In hospital maternity departments that care for high-risk patients, nurse-to-patient ratios are not always consistent with national nurse staffing standards.
Labor, delivery and recovery units at hospitals that are more likely to care for women at higher risk for complications are less likely to be staffed with enough nurses as compared to hospitals with lower-risk maternity patients, according to a study published in Nursing Outlook's May-June 2023 issue.
The study suggests the understaffed maternity wards may be a factor contributing to poor U.S. maternal health outcomes for vulnerable populations, including Black mothers and people insured by Medicaid.
Guidelines issued by the Association of Women's Health, Obstetric and Neonatal Nurses require one nurse to one woman in labor, two nurses during delivery and one nurse for mother and baby in the first few hours after delivery. One-to-one ratios are required for fetal heart rate monitoring, oxytocin administration and for patients with high-risk conditions.
"Patients at risk for serious maternal complications are particularly vulnerable and are likely to need more intensive nursing care based on their medical and psychosocial circumstances," Audrey Lyndon, PhD, RN, assistant dean for clinical research at New York City-based NYU Rory Meyers College of Nursing and Vernice D. Ferguson Professor in Health Equity, said in a March 31 New York University press release.
NYU researchers surveyed close to 3,500 registered nurses who work in 271 hospitals in the U.S. asking about levels of nurse staffing in maternity units at their hospitals as compared with the AWHONN guidelines.
The study revealed that while most hospitals reported high adherence to the guidelines overall, there were gaps in nursing coverage for high-risk maternity patients, fetal heart rate monitoring and oxytocin administration. The study also showed that teaching hospitals and hospitals with higher birth volumes, neonatal intensive care units and higher numbers of Medicaid beneficiaries had lower levels of adherence to the staffing guidelines, which disproportionately affects high-risk patients, who are more likely to deliver at these hospitals.
"These gaps in staffing are particularly troubling for our most at-risk patients," said Dr. Lyndon. "Many maternal complications can be prevented or quickly addressed through timely recognition of risk factors and clinical warning signs, and, when issues are identified, the escalation of care and coordination with the care team — but this is only possible when there are enough nurses monitoring patients."