All 14 OB Nurses Resign After TN Hospital Announces Labor & Delivery Closure

After learning that the Sweetwater Hospital Association (SHA) in Tennessee had decided to close down its obstetrical unit on February 28, all 14 of the unit's nurses turned in their two-week notice on February 5.

Defending their decision, the nurses penned a letter that stated: “Due to a significant breakdown in trust, we no longer feel we can effectively function as employees of SHA.” 

The nurses are urging the public to understand that their decision to walk out was not to abandon their patients, but to take a stand against the hospitals' decision to close the unit and put patients at potential risk. 

Taking a Stand

The SHA's decision to close down its obstetrical care unit, a unit historically associated with low profit margins for healthcare facilities, especially in rural areas, essentially eliminates hospital-based obstetric care for Monroe County and surrounding rural communities.

Pregnant patients will now be forced to travel significant distances for delivery and higher-acuity care. Veteran L&D nurse Sarah Ortez, who has spent about two decades at the hospital, described the decision as “devastating” for both caregivers and patients. 

She and her colleagues warn that longer travel times could translate into preventable risks, such as:

• Delays in care 
• Unplanned deliveries in emergency departments
• Transit births
• Labor and delivery-related complications
• An increase in emergencies like hemorrhage, severe hypertension, or fetal distress

Nurses involved in the walkout are urging the public to understand that their resignations are not abandonment, but a professional and ethical response to conditions they believe jeopardize maternal and newborn safety.

Patient risk aside, nurses also point out that the closure has shattered morale and eroded confidence in hospital leadership’s commitment to perinatal care. Many staff members report feeling blindsided by the announcement and frustrated by what they characterize as limited engagement with frontline clinicians before such a consequential decision was made. 

Several nurses emphasized that they chose to resign together as a statement of solidarity with one another and with the families who will now lose in‑county access to hospital deliveries.

The Hospital's Response 

Sweetwater Hospital Association maintains that the decision to close labor-and-delivery services stems from a combination of financial strain and chronic staffing challenges in a small rural unit. 

Leaders point to challenges such as:

• Difficulty securing specialty provider coverage, including obstetric and anesthesia call
• Low reimbursement rates 
• Rising operational costs

According to the hospital, low patient volumes and reimbursement shortfalls have made the unit increasingly difficult to sustain, even as overall expenses, including staffing and supplies, continue to climb.

Hospital officials have stated that gynecology and pediatric services will remain available at Sweetwater, along with some outpatient women’s health offerings. They say that current prenatal patients will be assisted in transitioning to other regional hospitals and obstetric practices, and that staff are working to coordinate records, referrals, and appointments. 

While SHA has declined to address specific pay or staffing grievances raised by nurses publicly, the administration released a letter from CEO Andrea Henry responding broadly to questions about the decision and reiterating that the closure was described as a “difficult but necessary” step.

A Closer Look at Finances

Of course, when financial talk is involved, some will take a closer look at hospital administration pay. For instance, publicly available tax filings reviewed by investigative outlets show that SHA board member and staff physician Dr. Ken Kozawa received nearly 2.9 million dollars in compensation from SHA in the most recent reporting period. 

Separate documents indicate that he also reported more than 3 million dollars in private‑practice income during that timeframe, drawing heightened attention from staff and community members. 

For some, these figures have become symbolic of a perceived disconnect between executive and physician pay and the hospital’s claim that essential services like labor and delivery are unaffordable.

A Broader Maternity Care Crisis

Sweetwater’s decision aligns with a larger national pattern of rural hospitals closing or “pausing” maternity units, a trend that has accelerated in recent years. 

Analysts have documented dozens of labor-and-delivery closures across the country, especially in communities with low birth volumes and heavy dependence on Medicaid or other public payers. In 2025 alone, Becker's Hospital Review reported 29 maternity units closing. 

Even more startling, less than 42% of rural hospitals offer labor and delivery, and more closures are expected. 

In response, federal lawmakers introduced the Keeping Obstetrics Local Act on June 12, 2025. The bill seeks to address some of the financial drivers behind closures by increasing Medicaid payments for maternity services, establishing standby payments to help sustain low‑volume labor-and-delivery units, and extending postpartum coverage to a full year to better support maternal health. 

Nursing organizations and patient advocates argue that this kind of targeted, long‑term funding is essential if rural hospitals are to keep labor-and-delivery services open, recruit and retain specialized staff, and maintain safe staffing ratios.

What Can Nurses Do?

If you're an OB nurse concerned about rural unit closures, or just a nurse concerned about the future of rural and obstetrical nursing, here are concrete steps nurses can take:

• Raise your voice with lawmakers. Contact your state and federal representatives to support legislation like the Keeping Obstetrics Local Act and other measures that stabilize funding for rural OB services. Share firsthand stories about how closures affect patients, staffing, and safety.
• Engage your professional organizations. Work through state nurses associations, specialty groups, and unions to adopt policy positions on rural maternity care, submit resolutions, and push for coordinated advocacy campaigns.
• Educate your communities. Use town halls, school boards, faith communities, and local media to explain what maternity unit closures mean in real terms: longer travel, higher risks, strained EMS, and more pressure on emergency departments.
• Support affected colleagues. Reach out to nurses in Sweetwater and similar communities with professional solidarity—sharing job leads, mental health resources, and platforms to tell their stories.
• Strengthen interprofessional alliances. Collaborate with obstetricians, midwives, family physicians, EMS professionals, and public health leaders to develop regional plans that prioritize maternal and newborn safety when closures occur.

Nurses in Sweetwater have taken a difficult, public stand to signal that the status quo is not acceptable for rural mothers and babies, and it will remain to be seen if their voice is heard.

🤔Nurses, what do you think about this? Share your thoughts in the discussion forum below!