson et al. Nurs Outlook. 2023 May-Jun.

Abstract

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.

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Conflict of interest statement

Conflicts of Interest: None to report.

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Figure 1.
Frequency of Guideline Adherence
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