Implementation of AWHONN 2010 Guidelines for Professional Registered Nurse Staffing for Perinatal Units—The Journey of a Level III Maternal/Newborn Unit in a Community Hospital Setting


Paper Presentation

Purpose for the Program

With a trial of staffing assignments, based on the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) 2010 staffing guidelines, the maternal–newborn unit of a mid-sized community hospital (with a level III obstetric center) desired to assess the effect of the trial on unit productivity. A trial staffing grid was developed based on published guidelines. The purpose of the trial was chiefly to assess the effect of the proposed changes on the overall unit productivity, which was based on hours per patient day.

Proposed Change

The previously followed staffing grid allowed for a 1:4 nurse to couplet patient assignment. During a 6-week trial period, nurses followed a 1:3 nurse to couplet patient assignment to assess the overall effect of the trial on total unit productivity and focus on time management related to individual nursing staff overtime. Unit productivity statistics were posted for staff at 2-week intervals during the initial 6-week trial.

Implementation, Outcomes, and Evaluation

During the 6-week trial period, overall productivity was maintained within the established budget for patient volume. Significant reductions were noted with regard to overtime. Findings included marked improvements in patient satisfaction scores and nurse satisfaction with a 1:3 nurse to couplet assignment. Numerous nursing comments related favorably to improvements in patient care and patient education, and overall satisfaction with the care provided by nurses and the nursing role. Because of the positive effect noted during the 6-week trial, the trial was extended for additional weeks.

Implications for Nursing Practice

The application of AWHONN's Guidelines for Professional Registered Nurse Staffing for Perinatal Units can be accomplished with overall improvement in individual nursing productivity and a moderate effect on unit productivity for the maternal–newborn unit. Both patient and nursing satisfaction are significantly improved with the implementation of a 1:3 nurse to couplet assignment for the postpartum mother and newborn. As follow-up to the trial, the maternal–newborn nursing unit is working toward fully adopting the 2010 AWHONN staffing guidelines.