Midwifery and nurse staffing of inpatient maternity services – A systematic scoping review of associations with outcomes and quality of care

Turner, Lesley; Griffiths, Peter; Kitson-Reynolds, Ellen

doi:10.1016/j.midw.2021.103118

Cited by 21 publications

(13 citation statements)

References 47 publications

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“…This composite outcome included some postnatal measures such as length of stay and readmission rates. Overall, this is an under researched area as a recent scoping review found just three studies which related maternity support worker staffing levels with patient outcomes [ 52 ] Our research highlights the importance of examining and adjusting for the contribution of different staff groups. Analysis of results for registered staffing showed differing results before and after adjustment for covariates, including support worker staffing.…”

Section: Discussionmentioning

confidence: 99%

Exploring the relationship between women’s experience of postnatal care and reported staffing measures: An observational study

et al. 2022

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Background Women have reported dissatisfaction with care received on postnatal wards and this area has been highlighted for improvement. Studies have shown an association between midwifery staffing levels and postnatal care experiences, but so far, the influence of registered and support staff deployed in postnatal wards has not been studied. This work is timely as the number of support workers has increased in the workforce and there has been little research on skill mix to date. Methods Cross sectional secondary analysis including 13,264 women from 123 postnatal wards within 93 hospital Trusts. Staffing was measured in each organisation as Full Time Equivalent staff employed per 100 births, and on postnatal wards, using Hours Per Patient Day. Women’s experiences were assessed using four items from the 2019 national maternity survey. Multilevel logistic regression models were used to examine relationships and adjust for maternal age, parity, ethnicity, type of birth, and medical staff. Results Trusts with higher levels of midwifery staffing had higher rates of women reporting positive experiences of postnatal care. However, looking at staffing on postnatal wards, there was no evidence of an association between registered nurses and midwives hours per patient day and patient experience. Wards with higher levels of support worker staffing were associated with higher rates of women reporting they had help when they needed it and were treated with kindness and understanding. Conclusion The relationship between reported registered staffing levels on postnatal wards and women’s experience is uncertain. Further work should be carried out to examine why relationships observed using whole Trust staffing were not replicated closer to the patient, with reported postnatal ward staffing. It is possible that recorded staffing levels on postnatal wards do not actually reflect staff deployment if midwives are floated to cover delivery units. This study highlights the potential contribution of support workers in providing quality care on postnatal wards.

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Section: Discussionmentioning

confidence: 99%

Exploring the relationship between women’s experience of postnatal care and reported staffing measures: An observational study

et al. 2022

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“…[41] The consequences of understaffing are known in terms of poor care experiences, outcomes, morale and retention of staff. [5, 42] A common reason for midwives leaving the profession is that they are not able to give the quality of care that is needed, that staffing is unsafe or they are experiencing burnout. [43] There is sufficient evidence of associations between midwifery staffing levels and outcomes to infer that any increases in staffing levels guided by Birthrate Plus are likely to be associated with improved quality of care.…”

Section: Discussionmentioning

confidence: 99%

“…[43] There is sufficient evidence of associations between midwifery staffing levels and outcomes to infer that any increases in staffing levels guided by Birthrate Plus are likely to be associated with improved quality of care. [5] However, while there is evidence that Birthrate Plus has been widely applied, it is less clear whether its use has resulted in changes in staffing plans and whether changes have reduced staffing shortfalls. There is no evidence that the calculations produced by Birthrate Plus give the optimal staffing levels (irrespective of the criteria used) or perform better than other systems or professional judgement alone.…”

Section: Discussionmentioning

confidence: 99%

Evidence on the use of Birthrate Plus® to guide safe staffing in maternity services – a systematic scoping review

