Linking Patient Safety Climate With Missed Nursing Care in Labor and Delivery Units: Findings From the LaborRNs Survey.

OBJECTIVE: This study aimed to explore the association of nurses' perceptions of patient safety climate with missed nursing care in labor and delivery (L&D) units. METHODS: We recruited nurse respondents via email distribution of an electronic survey between February 2018 and July 2019. Hospitals with L&D units were recruited from states with projected availability of 2018 state inpatient data in the United States. Measures included the Safety Attitudes Questionnaire Safety Climate Subscale and the Perinatal Missed Care Survey. We estimated the relationship between safety climate and missed care using Kruskal-Wallis tests and mixed-effects linear regression. RESULTS: The analytic sample included 3429 L&D registered nurses from 253 hospitals (response rate, 35%). A majority of respondents (65.7%) reported a perception of good safety climate in their units, with a mean score of 4.12 (±0.73) out of 5. The mean number of aspects of care occasionally, frequently, or always missed on respondents' units was 11.04 (±6.99) out of 25. χ2 Tests showed that six mostly commonly missed aspects of care (e.g., timely documentation) and three reasons for missed care (communications, material resources, and labor resources) were associated with safety climate groups ( P < 0.001). The adjusted mixed-effects model identified a significant association between better nurse-perceived safety climate and less missed care ( ß = -2.65; 95% confidence interval, -2.97 to -2.34; P < 0.001) after controlling for years of experience and highest nursing education. CONCLUSIONS: Our findings suggest that improving safety climate-for example, through better teamwork and communication-may improve nursing care quality during labor and birth through decreasing missed nursing care. Conversely, it is also possible that strategies to reduce missed care-such as staffing improvements-may improve safety climate.

Nurse-Reported Staffing Guidelines and Exclusive Breast Milk Feeding.

BACKGROUND: Nursing care is essential to overall quality of healthcare experienced by patients and families-especially during childbearing. However, evidence regarding quality of nursing care during labor and birth is lacking, and established nurse-sensitive outcome indicators have limited applicability to maternity care. Nurse-sensitive outcomes need to be established for maternity care, and prior research suggests that the initiation of human milk feeding during childbirth hospitalization is a potentially nurse-sensitive outcome. OBJECTIVE: The aim of this study was to determine the relationship between nurse-reported staffing, missed nursing care during labor and birth, and exclusive breast milk feeding during childbirth hospitalization as a nurse-sensitive outcome. METHODS: 2018 Joint Commission PC-05 Exclusive Breast Milk Feeding rates were linked to survey data from labor nurses who worked in a selected sample of hospitals with both PC-05 data and valid 2018 American Hospital Association Annual Survey data. Nurse-reported staffing was measured as the perceived compliance with Association of Women's Health, Obstetric and Neonatal Nurses staffing guidelines by the labor and delivery unit. Data from the nurse survey were aggregated to the hospital level. Bivariate linear regression was used to determine associations between nurse and hospital characteristics and exclusive breast milk feeding rates. Generalized structural equation modeling was used to model relationships between nurse-reported staffing, nurse-reported missed care, and exclusive breast milk feeding at the hospital level. RESULTS: The sample included 184 hospitals in 29 states and 2,691 labor nurses who worked day, night, or evening shifts. Bivariate analyses demonstrated a positive association between nurse-reported staffing and exclusive breast milk feeding and a negative association between missed nursing care and exclusive breast milk feeding. In structural equation models controlling for covariates, missed skin-to-skin mother-baby care and missed breastfeeding within 1 hour of birth mediated the relationship between nurse-reported staffing and exclusive breast milk feeding rates. DISCUSSION: This study provides evidence that hospitals' nurse-reported compliance with Association of Women's Health, Obstetric and Neonatal Nurses staffing guidelines predicts hospital-exclusive breast milk feeding rates and that the rates are a nurse-sensitive outcome.