In June 2022, the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) released updated nurse staffing standards for hospitalized patients over the childbirth continuum and for babies in the neonatal intensive care unit (NICU). Since the first edition was published in 2010, there has been a substantial amount of new evidence published linking nurse staffing with inpatient outcomes including morbidity, failure to rescue, and mortality as well as nurse outcomes such as satisfaction, burnout, retention, and a healthy work environment (AWHONN, 2022). The new nurse staffing standards (AWHONN, 2022) build on the original nurse staffing standards published by the American Academy of Pediatricians and the American College of Obstetricians and Gynecologists in the Guidelines for Perinatal Care in 1983 and each subsequent edition up to 2007.
As the practice of perinatal nursing has changed over the years, so have the nurse staffing standards to include more types of patients and types of clinical situations than were initially outlined by our physician colleagues. Each standard nurse-to-patient ratio was reviewed based on acuity (amount of nursing effort required for safe, high-quality nursing care), workload, supportive evidence, and associated standards and guidelines from other professional and regulatory agencies and organizations. AWHONN convened a task force of nurse experts in 2019 to conduct this review. They included staff nurses, nurse leaders, a nurse executive, a maternity nurse informatics specialist, and nurse researchers who have been studying nurse staffing in the inpatient maternity setting. The COVID-19 pandemic delayed the process. More than 1,800 AWHONN members responded to an online survey asking for their input on what to include in the updated document (Simpson et al., 2021). These data informed the standards and resulted in the addition of eight appendices to assist with implementation as well as how to frame budgetary support for enough nurses to provide care consistent with the standard nurse-to-patient ratios.
The standard nurse-to-patient ratios remain the same except for a minor change for units that do not assign the same nurse to a mother-baby couplet, rather assign separate nurses for mothers and nurses for newborn babies. The evidence and clarification for each standard nurse-to-patient ratio were significantly enhanced and expanded, for example, greater detail was offered for patients with high-risk medical or obstetric conditions, for various types of patients in labor, for the 2-hour immediate postpartum period, for mother-baby care, and for babies in the NICU. A section on contingency planning, staffing during disasters and events such as the COVID-19 pandemic was added.
Please review the AWHONN (2022) staffing standards in detail and make sure your nurse leaders have a copy if they are not AWHONN members. It is important to reinforce that the document provides more evidence and rationale, but the nurse-to-patient ratios are essentially unchanged. Some executives have called for time to implement the "new" staffing standards, but they are not new, rather accompanied by more supportive evidence and implementation tools. Safe, high-quality perinatal nursing care is predicated on evidence-based standards. All those who give birth, and their babies deserve this level of care.
References