An Update on Research Issues in the Assessment of Birth Settings Workshop Summary (2013) / Chapter Skim
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5 Workforce Issues
5 Workforce Issues
Pages 77-92
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From page 77... ...
birth setting workforce, including its changing supply and demand, varying educational backgrounds of different types of care providers, varying regulations for different types of providers, the role of care teams, and future research needs. 1 his T section summarizes information presented by Catherine Dower, J.D., University of California, San Francisco.
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From page 78... ...
• ccording to Debra Bingham, registered nurses (RNs) have played an in A creasingly important role in birth settings because of the many intervention and outcome changes that have occurred over the past few decades, most notably dramatic increases in Cesarean deliveries, severe maternal morbidity, and women receiving blood transfusions during hospital birth admissions.
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From page 79... ...
Dower had to contact colleagues from multiple organizations and, as she said, "pull all those pieces together." Not only are the data difficult to collect, but they are not standardized, making it very difficult to compare estimates across the various health professions. In terms of workforce demand, there has been a fairly steady and predictable need for birth setting professionals.
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From page 80... ...
Dower emphasized that all four professions -- MDs, CNMs, CPMs, and CMs -- share some of the same challenges. These include finding sites for clinical training, particularly sites outside of hospital settings; providing interprofessional education; providing evidence-based preparation (i.e., entering evidence into the curricula and training professionals based on that evidence)
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From page 81... ...
Thus, the impact of real teamwork is unknown. It is not clear how many of each type of provider are needed in each care setting; how real team care impacts provision of care and patient outcomes; how real teamwork impacts educational programs; and how real teamwork impacts cost.
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From page 82... ...
PERINATAL RN STAFFING IN BIRTH SETTINGS2 Representing the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) , Debra Bingham spoke about the importance of measuring and tracking perinatal RN staffing, what is known about trends in perinatal RN staffing, and the need for more research on perinatal RN staffing.
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From page 83... ...
Bingham noted that it is not clear whether women giving birth in nonhospital birth settings by non-RNs are missing important nursing interventions. Research on Perinatal RN Staffing and Outcomes "Unfortunately," Bingham said, "there has been very limited curiosity in the effect of nursing staff on birth settings and birth outcomes." There have been only a few studies, including one on the impact of nursing staff ratios on survival and outcomes for low-birth-weight and preterm infants (Hamilton et al., 2007)
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From page 84... ...
Bingham has witnessed transitions involving women transferring into the hospital setting from a home birth not going as smoothly as they should. She said, "I think there's a very important role for understanding those transitions and making them more effective." Based on the premise that the core, or essence, of nursing work is caring relationships, AWHONN is currently conducting a study on the effect of nurse staffing on a range of nurse-sensitive processes and outcomes and is developing nursing care quality measures (AWHONN, 2013)
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From page 85... ...
Summary of Key Points In summary, nurse staffing and nurses' education have been shown to affect patient outcomes, and the number of interventions performed and patient population characteristics have been shown to affect nurse staffing. However, there are limited data on perinatal staffing patterns and on the qualifications of perinatal nurses who provide care to women and newborns in the United States.
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From page 86... ...
• The current education system for maternity care providers tends to reinforce barriers to working collaboratively and is disparate in terms of resources devoted to different groups of providers. 4 his T section summarizes information presented by Susan R
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From page 87... ...
• What are the cost and outcome implications for new models of care that rely on perinatal teams providing collaborative care (e.g., the types of models mentioned by Catherine Dower)
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From page 88... ...
DISCUSSION WITH THE AUDIENCE5 Following the panel discussion on workforce research issues, the floor was opened to comments and questions from the audience. Workshop attendees touched on a range of research topics: collaborative care and teamwork, single-room maternity care, home births and nursing, pain relief and nurse staffing, rural maternity care, workforce diversity, and national trends.
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From page 89... ...
In addition to encouraging the consideration of non-physician-centric team leader models, Dower also encouraged thinking of teams "more expansively." She envisioned teams composed of a variety of professionals, from midwives and doulas to mental health professionals and community health workers, each being called on at a different point during the pregnancy -- teamwork that involves "many more touches with the health care system, but much shorter touches." Single-Room Maternity Care There was a suggestion that more research be done on single-room maternity care and its impact on safety, cost, patient satisfaction, and other outcomes. Not unlike the merged step-down units mentioned earlier in the workshop by Esther Sternberg, single-room maternity units staffed by crosstrained nurses (i.e., with staff not divided between labor and delivery)
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From page 90... ...
Likewise, it is unclear whether there are things being done in hospital settings that should not be replicated in a home birth setting. Another audience member asserted that evidence-based nursing care is already being provided in the home birth setting and that, in fact, nursing students would become much better nurses if they were to spend some time in those settings during their training.
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From page 91... ...
While the issue is on several organizations' "radar screens," she was unaware of any research being conducted to determine why or initiatives under way to change the situation for maternity care workforce specifically. A Need for National Trend Data It was mentioned that the seven midwifery organizations in the United States responsible for accreditation and certification are currently working together to resolve confusion around the numbers of the various professionals who provide maternal care and the need to gain a better understanding of those trends at a national level.
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