In the United States, we have surpassed a critical threshold. Over half of our critical access hospitals no longer provide inpatient obstetrical services and 100 facilities have closed their inpatient obstetrical programs in the last 5 years.
Among these struggles, many have asked—where are the success stories? What does a sustainable rural obstetrical program look like?
I had the unique opportunity to interview 7 amazing obstetrical leaders (nurses and physicians) across three rural hospitals in Minnesota, Vermont, and Maine. These multidisciplinary leadership teams are focused on their patients’ needs, their communities and creating sustainable programs that will be their legacy for years to come.
Some common themes emerged:
- Simulation for High Acuity Low Occurrence Events (HALO events) such as neonatal resuscitations and postpartum hemorrhage at these three rural obstetrical facilities is not optional. It is a must.
- All units echo the same thing. Physician recruitment to rural obstetrical programs takes 2-3 years. New nurses take over a year to orient to specialty obstetrical and neonatal care. Midwifery programs take time to grow and nurture. Hospitals and programs need to constantly be thinking ahead.
- Not one of the three units have physicians providing more coverage for their units than every 4th weekend. “You cannot live your life being on call all the time. You cannot recruit physicians to a job that has Q2 call. And there is no way we could ask our physicians to be on every other weekend anymore. It is just not feasible to ask that of our physicians and their families.”
- Flexibility and redundancy are critical. All units are creative in their obstetrical provider staffing models and nursing coverage. This includes building midwifery programs and partnering with family medicine.
All three programs are constantly thinking about the future and keenly aware that all members of their team need to feel a supportive work environment. “It is not hard to make people happy. You have to listen to what they want and make sure we all buy into the fact that we are on the same team and we need to work together. Doing this has made us successful.”
Sustainable units know that they can’t stay open by expecting their people (physicians, midwives, nurses) to work unsustainable hours and more than full-time jobs. Over and over, the leaders reaffirmed that recruitment takes time and have successfully posted positions early to ensure enough redundancy in their programs for success.
Many rural obstetrical units are thinking long-term and are invested in designing units that meet their communities needs. The dedication of rural obstetrical teams to their communities is grounded in a deep love for the patients and families they serve. These are the heroes.
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