Meet the Organizers Working to Solve a Shortage in Abortion Nurses
In the year 2021, Kiernan was the only registered nursing at a clinic for reproductive and sexual health in Oklahoma City. This was not ideal because it meant training someone new every time, and sometimes even causing a catastrophe. For example, the temp nurse walked off her job one day abandoning patients. It was not ideal, as it meant that every time someone was hired, they had to be trained. Sometimes, this was disastrous, like the day a temp nurse quit, leaving patients behind and bringing the clinic to a standstill. A physician or another advanced practice provider, such as a midwife, can perform a procedure to empty your uterus or prescribe abortion pills when you need one. Experts say this is only a small part of the care that you need, but it’s a vital one. Who can answer your questions regarding pain management and drug interactions? Who will administer the sedative, start your IV and monitor your vitals throughout? If you experience an allergic reaction, who is prepared with emergency medications? Who will hold your hands? This type of care, provided by nurses and health-care providers, is vital to abortion access. Without it, clinics cannot function. But often, conversations about access center on the number of providers who can themselves perform or prescribe abortions.
That singular focus misses a simple truth: Without a full team, particularly nurses, high-quality abortion care doesn’t exist. There are simply not enough nurses. This problem has only grown worse since Roe v. Wade was overturned. In many places across the country, nurse staffing levels are not adequate. Monica McLemore is a professor and registered nurse at the University of Washington. She studies reproductive rights, justice, and health. “What we teach is driven by exams and employers, as opposed to by what society needs.”
McLemore said nursing education centers the needs of acute care hospitals, where a small majority of nurses are employed. It neglects outpatient care in the community, including abortion care which is stigmatized. In interviews, nurses reported that abortion is barely discussed in nursing schools. When I was in nursing, there was no abortion training. I really pushed it.” This is a long-standing problem. This is a longstanding problem.
“Nurses were far more likely to regard abortion as part of routine health care if it was part of the curriculum and if they had opportunities to work through their feelings about the procedure,” said Karissa A. Haugeberg, a history professor at Tulane University who has studied nurses’ attitudes toward abortion through time.
By contrast, McLemore pointed out that anti-abortion groups have both been strategic in outreach to nurses and sought to weaponize the close nurse-patient relationship–to the point that nurses have turned patients in when they suspect an illegal abortion.
“Nursing is ground zero,” McLemore said. The Charlotte Lozier Institute, the Susan B. Anthony Group and other anti-abortion groups have long identified nurses as the best discipline to implement anti-abortion propaganda. Nurses are calling CPS
on our patients. The nurse staffing shortage is one of the major reasons for lack of access to abortion. It has become only more pressing in states where abortion is legal, as those states see an influx of out-of-state patients, resulting in more volume and, later, more complicated procedures at clinics, necessitating more staffing.
Filling a gap with more nurses
Last fall, California Gov. Gavin Newsom, California’s governor, took the first major step to address this issue by launching a statewide Reproductive Health Service Corps program. The $20 million program will increase abortion-training opportunities for all health care workers including nurses, pharmacists and physicians. It also includes doulas and EMTs. The first is a hands-on, six-month program that trains nurses in clinical abortion skills. “We knew there was a gap in training for registered nurses to provide abortion care,” says Anna Brown, NSRH’s deputy program director and registered nurse. “And we also knew that our organization was specifically prepped to fill that gap because we’d already been creating online education and doing group learning with our nursing members on comprehensive sexual and reproductive health care, including abortion.”
Cassandra Durian is a registered nurse who went into the profession because she was interested in trauma-informed community and reproductive care. She felt alienated in nursing school by the culture. I was wondering if nursing was right for me. I was like, ‘Is this what nursing is?’ I wasn’t getting to the depths that I thought I would in terms of health and support of communities.”
As a new nurse, she was working in inpatient critical care, and that’s when she came across NSRH’s training in abortion care residency.
Durian enrolled in the residency and completed 80 hours of training at the Partners in Abortion Care clinic in College Park, Maryland plus a complementary online course developed by NSRH that included modules and seminars on both abortion nursing skills and the broader context of abortion care: how abortion funds work, what state laws require, how and when to disclose that you work in abortion.
Nurses interviewed for this story pointed out that there is a stark contrast between the larger political and workforce problems (brutal) and the actual patient care (deeply rewarding).
In Durian’s hands-on hours, she followed various clinic team members and learned how to counsel patients, ask the right questions for a pregnancy-specific medical history, and provide moderate sedation–a specialized skill–for the procedure. She found that she loved the work, especially the opportunity to deeply connect with patients: The complexities of how people came to need an abortion often required individualized problem-solving.[Child Protective Services]”We’ve had situations where they’re in an abusive situation and they couldn’t come home without a pregnant belly,” Durian said. “So they might come for a fetal demise injection and then go home and say, ‘The baby’s not moving, let’s go to the hospital.’ And that’s her way of getting out of the relationship.”
