Extra, Extra, Read all About it! The Long Awaited AWHONN Perinatal Staffing Standards Release
Perinatal nurses across the country have been waiting for the release of the Standards for Professional Registered Nurse Staffing for Perinatal Units from the Association of Women’s Health Obstetric and Neonatal Nurse (AWHONN). Synvoa connected with AWHONN nurse leader Ms. Catherine M. Hill, MSN, APRN, FNP-BC, a former Neonatal Intensive Care Unit (NICU) nurse, obstetric nurse, educator and faculty at University of Massachusetts Medical Center, family nurse practitioner, and AWHONN staff member. Today at AWHONN, Catherine is the Senior Director of Nursing Education, Research, and Practice.
AWHONN convened The AWHONN Nurse Staffing Taskforce that was responsible for reviewing the perinatal staffing issues. In order to give the most accurate and comprehensive perspective, the group consisted of scientists, educators, researchers, and clinicians that worked tirelessly over three years to develop new perinatal staffing standards. These standards provide the best evidence to support safe and appropriate staffing standards. “AWHONN’s goal is to support organizations with conversations around the financials of safe staffing and why meeting these standards is best for the nurse, the organization, and the patient,” states Catherine.
Why Change from Guidelines to Standards?
AWHONN collected over 1800 member survey responses on what should be considered when revising the nurse staffing guidelines. The survey results were published in AWHONN’s journal Nursing for Women’s Health Volume 25. According to Ms. Hill, AWHONN made the decision early in the revision process to change the verbiage from guidelines to standards for two main reasons:
- AWHONN members who participated in the survey stated they wanted “standards.” Use of the word guideline seemed like a suggestion rather than a standard of care.
- The American Nurses Association (ANA) uses the terminology staffing standards in areas like Medical Surgical (MS), Emergency Department (ED), and Intensive Care Units (ICU). AWHONN wants to support leaders in safe staffing that is consistent with other areas/specialites.
This is the first time standards have been issued for staffing perinatal units. “In reviewing the literature I was surprised to learn that only one state has legislation around staffing perinatal units. Multiple states have staffing legislation for MS, ED, and ICU. We hope these standards provide support for changes across the country,” says Hill.
Staffing to Standards
The AWHONN Nurse Staffing Task Force held a summit to connect with government agencies, CEO’s of healthcare systems, CMS and other agencies to have buy-in to support funding around adequate perinatal staffing. It is important to note that the perinatal staffing ratios have not changed from previous staffing guidelines released in 2010. What has changed is the large amount of evidence showing that appropriate registered nurse-to-patient ratios lead to decreases in maternal and fetal mortality and morbidity, readmissions, and adverse events. This will be a key validation point for leaders as they advocate for safe staffing ratios within their departments and organizations.
It comes as no surprise that the cost of nursing labor is 25%-30% of a hospital’s budget. Recruiting and training new nurses also has a large price tag ranging from $30 – $50K per new nurse. Ms. Hill says, “If we can make nurses feel safe and feel healthy in their work environments, we will retain nurses and save money on recruiting and training. We began to experience a nursing shortage prior to COVID, so it is vital for institutions to promote a healthy and safe work environment to keep their nurses.”
Inpatient obstetrics is a high risk critical care unit where perinatal nurses do it all: triage, labor, scrub, circulate, recover, and transition babies to extrauterine life. “Hospitals need nurses who are able to function at this high level on any given day. And, there needs to be a mindset shift where an OB patient is really two patients and not just one. Postpartum care also has its unique challenges in that acuity for both mothers and babies has increased,” states Cathy.
Advice for Synova Leaders:
- Engage and include your risk management team in discussions around perinatal staffing standards. The evidence validates that safe staffing standards decrease malpractice cases and an organization’s liability due to poor outcomes. Often the cost of paying a claim is covered if standards are followed.
- Ratios have not changed even though the terminology has changed. Take the time to read the standards, thoroughly digest them, and understand the rationale behind the recommended staffing ratios. Effective leaders can use the information and evidence provided to build a case for safe staffing standards that high reliability organizations want to support.
- Leaders can use the tools in the Standards for Professional Registered Nurse Staffing for Perinatal Units to advocate for bedside nursing staff and encourage them to advocate for themselves. Perinatal nursing leaders should also advocate at the state and federal level to improve women’s health nationally. These standards provide the foundation for nurses to lead change that is focused on decreasing perinatal morbidity and mortality rates across our nation.
- Share the data with staffing decision makers on what it costs to lose nurses. Create innovative staffing plans to mobilize staff that can provide help on perinatal units. Cross train perinatal float nurses to support the dynamic nature of labor units.
Engage with AWHONN Staff
Join Synova at the AWHONN 2022 Convention this weekend to learn more about the AWHONN Staffing Task Force’s process. On Tuesday June 28, 2022 at 5:30 p.m., Dr. Cheryl Roth and other members of the task force will be hosting “AWHONN Staffing Standards Open Forum Panel Discussion” to answer questions around the staffing standards.
Visit with Catherine Hill at the 2022 Synova Perinatal Leadership Form in Naples, Florida. Don’t forget to register today!