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AWHONN Publishes New Staffing Guidelines for Perinatal Nursing Units

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) announced it has published new perinatal nurse staffing guidelines.

The Guidelines for Professional Registered Nurse Staffing for Perinatal Units promote patient safety and allow perinatal nurses to spend more time caring for mothers and their newborns, according to AWHONN, which adds the guidelines are endorsed by the National Association of Neonatal Nurses and the American College of Nurse Midwives.

AWHONN officials say the association introduced the new guidelines because those hospitals now use, first published in 1983, required an update to reflect the demands of providing nursing care in contemporary perinatal settings.   

According to AWHONN, in the past 27 years, perinatal patients and their care have changed in many important ways, including:

  • increases in labor inductions, preterm births and surgical births;
  • maternal and fetal assessments for women with more complicated pregnancies, e.g., women with diabetes, advanced maternal age and heart disease;
  • shorter hospital stays resulting in higher acuity of hospitalized mothers and babies;
  • the introduction of electronic health record systems demanding more of nurses' time; and  
  • increases in what nurses are required to document in health records.

Hence, the new, more comprehensive AWHONN guidelines describe the growing complexity of perinatal settings and address the implications for registered nurses' workloads. This is especially critical, AWHONN officials say, because mounting evidence suggests that increasing nurse-patient ratios is associated with improvements in patient outcomes, fewer deaths and complications, such as infection and bleeding, and a decrease in prolonged hospital stays. 

"Planning for appropriate nurse staffing is crucial to providing safe and effective care," said AWHONN's chief executive officer Karen Peddicord, PhD, RNC. "While these new guidelines are not mandates, they serve as a basis for planning, and help ensure that nurses will be able to spend more time with women in labor and new mothers in order to meet their health care needs and offer more personalized care."

Recommendations in the new guidelines, available for the purchase price of $49.95 at the association's website, include:

  • Nurses in labor and delivery units should have only one patient to care for if the woman is having her labor induced or chooses a low-tech birth without pain medication.
  • Nurses should have fewer new mothers and babies to care for than in the past.
  • Two nurses should attend every birth, vaginal or cesarean, one to attend the woman and one to attend the baby.

Also included in the new guidelines are:

  • 13 new classifications of antepartum, intrapartum and postpartum patients with accompanying recommendations for perinatal nurse staffing.
  • 6 recommendations updated from existing guidelines which call for decreasing the number of patients a nurse cares for in each instance.
  • New guidance for contingency planning and minimum staffing of low-volume perinatal care units.
  • Practice standards from professional organizations relevant to specific areas of perinatal patient care are cited as support for each recommendation in the guidelines. For example, AWHONN's post-anesthesia recovery recommendations are accompanied by the relevant practice standards from the American Society of PeriAnesthesia Nurses.

National News Archives
  Last Post: January 25, 2016 | View Comments(16)

Who is overseeing that these guidelines are being followed? More often than not, we the nurses are forced to manage one active laboring patient(on pitocin), plus a patient on magnesium sulfate for neural protection or pre-eclampsia. Despite of our protests, and assignment despite objections, the nurses are forced to manage the patients. This is unsafe nursing practice. There are many instances whereby, one nurse has two active laboring patients. This is as a result of poor staffing.

Ann D'Abreu,  RN,  Howard University HospitalJanuary 25, 2016
Hyattsville, MD

I have the most recent Guidelines for Professional RN Staffing for Perinatal Units in my hands. We have a Supplemental Staff LPN that in the past, has floated into mom/baby unit; I am looking for a guideline that specifies that a Level III OB unit should be staffed by all/100% RNs for direct patient care and accountability. Can someone direct me to a great reference?

Ruthie Watt,  Nurse Manager,  MSJCHSeptember 23, 2015
Marshfield, WI

Would like staffing ratios for level II nursery whose staff is required to attend all deliveries and complete that admission, care for late preterm infants on the floor below scan, complete all cardiac screenings at 24 hrs of age and assignment in the special care nursery. Also guidelines for ratios in caring for baby on cpap.

Sandy Heim,  Rn,  The Christ hospitalApril 22, 2015
Cincinnati, OH

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