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September 14, 2012

Staffing For Mother/Baby Success

As of this year, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) published new perinatal nurse staffing guidelines in an effort to uphold patient well-being and permit these nurses to dedicate more time to patient care.  With endorsement from other major healthcare organizations, the updated guidelines reflect the difficulties of delivering perinatal care in current hospital settings. While these new guidelines are not mandated, they function as a foundation for scheduling, allowing nurses to offer more personalized care to women in labor and delivery. 

In this offering of Off the Shelf  we outline the new guidelines and offer tips for managing your department under them.

Overview of the New Guidelines
Managing to the New Guidelines

Reason for Changes

According to AWHONN, perinatal patients and the way nurses care for them have undergone numerous changes over the last 27 years, including:

  • More labor inductions, preterm and surgical births, and maternal and fetal assessments for patients with difficult pregnancies
  • Shorter hospital stays
  • Introduction of EHR systems and increased documentation requirements
Overview of the New Guidelines

The reason to update the staffing guidelines came about after evidence indicated higher nurse staffing correlated with better patient outcomes, fewer complications and deaths, and shorter inpatient stays in Maternal/Child. The newer, more all-inclusive AWHONN guidelines define the increasing complexity of the perinatal environment and address the effects on the RN's capability.  Suggestions in the modernized guidelines include (full guidelines are available at the AWHONN website):

  • Nurses should have fewer new mothers and babies to care for than in the past
  • Nurses in L & D units should have only one patient to care for if the woman is having her labor induced or chooses a low-tech birth without pain medication
  • Two nurses should attend every birth, vaginal or cesarean, one for the mother and another for the baby
Managing to the New Guidelines

How to cope with/meet the new AWHONN guidelines:

  • Calculate required FTEs per category of care based on recommended staffing standards
    • OB Triage, LDR care, percent of C/S, staffing during operative case and post-op recovery for at least two hours, M-B Couplet Care, etc.; historical productivity targets for these areas may not be adequate to meet the new standards
  • Analyze volume activity by time of day and day of week, to be able to prospectively provide extra staffing on select days of week or times of the day for L&D and postpartum
  • Place more strict limits on the number of scheduled procedures and have scheduled times for inductions and C/S throughout the day to more effectively manage staffing resources, for example, inductions at 0600, 1100, 1500 and C/S at 0700, 1000, 1300
  • Provide for a "surge" staffing plan - particularly for L&D; call staff should be utilized for unexpected patient volume surge rather than automatic coverage for staff "sick" calls or high volume of "elective" scheduled procedures
  • Monitor and address unscheduled staff absences, as some departments that have historically not addressed this find their on-call staff is constantly consumed by being essential staff coverage

Whether your facility manages perinatal services in a demanding, metropolitan institution or a smaller, rural hospital, you must have knowledge of the national guidelines for staffing if your perinatal nurses are going to successfully meet the needs of the families they serve.

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