Sabrina Stratman left a spring 2024 Planned Parenthood fundraiser feeling inspired — so inspired that the registered nurse and occasional volunteer applied for a job at the nonprofit’s Omaha clinic.
A lifelong advocate for abortion access, she thought this would become her life’s work.
But Stratman, feeling disillusioned and disrespected, quit that job in March, becoming one of the latest departures in an exodus of employees from Nebraska’s lone surgical abortion provider.
The turbulence has further limited access to abortion in the state, which already bans most abortion after 12 weeks of pregnancy. The number of abortion procedures plummeted in the past month and a half due to understaffing, employees said. The clinic’s last remaining nurse trained and working in abortion recently resigned.
The Flatwater Free Press spoke with seven current and former Planned Parenthood employees. Most said that out-of-state executives are largely responsible for the staffing woes and other issues. Several said that recent news coverage of the national organization’s broader struggles in clinics across the country resonated with their own experiences.
Insufficient training has led to problems beyond burnout, they said, including a recent pause on rapid testing for two sexually transmitted infections due to inconsistencies in how the tests were being administered.
They say executives often dismiss concerns. In two instances, Stratman said she felt pressured to assist with a surgical abortion despite being the only nurse available — a break with the clinic’s standard operating procedures.
Planned Parenthood officials rejected the characterization, including claims that employees were ever pressured to break with standard procedures. The nonprofit pointed to ongoing political hostilities in Nebraska and nationally, as well as broader challenges being felt across health care and said the clinic will soon staff up.
“We are working within and against these trends to build structures that will expand care long term,” spokesperson Erin Heisler Wagner wrote in an email. “It is not easy work, and we will experience ups and downs, but we are committed to providing care to our patients and doing whatever it takes to make that happen.”
Current and former employees who spoke with Flatwater agree that the clinic continues to provide important services in a difficult climate — but that is despite the obstacles posed by the organization’s leadership.
“(Planned Parenthood is) kind of creating a ban of its own,” Stratman said.
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Leaving was a difficult decision for Stratman. As a nurse she knew her departure would limit access to abortion, a cause close to her heart. But she felt she had little choice after a day in early March.
As a blizzard blanketed Omaha, management asked Stratman to assist in a surgical abortion. The request normally wouldn’t be a problem, but Stratman was the only abortion nurse available.
The organization’s standard operating procedure calls for a procedural abortion to involve a physician, two registered nurses and several unlicensed support staff.
It wasn’t the first time management had asked Stratman to break with the standard, she said. Last fall, a similar request came, and Stratman told management she felt uncomfortable. They tried to find a solution, she said, but she ultimately was the only nurse present for the procedure.
When she expressed similar uneasiness that day in March, a Minnesota-based executive who was in town and has a nursing degree stepped in as the second nurse, Stratman said.
She felt the clinic manager used her passion for abortion access as leverage. She reached her limit.
“I didn’t leave because I didn’t believe in the work,” she said. “I left because the environment became unsustainable.”
Planned Parenthood said that “at no time has management pressured or implied that staff should break standard processes,” and that “it’s an expectation that they adhere to standard operating procedures and best practices in all care delivery.”
Staffing is adjusted with patient volume, Heisler Wagner said, and staff work with an “advanced practice clinician” during procedures.
Now Stratman is gone, and the only remaining nurse dedicated to the Omaha clinic and trained to assist with abortions left in April.
As of this week, employees said the clinic had done just three procedures since mid-March.
That’s much less than what would be possible with full staffing. The clinic had been offering multiple procedural abortions at least two days a week in January, according to former employees.
Planned Parenthood did not confirm the number of procedures but said there were three days in that period when the schedule was open for patients to schedule procedural abortions.
Heisler Wagner said there’s a significant no-show rate — 14.7% for abortion care in Omaha last month — that impacts the number of procedures provided, so a number isn’t an accurate reflection of “staffing or commitment to providing regular procedural abortion appointment options.”
Medication accounts for the vast majority of reported abortions in Nebraska: 82% in 2023, according to state data, but there are times when procedures are the safest option.
In Nebraska, clinics offer medication abortion up to 11 weeks of pregnancy. That leaves people between 11 and 12 weeks pregnant with one option for in-person care: the Planned Parenthood Omaha clinic. Procedures are recommended in other cases, including women with bleeding disorders or in domestic violence situations.
Heisler Wagner said the clinic has hired replacement staff and will provide medication and procedural abortions in May.
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Employees said turnover has long been an issue at the clinic, but chaotic management over the last year during a major construction project, coupled with unresponsive out-of-state executives, added additional stress.
In 2019, Planned Parenthood merged its branch serving Nebraska and Iowa into a new regional affiliate with Minnesota, North Dakota and South Dakota.
Health care workers across Planned Parenthood North Central States voted to unionize in 2022, triggering a contentious bargaining process. Organizers said in 2023 that the affiliate’s turnover rate had escalated to 44% during negotiations, according to reporting in The St. Paul Union Advocate. An internal union organizer declined to comment for this story.
Ashley Schmidt, who was on the bargaining team, started working for Planned Parenthood in Nebraska because of the nonprofit’s mission. She left in December after six years, she said, because of the executive leadership.
Regional executives at the headquarters in Minnesota are disconnected from the reality in Nebraska and clinics generally, Schmidt and others said, resulting in a lack of transparency and communication around big decisions.
Training suffered within the churn of turnover and expectations that they do more with fewer people, current and former employees said.
