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Implementation of AWHONN 2010 Guidelines for Professional Registered Nurse Staffing for Perinatal Units - The Journey of a Level III Maternal/Newborn Unit in a Community Hospital Setting
Title: Implementation of AWHONN 2010 Guidelines for Professional Registered Nurse Staffing for Perinatal Units - The Journey of a Level III Maternal/Newborn Unit in a Community Hospital Setting
- Describe budgeted nursing hours per patient day (HPPD), and impact of trial on productive hours related to AWHONN staffing guidelines.
- Review patient satisfaction scores during trial of 1:3 nurse:couplet assignment according to AWHONN guidelines.
- Summarize the impact of implementation of AWHONN staffing guidelines on nurse satisfaction with patient assignment.
The maternal/newborn unit of a mid-sized community hospital with a Level III obstetric center desired to assess the impact on unit productivity with a trial of staffing assignments based on AWHONN 2010 staffing guidelines. A trial staffing grid was developed based on published guidelines. The purpose of the trial was chiefly to assess the affect of proposed changes on overall unit productivity based on hours per patient day (HPPD).
Proposed change:
The previously followed staffing grid allowed for a 1:4 nurse to couplet patient assignment. During a 6 week trial period, nurses followed a 1:3 nurse to couplet patient assignment to assess the overall impact on total unit productivity, as well focusing on time management for individual nursing staff related to overtime and nursing time over shift. Unit productivity statistics were posted for staff at 2 week intervals during the initial 6 week trial.
Implementation, outcomes and evaluation:
During the 6 week trial period, overall productivity was maintained within established budget for patient volume. Significant reductions were noted with regard to overtime and nursing time over shift. Serendipitous findings included marked improvements in patient satisfaction scores, as well as nursing satisfaction with 1:3 couplet assignment. Numerous nursing comments related favorably to improvements in patient care, patient education and overall nursing satisfaction with nursing care given and the nursing role. Due to the positive impact noted during the 6 week trial, the trial was extended for additional weeks.
Implications for nursing practice:
Application of AWHONN Guidelines for Professional Registered Nurse Staffing for Perinatal Units can be accomplished with overall improvement in individual nursing productivity with moderate effect on unit productivity for the maternal/newborn unit. Both patient and nursing satisfaction are significantly improved with implementation of 1:3 nurse to couplet assignment for the postpartum mother and baby. As follow up to the trial, the maternal/newborn nursing unit is working toward fully adopting 2010 AWHONN staffing guidelines.
Keywords:
Staffing guidelines, Hours per patient day, productivity, budget, patient satisfaction, nurse satisfaction.