Griffiths,

Turner,

Lown

et al. 2023

Preprint

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Background : Birthrate Plus® is a widely used tool that informs decisions about the number of midwifery staff needed to provide safe and high quality care in maternity services. Evidence about the effectiveness, validity, reliability, and feasibility of tools such as this is needed. Objective : To identify, describe and analyse the available evidence supporting the use of Birthrate Plus. Methods: We searched PubMed, Medline, CINAHL, Google Scholar, Scopus, Academic Search, British Library Ethos, Directory of Open Access Journals and Science Direct. Studies were eligible if they reported empirical data relevant to the validity, reliability, or useability of Birthrate Plus or if they measured the impact on staffing levels, outcomes, costs or provided a comparison with other methods. Results: 23 sources of evidence were identified and reviewed. We found no prospective intervention studies on the use of Birthrate Plus to demonstrate outcomes for mothers, babies or staff wellbeing. Nor did we find studies comparing the tool to other methods or addressing resource use. Most of the evidence was descriptive, focussing on the use of the tool or the results of Birthrate Plus assessments. There is some evidence of the reliability of application of categories within the tool, the ability of the tool to detect variation in demand and to highlight staff shortages. Conclusions: In terms of traditional hierarchies of evidence, the evidence for Birthrate Plus is weak. There is a need for more independent research or simulation using real world data to understand how the tool performs in the current context of midwifery practice.

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“…Several studies have identified nurse-sensitive outcomes for NICU (Hallowell et al, 2016; Tawfik et al, 2020; Tubbs-Cooley et al, 2015). However, our study is one of few that has tested the relationship of any measure of RN staffing during labor, birth, and the immediate postpartum period with patient outcomes, and those who have tested these relationships have had mixed results (Simpson et al, 2020; Turner et al, 2021; Wilson & Butler, 2021). Hence, our results represent a step toward developing nurse-sensitive outcome indicators specific to maternity care.…”

Section: Discussionmentioning

confidence: 99%

Nurse-Reported Staffing Guidelines and Exclusive Breast Milk Feeding

et al. 2022

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BackgroundNursing care is essential to overall quality of healthcare experienced by patients and families—especially during childbearing. However, evidence regarding quality of nursing care during labor and birth is lacking, and established nurse-sensitive outcome indicators have limited applicability to maternity care. Nurse-sensitive outcomes need to be established for maternity care, and prior research suggests that the initiation of human milk feeding during childbirth hospitalization is a potentially nurse-sensitive outcome.ObjectiveThe aim of this study was to determine the relationship between nurse-reported staffing, missed nursing care during labor and birth, and exclusive breast milk feeding during childbirth hospitalization as a nurse-sensitive outcome.Methods2018 Joint Commission PC-05 Exclusive Breast Milk Feeding rates were linked to survey data from labor nurses who worked in a selected sample of hospitals with both PC-05 data and valid 2018 American Hospital Association Annual Survey data. Nurse-reported staffing was measured as the perceived compliance with Association of Women’s Health, Obstetric and Neonatal Nurses staffing guidelines by the labor and delivery unit. Data from the nurse survey were aggregated to the hospital level. Bivariate linear regression was used to determine associations between nurse and hospital characteristics and exclusive breast milk feeding rates. Generalized structural equation modeling was used to model relationships between nurse-reported staffing, nurse-reported missed care, and exclusive breast milk feeding at the hospital level.ResultsThe sample included 184 hospitals in 29 states and 2,691 labor nurses who worked day, night, or evening shifts. Bivariate analyses demonstrated a positive association between nurse-reported staffing and exclusive breast milk feeding and a negative association between missed nursing care and exclusive breast milk feeding. In structural equation models controlling for covariates, missed skin-to-skin mother–baby care and missed breastfeeding within 1 hour of birth mediated the relationship between nurse-reported staffing and exclusive breast milk feeding rates.DiscussionThis study provides evidence that hospitals’ nurse-reported compliance with Association of Women’s Health, Obstetric and Neonatal Nurses staffing guidelines predicts hospital-exclusive breast milk feeding rates and that the rates are a nurse-sensitive outcome.

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Midwifery and nurse staffing of inpatient maternity services – A systematic scoping review of associations with outcomes and quality of care

Cited by 21 publications

References 47 publications

Exploring the relationship between women’s experience of postnatal care and reported staffing measures: An observational study

Exploring the relationship between women’s experience of postnatal care and reported staffing measures: An observational study

Evidence on the use of Birthrate Plus® to guide safe staffing in maternity services – a systematic scoping review

Nurse-Reported Staffing Guidelines and Exclusive Breast Milk Feeding

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