Article
Midwifery staffing calculations based on care demand and care supply using routine hospital data
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Authors
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Luisa Eggenschwiler
- Institute of Nursing Science, University of Basel, Switzerland
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Giusi Moffa
- University of Basel, Switzerland
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Valerie Smith
- Trinity College Dublin, Ireland
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Michael Simon
- Institute of Nursing Science, University of Basel, Switzerland
| Published: | February 7, 2024 |
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Outline
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Background: A staffing shortage of registered nurses and midwives has been identified in Switzerland. There is currently no recommendation regarding midwifery staffing and staffing levels in Swiss maternity wards are unknown.
Aim: The aim of this study was to model current care demand and care supply by midwives in the maternity department of a Swiss university hospital.
Methods: This single-centre retrospective observational longitudinal study investigated a four-year timeframe (2019–2022). The primary focus was on the labour ward with 2,500 births annually. All maternal and neonatal patients who were admitted as inpatients were included. We also included all registered midwives working in a three-shift pattern (day, late, and night shifts) in the labour ward. To model the care demand, we worked with the count of birthing parents and newborns. Based on the objective to provide 1-to-1 care we recorded midwifery working hours as care supply and the duration patients’ presence as care demand for each shift. The supply-demand-match was calculated by subtracting care demand hours from care supply hours for each shift.
Results: In total, there were 10,458 deliveries across 4,383 shifts. Preliminary findings reveal high daily birth rate variation ranging from zero up to 17 births, with an annual average of seven births per day.
The average care supply was 44.1 hours per shift (SD +/–6.6 hours), and 48.4 hours for care demand (SD +/–17.1 hours). Regarding the match between care supply and care demand, this led to a shortage of –4.3 hours per shift (SD +/–15.4 hours). During day shifts, on average one midwife was missing (mean=–8.0 hours, SD +/–15.9 hours), while late shifts showed a good match (mean = -0.4 hours, SD +/–14.5 hours). Half a midwife was missing during night shifts (mean=–4.5 hours, SD +/–14.8 hours).
Relevancy: Showing the match between care demand and care supply increases the understanding of the current staffing arrangements in a Swiss university hospital. As we anticipate ongoing staff shortages in the future, it is critical to explore options for enhancing the alignment between care demand and supply.
Recommendations/conclusions: Staffing resources are limited and need to be handled with great care. Without the need for additional midwifery staff, it could be feasible to attain an improved match between care demand and care supply. Adapting staff scheduling according to the monthly number of registered pregnant parents for birth may be feasible. As this might not be enough, new arrangements of staffing to secure quality of care and improve staff scheduling might be needed. The current representation of care demand does not include patient complexity, which will be addressed in a future step to improve the comprehension of care demand variation in Swiss labour wards and its effect on the supply-demand-match.
Ethics and conflicts of interest: The clarification of responsibilities by the cantonal ethics committee stated that it was not responsible, KEK-Nr. Req-2022-00208. The dissertation project is funded by the Swiss National Science Foundation. There are no conflicts of interest.
