Short on nurses, a rural NC hospital struggles to keep its maternity center open

Chatham Hospital knew it was defying a national trend among small, rural hospitals two years ago when it began delivering babies again for the first time in 28 years.

But hospital leaders didn’t anticipate the severe national nursing shortage that brought them to the brink of closing their Maternity Care Center last summer.

Chatham Hospital’s president, Jeff Strickler, says the maternity center is on better footing now. Next month, it anticipates having enough nurses to operate around the clock seven days a week for the first time since early last summer.

But the center’s long-term future is still uncertain, and the hospital, along with its parent UNC Health, local agencies and the county health department, is struggling to keep the center open. It primarily serves a rural, minority population that would otherwise have to travel up to an hour to deliver a baby.

Last week, the Chatham County Board of Health sent a letter urging UNC Health executives to maintain the center, which it referred to as “MCC.” The letter notes that before the center opened, the county’s infant mortality rate was 50% higher than the state average and was more than twice as high among Black residents as white residents.

“Like UNC Health, the Chatham County Board of Health seeks to eliminate disparities such as these and achieve health equity and overall health for all,” the letter said. “Losing the MCC would significantly impede our collective work toward these important goals and put mothers and infants in Chatham County at risk.”

Last month, a 26-member task force of physicians, UNC Health administrators and others recommended dozens of strategies for trying to recruit and retain staff and attract more patients. Strickler said UNC and the hospital will try some of the recommendations over the next six months and see if they help.

“At this point, there have been no decisions made to close,” Strickler said in an interview Monday. “What we’re trying to do is to keep the unit staffed. But we’ve also been emphasizing just the reality that this is a staffing situation and therefore doesn’t lend itself to easy solutions.”

Hospitals in North Carolina have long strained to find enough nurses, as growing demand exceeds the supply of nursing graduates. The COVID-19 pandemic, with its risks and demands, made matters much worse by driving many nurses to retire early or seek work outside hospitals.

Like many rural hospitals, Chatham also has trouble competing with hospitals with better pay and benefits, including UNC Medical Center in Chapel Hill. Since the hospital’s maternity center opened in September 2020, staff turnover has been close to 80%, according to the task force report.

Chatham Hospital needs the equivalent of 8.5 full-time maternity nurses to operate the center around the clock seven days a week. Even after eliminating weekend hours, Strickler said, the hospital has more than once come within one resignation of having to suspend birthing services.

Strickler says Chatham is now augmenting its full-time staff by signing travel nurses to temporary contracts through UNC, allowing it to operate the maternity center seven days a week starting in January.

“Those contracts continue until the spring,” he said. “At that point, if we’re not able to replace those individuals with others, then our staffing concerns will continue.”

A new maternity center bucks trend for rural hospitals

Even before the pandemic, small hospitals in rural areas struggled to maintain maternity centers. Since 2013, at least 10 rural communities in North Carolina lost their labor and delivery services when the local maternity center or the entire hospital was closed, James DeVente, an obstetrician and gynecologist at East Carolina University’s medical school, told North Carolina Health News.

The Chatham Hospital task force recommended several steps for recruiting and retaining maternity nurses, including hiring and retention bonuses and a streamlined review and interview process.

It also recommended reducing the amount of time maternity nurses are loaned to other hospital departments to help with shortages. Maternity nurses who have left Chatham have reported frustration with not being able to use their specialized skills full time, according to the task force.

That’s in part because the hospital has not drawn as many patients as Chatham and UNC Health expected. In the 22 months ending last June, 217 babies were born at Chatham Hospital. The task force cites a study that concludes rural hospitals need a minimum of 240 births a year to maintain a “stable and viable” maternity center.

Strickler said Chatham Hospital needs to do a better job promoting the center and partnering with local physician practices that are now steering patients to more distant hospitals in Chapel Hill, Greensboro, Asheboro and Burlington.

It’s also critical that the Maternity Care Center be open 24 hours a day seven days a week, which it will be again starting next month. Anything less puts doubt in a patient’s mind about whether the hospital will be able to care for her.

“With laboring mothers, that’s generally not planned,” Strickler said. “So having 24/7 coverage really takes those questions away from the mother, helps them be more comfortable with our services, and then they’re more likely to choose us.”