Adherence to the to Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) Staffing Guidelines as Perceived by Labor Nurses


Kathleen Rice Simpson, Audrey Lyndon, Joanne Spetz, Caryl L. Gay, and Gay L. Landstrom.

May 2, 2019

The objective of this study was to evaluate the degree to which registered nurses perceive their labor and delivery units to be adhering to Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) staffing guidelines. In late 2016 and early 2017, labor nurses in selected hospitals in California, Michigan, and New Jersey were contacted via e-mail invitation to participate in a study about nursing care during labor and birth. Nurse leaders in each hospital facilitated the invitations. A total of 615 labor nurses from 67 hospitals were surveyed.

Most nurses reported that the AWHONN nurse staffing guidelines were frequently or always followed in all aspects of care surveyed. Hospitals with annual birth volumes of 500 to 999 range were significantly more likely than hospitals with 2,500 or more annual births to be perceived as compliant with AWHONN staffing guidelines.

When the AWHONN staffing guidelines were first published in 2010, there was concern among some nurse leaders that they would not be adopted into clinical practice, yet nurses in our sample overwhelmingly perceived their hospitals to be guideline compliant. There remains much more work to be done to determine nurse-sensitive outcomes for maternity care and to ensure that all women in labor in the United States are cared for by nurses who are not overburdened or distracted by being assigned more women than can be safely handled.