Midwifery and nurse staffing of inpatient maternity services – a systematic scoping review of associations with outcomes and quality of care
Midwifery and nurse staffing of inpatient maternity services – a systematic scoping review of associations with outcomes and quality of care
Objective: to undertake a scoping literature review of studies examining the quantitative association between staffing levels and outcomes for mothers, neonates, and staff. The purpose was to understand the strength of the available evidence, the direction of effects, and to highlight gaps for future research.
Data sources: systematic searches were conducted in Medline (Ovid), Embase (Ovid), CINAHL (EBCSCO), Cochrane Library, TRIP, Web of Science and Scopus.
Study selection and review methods: to be eligible, staffing levels had to be quantified for in-patient settings, such as ante-natal, labour/delivery or post-natal care. Staff groups included midwives, nurse midwives or equivalent, and assistant staff working under the supervision of professionals. Studies of the quality of care, patient outcomes and staff outcomes were included from all countries. All quantitative designs were included, including controlled trials, time series, cross-sectional, cohort studies and case controlled studies. Data were extracted and sources of bias identified by considering the study design, measurement of exposure and outcomes, and risk adjustment. Studies were grouped by outcome noting the direction and significance of effects.
Results: the search yielded a total of 3280 records and 21 studies were included in this review originating from ten countries. There were three randomised controlled trials, eleven cohort studies, one case control study and six cross sectional studies. Seventeen were multicentre studies and nine of them had over 30,000 participants. Reduced incidence of epidural use, augmentation, perineal damage at birth, postpartum haemorrhage, maternal readmission, and neonatal resuscitation were associated with increased midwifery staff. Few studies have suggested a negative impact of increasing staffing rates, although a number of studies have found no significant differences in outcomes. Impact on the mode of birth was unclear. Increasing midwifery assistants was not associated with improved patient outcomes. No studies were found on the impact of low staffing levels for the midwifery workforce.
Conclusions and implications for practice: although there is some evidence that higher midwifery staffing is associated with improved outcomes, current research is insufficient to inform service planning. Studies mainly reported outcomes relating to labour, highlighting a gap in research evidence for the antenatal and postnatal periods. Further studies are needed to assess the costs and consequences of variations in maternity staffing, including the deployment of maternity assistants and other staff groups.
Midwife, Nurse, Patient safety, Staffing, Workforce planning, Workload
Turner, Lesley
7c4a1fe5-21a1-4634-a1cc-0230322603d1
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Kitson-Reynolds, Ellen
fb705ade-b899-40c9-9a48-6f44fee9d385
14 August 2021
Turner, Lesley
7c4a1fe5-21a1-4634-a1cc-0230322603d1
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Kitson-Reynolds, Ellen
fb705ade-b899-40c9-9a48-6f44fee9d385
Turner, Lesley, Griffiths, Peter and Kitson-Reynolds, Ellen
(2021)
Midwifery and nurse staffing of inpatient maternity services – a systematic scoping review of associations with outcomes and quality of care.
Midwifery, 103, [103118].
(doi:10.1016/j.midw.2021.103118).
Abstract
Objective: to undertake a scoping literature review of studies examining the quantitative association between staffing levels and outcomes for mothers, neonates, and staff. The purpose was to understand the strength of the available evidence, the direction of effects, and to highlight gaps for future research.
Data sources: systematic searches were conducted in Medline (Ovid), Embase (Ovid), CINAHL (EBCSCO), Cochrane Library, TRIP, Web of Science and Scopus.
Study selection and review methods: to be eligible, staffing levels had to be quantified for in-patient settings, such as ante-natal, labour/delivery or post-natal care. Staff groups included midwives, nurse midwives or equivalent, and assistant staff working under the supervision of professionals. Studies of the quality of care, patient outcomes and staff outcomes were included from all countries. All quantitative designs were included, including controlled trials, time series, cross-sectional, cohort studies and case controlled studies. Data were extracted and sources of bias identified by considering the study design, measurement of exposure and outcomes, and risk adjustment. Studies were grouped by outcome noting the direction and significance of effects.
Results: the search yielded a total of 3280 records and 21 studies were included in this review originating from ten countries. There were three randomised controlled trials, eleven cohort studies, one case control study and six cross sectional studies. Seventeen were multicentre studies and nine of them had over 30,000 participants. Reduced incidence of epidural use, augmentation, perineal damage at birth, postpartum haemorrhage, maternal readmission, and neonatal resuscitation were associated with increased midwifery staff. Few studies have suggested a negative impact of increasing staffing rates, although a number of studies have found no significant differences in outcomes. Impact on the mode of birth was unclear. Increasing midwifery assistants was not associated with improved patient outcomes. No studies were found on the impact of low staffing levels for the midwifery workforce.
Conclusions and implications for practice: although there is some evidence that higher midwifery staffing is associated with improved outcomes, current research is insufficient to inform service planning. Studies mainly reported outcomes relating to labour, highlighting a gap in research evidence for the antenatal and postnatal periods. Further studies are needed to assess the costs and consequences of variations in maternity staffing, including the deployment of maternity assistants and other staff groups.
Text
Midwifery and nurse staffing of inpatient maternity services
- Accepted Manuscript
More information
Accepted/In Press date: 29 July 2021
e-pub ahead of print date: 14 August 2021
Published date: 14 August 2021
Additional Information:
Funding Information: Peter Griffiths receives support from a Senior Investigator award made by the National Institute for Health Research and the National Institute for Health Research Applied Research Centre (Wessex). This research was part funded by the National Institute for Health Research's Health Services & Delivery Research programme (Award ID: NIHR128056).
Keywords:
Midwife, Nurse, Patient safety, Staffing, Workforce planning, Workload
Identifiers
Local EPrints ID: 451290
URI: http://eprints.soton.ac.uk/id/eprint/451290
ISSN: 0266-6138
PURE UUID: 592bdced-b059-4074-8cfd-6a8e0b75dac0
Catalogue record
Date deposited: 17 Sep 2021 16:30
Last modified: 17 Mar 2024 06:48
Export record
Altmetrics
Contributors
Author:
Ellen Kitson-Reynolds
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics