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Member Research and Reports

Minnesota: Obstetric Nurses in Rural Hospitals Often Work across Hospital Units

Rural hospitals in the U.S. face big challenges staffing their obstetric units with well-trained nurses due to tight budgets, employment competition with urban hospitals, and low birth volumes. A new study from the University of Minnesota School of Public Health shows that many rural hospitals are solving the problem through creative staffing approaches that take advantage of a nurse’s versatile talent and expertise.

“We found different models across rural hospitals — including some where nurses were shared across units when they aren’t actively supporting a birth or a woman and baby after delivery,” said study lead author Dr. Carrie Henning-Smith, research associate at the Rural Health Research Center


[Photo: Dr. Carrie Henning-Smith]

The study, which sought to describe the state of rural maternity nursing care, was co-authored by associate professor Dr. Katy Kozhimannil and published in the Journal of Obstetric, Gynecologic & Neonatal Nursing.

Among its various findings, the study revealed that nearly 80 percent of rural hospitals with low birth volume — less than 300 babies born there every year — staff their delivery units with nurses who are trained in obstetrics but work in other parts of the hospital until needed. The approach is also relatively popular in busier rural hospitals with 300 or more births a year, where more than 30 percent used cross-trained nurses to bolster obstetrics units.

While training nurses to work in obstetrics solves staffing problems, the study found it’s not without its own issues. Among them, hospitals reported that the approach can lead to scheduling problems — including difficulty replacing nurses who need time off or have to be pulled to work in the delivery unit; challenges training nurses across units so that they’re comfortable in multiple areas; and training nurses to be comfortable with obstetric care — especially in remote locations where they don’t deliver a lot of babies.

Dr. Henning-Smith said hospital administrators can use these findings to learn about different models and approaches to nurse staffing for obstetric units.

“Policymakers should also pay attention to the challenges faced by rural hospitals in maintaining a well-trained obstetric unit nursing staff as they think of ways to support rural hospital services,” said Dr. Henning-Smith

In particular, the researchers said policies should be focused on innovative solutions to recruiting and retaining nursing workforce in rural areas, and possibly training those nurses using technology and simulation models in hospitals with low birth volumes and infrequent opportunities for hands-on practice.

Dr. Henning-Smith and her colleagues are continuing to expand on their research and are currently writing a series of papers on rural obstetric unit closures.

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