Maternity Units in Rural Hospitals in North Carolina: Successful Models for Staffing and Structure.

dc.contributor.author

Carlough, Martha

dc.contributor.author

Chetwynd, Ellen

dc.contributor.author

Muthler, Sarah

dc.contributor.author

Page, Cristen

dc.date.accessioned

2024-07-09T13:57:12Z

dc.date.available

2024-07-09T13:57:12Z

dc.date.issued

2021-02

dc.description.abstract

Objectives

Almost 15% of all US births occur in rural hospitals, yet rural hospitals are closing at an alarming rate because of shortages of delivering clinicians, nurses, and anesthesia support. We describe maternity staffing patterns in successful rural hospitals across North Carolina.

Methods

All of the hospitals in the state with ≤200 beds and active maternity units were surveyed. Hospitals were categorized into three sizes: critical access hospitals (CAHs) had ≤25 acute staffed hospital beds, small rural hospitals had ≤100 beds without being defined as CAHs, and intermediate rural hospitals had 101 to 200 beds. Qualitative data were collected at a selection of study hospitals during site visits. Eighteen hospitals were surveyed. Site visits were completed at 8 of the surveyed hospitals.

Results

Nurses in CAHs were more likely to float to other units when Labor and Delivery did not have patients and nursing management was more likely to assist on Labor and Delivery when patient census was high. Anesthesia staffing patterns varied but certified nurse anesthetists were highly used. CAHs were almost twice as likely to accept patients choosing a trial of labor after cesarean section (CS) than larger hospitals, but CS rates were similar across all hospital types. Hospitals with only obstetricians as delivering providers had the highest CS rate (32%). The types of hospitals with the lowest CS rates were the hospitals with only family physicians (24%) or high proportions of certified nurse midwives (22%).

Conclusions

Innovative staffing models, including family physicians, nurse midwives, and nurse anesthetists, are critical for the survival of rural hospitals that provide vital maternity services in underserved areas.
dc.identifier

SMJ_200004

dc.identifier.issn

0038-4348

dc.identifier.issn

1541-8243

dc.identifier.uri

https://hdl.handle.net/10161/31252

dc.language

eng

dc.publisher

Southern Medical Association

dc.relation.ispartof

Southern medical journal

dc.relation.isversionof

10.14423/smj.0000000000001208

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.subject

Humans

dc.subject

Health Care Surveys

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Pregnancy

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Qualitative Research

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Nurse Anesthetists

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Nurse Midwives

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Physicians, Family

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Delivery Rooms

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Hospitals, Rural

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Maternal Health Services

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Rural Health Services

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Medically Underserved Area

dc.subject

Health Services Accessibility

dc.subject

North Carolina

dc.subject

Female

dc.subject

Workforce

dc.title

Maternity Units in Rural Hospitals in North Carolina: Successful Models for Staffing and Structure.

dc.type

Journal article

duke.contributor.orcid

Carlough, Martha|0000-0002-5572-5418

pubs.begin-page

92

pubs.end-page

97

pubs.issue

2

pubs.organisational-group

Duke

pubs.organisational-group

Divinity School

pubs.organisational-group

University Institutes and Centers

pubs.organisational-group

Duke Global Health Institute

pubs.publication-status

Published

pubs.volume

114

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