In September 2015, the American Nurses Association (ANA, 2015) issued a white paper on nurse staffing in acute care hospitals Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes. Current literature is summarized and various improvements in patient outcomes associated with appropriate nurse staffing based on census and acuity are discussed in detail. These outcomes include decreases in: medical and medication errors, patient mortality, hospital readmissions, length of stay, patient falls, pressure ulcers, central line infections, healthcare-associated infections, and costs. Benefits to nurses include a reduction in nurse fatigue, and increases in nurse retention and job satisfaction. High-quality care depends on adequate numbers of well-educated experienced nurses consistent with the needs of the patients being served. Just as consumers can now check on various aspects and outcomes of hospitals and physicians they are considering, ANA recommends public reporting of staffing data to promote transparency and enhance well-informed consumer decision making.

As we all know, and ANA (2015) confirms, ideal staffing is much more than just numbers. Multiple factors should be part of staffing decisions. In perinatal nursing, staffing conditions are dynamic with patient status and patient census potentially changing dramatically within a very short time. Obstetric triage, antepartum, labor, birth, recovery, postpartum, and newborn care all have the possibility of immediately requiring intensive nurse staffing resources when maternal-fetal-newborn status deteriorates, multiple women present for care simultaneously, and/or many births occur within a short time. The number of women with high-risk pregnancies has increased over the years. For some pregnant women complex nursing care is essential; however, even normal healthy processes like labor and birth can be resource intensive because of their unpredictable nature and timing. The fetus must be considered as a distinct patient when assessing staffing needs. Any nurse who has ever cared for a woman in labor can attest to the significant medical record documentation about the fetus that is expected, along with various intrauterine resuscitation measures often needed. We were all new nurses once; we welcome nurses new to our specialty. However, accumulation of experience and mastering necessary skills take time, so these elements must be considered when determining nurse staffing needs. For example, the night shift cannot be staffed by all nurses who recently graduated. In small volume perinatal services, it may take longer to gain required experience.

All nurses should be aware of the evidence to date on nurse staffing. This ANA (2015) white paper is an excellent resource that summarizes what is known and gaps in knowledge. It's clear from the review that there is not enough information about staffing for perinatal units. Most of the data are about medical-surgical and intensive care units in acute care hospitals. The Association of Women's Health, Obstetric, and Neonatal Nurses is sponsoring an ongoing study on nurse staffing during labor and birth. Results will be available over the next several years and hopefully will provide much needed information to promote high-quality safe care for mothers and babies. In the meantime, nurses are encouraged to review the ANA white paper and keep up-to-date on the continuing evidence being published on nurse staffing. <

Reference