The Maternity Care Nurse Workforce in Rural US Hospitals

Publication Date: May 6th, 2017
Publication Type(s): Peer-reviewed Journal Publications
Topic(s): , , , , ,
Author(s): Henning-Smith C., Almanza J., Kozhimannil K

J Obstet Gynecol Neonatal Nurs. 2017 May – Jun;46(3):411-422. doi: 10.1016/j.jogn.2017.01.010. Epub 2017 Mar 31.



To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce.


Cross-sectional survey study.


Maternity care units within rural hospitals in nine U.S. states.


Maternity care unit managers.


We calculated descriptive statistics to characterize the rural maternity carenursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals.


Of the 263 hospitals, 51% were low volume (<300 annual births) and 49% were high volume (≥300 annual births). Among low-volume hospitals, 78% used a shared nursestaff model. In contrast, 31% of high-volume hospitals used a shared nurse staff model. Respondents praised the teamwork, dedication, and skill of their maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses.


Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals.

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