Research
The Maternity Care Nurse Workforce in Rural U.S. Hospitals

https://doi.org/10.1016/j.jogn.2017.01.010Get rights and content

Abstract

Objective

To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce.

Design

Cross-sectional survey study.

Setting

Maternity care units within rural hospitals in nine U.S. states.

Participants

Maternity care unit managers.

Methods

We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals.

Results

Of the 263 hospitals, 51% were low volume (<300 annual births) and 49% were high volume (≥300 annual births). Among low-volume hospitals, 78% used a shared nurse staff model. In contrast, 31% of high-volume hospitals used a shared nurse staff model. Respondents praised the teamwork, dedication, and skill of their maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses.

Conclusion

Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals.

Section snippets

Methods

We used a quantitative and qualitative analysis of cross-sectional survey data to describe characteristics of the rural maternity care nursing workforce and identify key challenges and opportunities related to rural maternity care nurse staffing.

Nurse Staffing and Hospital Characteristics

Among rural hospitals with fewer than 300 births annually, more than three quarters of maternity care units shared nurses across other areas of the hospital (see Figure 1). Among rural hospitals with birth volumes of 300 or more annually, 69.4% had dedicated nurses in maternity care units, as did more than one fifth (21.8%) of small-volume (<300 births) hospitals. Differences in shared versus dedicated nurse staffing were significant at p < .001 within birth-volume categories.

Frequent

Discussion

We found that regardless of birth volume (< 300 vs. ≥300 annual births), a variety of nurse staffing models are used in rural U.S. hospitals; however, small-volume hospitals were more likely than large-volume hospitals to use a shared nurse staffing model. This indicates that rural maternity care unit leaders find a variety of ways to fill their staffing needs, and nursing experiences differ from hospital to hospital. We also found variation in clinician type and procedure use based on birth

Acknowledgment

Supported by the Office of Rural Health Policy, PHS grant number 5U1CRH03717. The authors thank Kristin DeArruda Wharton for her helpful feedback.

Carrie Henning-Smith, PhD, MSW, MPH, is a research associate in the Division of Health Policy and Management, School of Public Health, University of Minnesota Rural Health Research Center, Minneapolis, MN.

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    Carrie Henning-Smith, PhD, MSW, MPH, is a research associate in the Division of Health Policy and Management, School of Public Health, University of Minnesota Rural Health Research Center, Minneapolis, MN.

    Jennifer Almanza, BAN, RN, PHN, is a doctor of nursing practice student in the School of Nursing, University of Minnesota, Minneapolis, MN.

    Katy B. Kozhimannil, PhD, MPA, is an associate professor and Director of Research in the Division of Health Policy and Management, School of Public Health, University of Minnesota Rural Health Research Center, Minneapolis, MN.

    The authors report no conflicts of interest or relevant financial relationships.

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