Nurse-Reported Staffing Guidelines and Exclusive Breast Milk Feeding

Abstract

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.

Small Patients but a Heavy Lift

“…8,9 Missed nursing care associated with increased workload, such as missed adherence to infection prevention bundles, hourly intravenous (IV) assessments, and assistance with breastfeeding, is reported in both obstetrics and neonatal nursing and is associated with poorer outcomes and increased length of stay for NICU infants. [10][11][12] However, little is known about the effect of the workload of other clinicians in NICUs, such as nurse practitioners, physician assistants, and physicians, on infant outcomes or the specific factors contributing to clinician workload in the NICU. Previous workload research in the NICU has focused on bedside nursing care, and this study is novel in that it addresses workload specific to other clinicians in the NICU.…”

Effects of Nurse Staffing on Missed Breastfeeding Support in Maternity Units With Different Nurse Work Environments

“…1 Therefore, breastfeeding has been suggested as a nurse-sensitive quality indicator, a suggestion of how good the nursing care is in a hospital. 11 Unfortunately, nurses may miss providing breastfeeding care due to organizational constraints, which require them to ration care and attend to other clinical care tasks deemed a higher priority. 12 Missed nursing care, when nurses do not perform necessary care tasks, has been identified as a reflection of care quality.…”

“…13 Nurses' capacity to provide care is impacted by modifiable organizational factors, including staffing and the work environment. 7,11,[14][15][16] Staffing is defined as the number of patients assigned per nurse. Inadequate staffing, not having enough nurses to care for the patients on the unit, is associated with poor breastfeeding support and outcomes.…”

Linking Patient Safety Climate With Missed Nursing Care in Labor and Delivery Units: Findings From the LaborRNs Survey

“…31 Recent studies with labor nurses suggest that missed nursing care may be prevalent during labor and birth 32 and may be associated with structural indicators, nurse outcomes such as job satisfaction and burnout, 33,34 and birth outcomes such as exclusive breastfeeding rates. 29,35 In this study, we conceptualized patient safety climate as an aspect of structure and missed nursing care as an error of omission, both of which can be essential indicators of quality care. The goal of this analysis was to explore the relationship between nurse perceptions of patient safety climate and missed nursing care in L&D units.…”

“…Approximately 1178 women died of pregnancy-related complications in 2020, and a majority of deaths were preventable 31 . Recent studies with labor nurses suggest that missed nursing care may be prevalent during labor and birth 32 and may be associated with structural indicators, nurse outcomes such as job satisfaction and burnout, 33,34 and birth outcomes such as exclusive breastfeeding rates 29,35 …”