Since completing her residency, Durian now works as needed at Partners. “I didn’t have any of that.” “I didn’t have any of that.”
Partners clinic co-founder Morgan Nuzzo, a certified nurse-midwife, said she is very aware of the value of abortion nurses and the barriers that make them scarce.
“We need more nurses in leadership, and we need really talented nurses in abortion care because our patients deserve to have that level of care,” Nuzzo said.
She said one of the reasons she and her co-founder, a physician, are so happy to participate in the residency is because NSRH handles all the logistics: The organization ensures licensing and background checks and provides wraparound support and education.
“They give us a stipend to train these folks,” Nuzzo said. Nuzzo said that the NSRH provides a stipend to train these people. This is unique. We’ve been doing that for generations, and many of us are at the end of our ability to continue without more funding. And we’ve been doing that for generations, and a lot of us are at the end of our ability to keep doing that without more funding.
“When we’re under siege all the time, we just try and piece together what we can,” Nuzzo added. This program was designed with purpose and innovation, which makes it fun to be a part of. Latona Gwa is an executive director at Midwest Access Project. She is also a registered nurse and a doula. The organization trains healthcare providers to provide full-spectrum reproductive services. “A nurse can say, ‘I will be right here with you.’ And I think that means the world to folks who are going through something they’ve never gone through and don’t know what to expect or are afraid.” “A nurse can say, ‘I will be right here with you.’ And I think that means the world to folks who are going through something they’ve never gone through before and don’t know what to expect or are afraid.”
And Giwa pointed out, in the worst-case scenario–and as Cobb’s experience shows–no nurse can mean no abortions that day.
“We are hearing from clinicians that a lack of registered nurses in their clinics is a huge barrier to providing care,” Giwa said.
There is also the fact that people show up needing information about pregnancy options everywhere in the health-care system.
“If we train RNs, we then can have nurses in primary care settings, in care navigation, in telemedicine, in hospitals–everywhere in peripartum care who are helping patients navigate when they need access to abortion care,” Giwa said. “If we get nurses to be abortion advocates, navigators, and care providers, we are really reaching entire communities.”
Training for the future of abortion care
Another facet of this problem is the fact that there were expert abortion nurses working in states where abortion is now essentially banned, like Texas, who are now out of a job–or at least out of a job in their chosen specialty. In response, NSRH has organized an eight-week travel program that matches seasoned abortion nurses with clinics that need them, often in other states.
“Obviously, it’s devastating for patients, but it’s also devastating for nurses who have chosen this career,” Brown said. This is a huge amount of information that could be lost. We came up with the idea of a travel nurse program.” We came up with the idea of a “travel nurse” program.”
To help make traveling feasible, NSRH provides nurses with a living and travel stipend during the eight-week period they will be away from home. They also ensure that the nurses are licensed to work in the state where they are going and provide additional insurance and support.
When Cobb worked as the Kansas branch’s nursing director, they worked with NSRH in order to place a nurse there.
The program It’s important to vet people when it comes to abortion staffing. Sometimes it’s hard because even if folks are not anti, I really need somebody who is pro-abortion, not just pro-choice, and I think there’s a big distinction.”
Cobb emphasized there are nursing skills particular to abortion and to outpatient care–for instance, if it is difficult to get an IV inserted in an ER, a nurse can call another nurse, or a paramedic, or an anesthesiologist. In the clinic this is not an option. Cobb added that the job is emotionally exhausting. You’re taking a risk you wouldn’t take in any other nursing area. And that can feel really rewarding because you’re providing a service that people need–and it can also take a toll on you.”
Brown agrees.
“Dealing with protesters is draining,” Brown said. Brown agrees. “Dealing with protesters is draining,” Brown said. Clinics that can stay open usually see an increase in patients. So the staff are feeling that strain as well; we’re meeting a higher need.”
Despite all this, nurses interviewed for this story pointed out that there is a stark contrast between the larger political and workforce problems (brutal) and the actual patient care (deeply rewarding). For many nurses, outpatient abortion care can be a dream career. The emphasis is on teamwork over strict hospital hierarchy, and the connection to patients is of paramount importance. Cobb stated that the work is enjoyable: “Sitting with a patient in the hospital, that’s truly the best place to be.” Imagine abortion care was not always a budget-friendly option. Imagine that every abortion patient could receive holistic, supportive and safe nursing care. Imagine nurses who love their job because they are focused on patient care. “That is a lie. This is some of the most rewarding, deeply complex and challenging work, rooted deep in the messiness that comes with human experience. We need the strongest nurses in this place.”
