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

https://doi.org/10.1111/j.1552-6909.2012.01383.xGet rights and content

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.

Section snippets

Design

This study was a secondary analysis of data from the AWHONN staffing survey. AWHONN members were invited by email to respond to an on‐line survey posted to the AWHONN website over a two week period from June 1 to June 15, 2010. The invitation to participate was included in the June 2010 issue of the monthly AWHONN electronic newletter AWHONN Vitals. The newsletter embedded in the email included a link to the survey for easy access by members. The survey included one open‐ended question to avoid

Results

Prevalent themes identified are listed in Table 1. A central theme across the data set of participant responses was the passion perinatal nurses felt for providing the safest and best care possible as well as the challenges of doing so under current staffing conditions. It was clear from the responses that nurses knew what type of care represented quality and met the needs of their patients but were frustrated that they could not always provide this level of care. Increased acuity and the

Discussion

Research regarding perinatal nurse staffing has been limited. There is great need for large scale studies linking perinatal nurse staffing to maternal and infant health outcomes. In the interim, these rich data from perinatal nurses in their own words demonstrate the ongoing challenges of providing safe and effective care that meets the myriad of needs of new mothers and babies within the context of staffing guidelines that had not been updated since 1983. There were numerous poignant comments

Conclusion

Participants overwhelmingly indicated that current nurse staffing guidelines were inadequate to meet the needs of contemporary perinatal clinical practice and required revision based on the significant changes that had occurred since 1983 when the original staffing guidelines were published. There was a general consensus that mothers and babies would be better served by ratios that included more nurses to fewer patients. Responses reflected nurses’ appreciation for being asked for their input

Acknowledgement

Dr. Lyndon is supported by NIH/NCRR/OD UCSF‐CTSI Grant Number KL2 RR024130. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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