Employees recently discovered that training was inconsistent for staff performing rapid tests for HIV and syphilis, prompting the clinic to pause those tests while management sorted through whether past tests were accurate.
Employees were not sure what follow-up ultimately happened with patients, and said management attempted to pin the problem on one particular trainer.
Planned Parenthood said it could not publicly disclose details of staff or patient experiences for privacy reasons. But Heisler Wagner said that “management continually monitors and reviews the care provided” at health centers to ensure guidelines are followed and improve patient outcomes.
Sheilahn Davis-Wyatt, the affiliate’s chief operating officer, said in an interview that executives like her are “absolutely not” disconnected.
“I visit multiple times during the year, I sit down with staff, I talk to staff, we engage routinely and we stay connected at all levels. … There’s management directly on the ground in Nebraska,” she said.
But Melissa Forsyth, who served as a go-between for Omaha employees and executives like Davis-Wyatt, said leadership was often dismissive.
After the Omaha clinic’s manager left last summer, Forsyth — then the senior director of health centers for Planned Parenthood North Central States — was one of at least two off-site managers called upon to help until executives hired a replacement. Employees said the patchwork lasted over six months and contributed to clinic chaos.
One cause for concern among employees was major construction that started over a year ago.
The project will triple the center’s number of exam rooms and improve staff and patient flow, according to Planned Parenthood. It is slated to wrap up in May.
“Through the process there was onsite monitoring by management, staff, and contracted vendors to maintain adherence to safety and construction standards,” Heisler Wagner said in an email.
When the noise and odors would impact staff and patients, though, Forsyth and Stratman said executives would dismiss requests to limit services or close the clinic.
“I think you’re faced with enough dismissiveness over time that we weren’t surprised when staff started leaving over it,” Forsyth said.
Forsyth worked for Planned Parenthood for over six years before she was told she was part of a layoff in January. Heisler Wagner said there were two positions eliminated as the health services team was “restructured.”
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Planned Parenthood and outside observers point to the current political environment in the U.S. and Nebraska as a main source of staffing struggles.
“Access to this health care should not be dependent on the employment choices of just a couple of people at a single provider in Nebraska,” Davis-Wyatt said. “Unfortunately, in this moment, it is. But it’s not by chance. This is a result of years of anti-choice politicians chipping away at access to abortion care …”
A year after the U.S. Supreme Court overturned a constitutional right to abortion, Nebraska enacted a 12-week ban — down from 22 weeks. In the seven months after that law passed, the total number of reported abortions in Nebraska dropped by 24%.
Options for people seeking abortions have diminished, too. As of 2022, there were three in-state providers: A clinic in Bellevue and Planned Parenthood clinics in Lincoln and Omaha.
Bellevue still provides medication but no longer does procedures, staff confirmed.
Last fall Nebraska voters opted to put the current ban on most second- and third-trimester abortions into the Nebraska Constitution.
More recently, lawmakers gave first-round approval to a bill that would require facilities that perform “elective abortions” to cremate or bury “the remains of aborted unborn children” if possible. Abortion opponents argue this would honor the dignity of a human life.
Abortion access advocates say it would act as a “shadow ban,” creating a burden unique to these facilities that could force providers to stop offering procedures altogether.
“Anti-abortion activists have a long history of pushing laws that make it harder, or in some cases, impossible, for clinics to open and operate,” said Shelley Mann, who leads the abortion fund Nebraska Abortion Resources. “Nebraska sees gaps in access all the time.”
Mann said there have been times when abortion wasn’t accessible at all in Nebraska for weeks and even months. In those times, she said, more Nebraskans travel out of state for care.
“People are not getting fewer abortions as a result of eroding access, they are just getting more expensive ones,” Mann said in a text message.
Nationally, it has been tough for providers to set up clinics even in states where abortion access is protected, according to national reporting. Planned Parenthood clinics across the country are struggling financially and dealing with high turnover as most of the organization’s fundraised money goes to legal and political causes, a recent New York Times investigation found. Staff regularly face harassment from protestors.
Additional threats lurk at the national level. A leaked Trump administration Health and Human Services budget proposal recently prompted a hiring freeze, according to Heisler Wagner. The freeze doesn’t impact nurses at the Omaha clinic, she said.
Planned Parenthood said that widespread struggles to recruit and retain providers are “compounded” by the state’s politicization of health care.
The Omaha clinic provides a wide scope of care, including cancer screenings, tests for sexually transmitted diseases, gender-affirming care and vaccines. It commits to not turning away patients if they can’t pay.
“I worry about that,” said Emily Patel, an Omaha maternal-fetal medicine doctor who has advocated for abortion access. “If we’re already running into concerns about staffing and management … not only will we lose access to abortion care, but those other services that are so vital.”
Despite the many issues in her time at the clinic, Stratman said she never saw staff providing unsafe care, and that they “showed up every day with their absolute best for patients, often under really tough conditions.” She and Schmidt both said they sought birth control there for themself or a family member in the last year.
But, Stratman said, the current environment is a “recipe for disaster.”
When she arrived last year, she said morale was already poor and she took on the task of activities meant to boost it, including goodbye parties. Earlier this year, she started planning more and more of them before, ultimately, she planned her own.
“In the end, construction’s a factor, turnover is a factor, but I think when it all comes down to it … I don’t think they felt heard. I don’t think they felt respected in their work,” Forsyth said.
“And you do that for so long that you eventually just decide to move on.”
