Research regarding perinatal nurse staffing has been limited. There is great need for large scale studies linking perinatal nurse staffing to maternal and infant health outcomes. In the interim, these rich data from perinatal nurses in their own words demonstrate the ongoing challenges of providing safe and effective care that meets the myriad of needs of new mothers and babies within the context of staffing guidelines that had not been updated since 1983. There were numerous poignant comments describing in detail the issues perinatal nurses confront on a routine basis related to inadequate staffing. The resilience revealed by the many participants in attempting to do their best in sometimes unfavorable conditions is a testament to their strength, perseverance, and commitment to quality nursing care and their patients. The general tone of the comments was not complaints, but rather practical, concrete and thoughtful suggestions supported by rationales regarding what aspects of the existing staffing guidelines needed revision.
The task force expected some of the themes that emerged from the dataset including the issue of one-to-one care for women in labor and the significant changes in patient acuity over the last three decades. Increases in intrapartum procedures (Martin et al., 2011
; Podulka, Stranges, & Steiner, 2011
) are well documented and the designation of oxytocin as a high alert medication by the Institute for Safe Medication Practices (2007)
has served to highlight safety requirements when using oxytocin during labor. Conditions complicating pregnancy and childbirth have also increased since the original staffing guidelines were published (Elixhauser & Wier, 2011
; Kuklina, Ayala, & Callaghan, 2009
; Martin et al., 2011
). However, the majority of the comments included some mention of the difficulties in caring for four or more mother-baby couplets with all of their clinical, emotional, breastfeeding and learning needs within the very short inpatient length of stay and the comprehensive, time-consuming nature of documenting this care. Much of the attention in the literature related to perinatal nursing has focused on intrapartum care. The real work of mother-baby care has sometimes been overlooked. This study documented the numerous responsibilities facing mother-baby nurses and the often lean resources devoted to postpartum women and their newborns.
Another aspect of nursing that has not well studied is the role of rural and small volume perinatal units in providing care to childbearing women and families who live far from hospitals offering perinatal services. These units may experience several days or even weeks without patients, but need to be staffed at all times with nurses skilled to care for any pregnant women who present for care. A number of participants specifically requested recommendations for minimal staffing in small volume units.
The toll of working with less than ideal numbers of nurses was noted by many of the participants. It was clear that nurses did not always feel they were able to meet all of the needs of their individual patients and they expressed the frustration with increased demands on their time unrelated to direct bedside care. While there are reports of nurse burn-out and dissatisfaction related to inadequate staffing in other nursing specialty areas (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002
; Garrett, 2008
; Leiter, & Spence Laschinger, 2006
), this issue had not been previously identified among perinatal nurses and must be successfully addressed to prevent experienced perinatal nurses from leaving the field.
Limitations of this analysis include inability to determine the nature and direction of any non-response bias, inability to follow-up on responses obtained in a survey format, and other limitations inherent in secondary data analysis. Perinatal nurses who did not respond may have different priorities and concerns regarding perinatal staffing ratios. However, non-response rates are less concerning when measurements or estimates of population characteristics are not being made (Archer, 2008
; Cook, Heath, & Thompson, 2000
), and the consistency of responses within a relatively large group of respondents lends credibility to the findings, as does the independent coding of themes by four analysts. Each participant potentially may have had different views as to what constituted quality care, however consistency of responses suggests they were quite similar for all aspects of perinatal nursing care that were described and included as concerns.