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

Background: Evidence is limited on nurse staffing in maternity units. Purpose: To estimate the relationship between hospital characteristics and adher-ence 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 guide-lines (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 complica-tions, leaving the most vulnerable patients at risk.

Automated summary

This study aimed to examine the relationship between hospital characteristics and adherence to the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) nurse staffing guidelines. Findings showed that nurses generally had strong adherence to the guidelines in their hospitals. However, higher birth volume, having a neonatal intensive care unit, teaching status, and higher percentage of births paid by Medicaid were associated with lower adherence scores.