Purpose for the program: Improve current nursing staffing plan thereby improving patient safety

Proposed change: Implementation of the recommended AWHONN staffing guidelines in a level-one family birth center.

Implementation, outcomes and evaluation: Implementation began with education of the charge nurses which included mandatory participation of the AWHONN webinar on the staffing guidelines. Monthly charge nurse committee meetings were dedicated to education and practicing different scenarios of the staffing plan based on the staffing guidelines. Secondly, a charge nurse sheet was created to include an audit tool to assist the charge nurse in identifying when there was a staffing variance in comparison to the staffing guidelines.  The charge nurse sheet provided a more accurate assessment of current staffing levels in four-hour increments and an opportunity to determine if staffing levels were appropriate for the next 4-hr increment.  Each charge nurse sheet was carefully reviewed by the charge nurse committee for learning opportunities. Lastly, initiation of the new staffing plan based on the AWHONN guidelines began November 2010, using a three-phase approach. Phase one implemented the Intrapartum aspect of staffing which was adjusted to accommodate laboring patients, cesarean births, and post-partum recovery for vaginal and cesarean deliveries. Phase two introduced the postpartum/Newborn care aspect of staffing which was adjusted to accommodate postpartum couplets and newborn care. Phase three was the implementation of the Antepartum/Charge Nurse Role change which was adjusted to accommodate triage patients and charge nurse availability. 

Transition to the recommended AWHONN staffing guidelines occurred with the following challenges having the biggest impact on staffing a) Failure to rescue as it relates to the perinatal team’s ability to gather resources required to decrease risk of adverse events in situations of obstetrical complications and emergencies;  b) Staff turnover as it affects staff morale due to the inability to spend time with patients, increased workload, and inability to meet the guidelines as recommended.

Implementation of the phases should have progressed over a longer period of time to ensure the educational component for the staff and the completion of one phase before concurrently moving on to the next.  LDRP staffing is unique for a level-one facility as all areas and all implemented phases affect one another. Careful analysis of data will provide justification for additional staff if needed as well as improvement of patient safety outcomes.

Implications for nursing practice: Appropriate staffing plans and careful monitoring of outcomes are needed to ensure patient safety

Keywords: AWHONN, staffing guidelines, patient safety, Challenges