The United States has one of the highest maternal mortality rates in the developed world, and most of these maternal deaths are preventable. Prior studies have shown that hospital staffing significantly influences patient outcomes in other clinical areas, and nursing resources (work environment, staffing, education, specialty certification) may be an important contributor. But little is known about the context in which nurses work on maternity units.

In our recent study in the Journal of Obstetric, Gynecological, and Neonatal Nursing, we examined differences in nursing resources across three different types of maternity units in five regions of the United States. We used the 2016 National Database of Nursing Quality Indicator (NDNQI) survey representing nearly 20,000 nurses who worked in 707 maternity units in 444 hospitals. Our study included nurses working in labor and delivery units, combined labor/delivery and postpartum (LDRP) units, and postpartum units.

We found that the work environment—meaning teamwork, resources, and managerial support—did not vary much across unit types. However, staffing, education, and specialty certification did vary significantly. Notably, most maternity units did not meet staffing guidelines, and staffing was poorest in units in the Southeast. Postpartum units had the worst staffing.

The wide variations in staffing levels suggest that increasing nursing resources may be a system-level target for improving maternity care and outcomes in the United States. In maternity care, one-to-one nursing care is associated with improved birth outcomes. Other research has linked inadequate staffing with more missed care, a problem that is connected to a higher risk of cesarean birth and hemorrhage, poor patient satisfaction, and difficulties establishing breastfeeding, among other issues.

Staffing was but one aspect of work environment that we examined however, improvements in maternal care are sorely needed given the poor U.S. maternal mortality rates. More than half of maternal deaths occur either on the day of delivery or within the first 6 weeks after giving birth. If nurse staffing in maternal units can improve outcomes, hospitals need to find ways to better meet staffing guidelines.

The study, Nursing Resources by Type of Maternity Unit Across Regions of the United States, was published in the Journal of Obstetric, Gynecologic and Neonatal Nursing on March 10, 2022. Authors include Rebecca R.S. Clark, Morgan E Peele, and Eileen T. Lake.


Rebecca Clark

Rebecca R.S. Clark, PhD, RN

Assistant Professor, Family and Community Nursing, Penn Nursing

Eileen Lake

Eileen Lake, PhD, RN

Jessie M. Scott Endowed Term Chair, Professor of Nursing and Health Policy, Penn Nursing; Professor, Sociology, School of Arts and Sciences; Associate Director, Center for Health Outcomes and Policy, Penn Nursing

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