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Practice Advice: Managing Caseloads During Staffing Shortages

February 8, 2022

Our advice column answers the question: What should midwives consider when managing caseloads during staffing shortages?

Case Scenario:
A midwifery practice group has recently lost two midwives to unexpected leaves of absence. The midwives were both part of separate shared care pods where midwives were on call one week, off call but doing clinic one week and on vacation the third week.

Since the midwives went on leave one week ago, there are 60 clients who no longer have a midwife assigned to them and two pods that are short one midwife.

Question: What is the responsibility of the practice owners in this situation?
Answer:
The following standards apply to practice owners:

  • 10 Maintain a practice environment that supports compliance with relevant legislation, regulations, policies, and standards governing the practice of midwifery.
  • 45 Manage practice in a way that supports the physical and mental well-being of all individuals involved in client care.

These standards require practice owners to consider the well-being of all midwives in the practice when determining how to manage the caseloads. In a very large practice, they may decide to reallocate some or all the caseload, if this does not compromise the wellbeing of the remaining midwives and allows them to work in compliance with all relevant legislation, regulations, policies, and standards.

In a smaller practice, they may decide that most or all clients must be transferred to another care provider temporarily or permanently to ensure midwives are able to work in accordance with the standards of the profession. Other considerations may include how long the midwives are on leave, the practice’s ability to work inter-professionally, and the distances midwives must travel to provide care.

Question: What is the responsibility of the midwives who are working in the pod?
Answer:
The following standards apply to midwives:

  • 17 Ensure clients have 24-hour access to midwifery care throughout pregnancy, birth, and postpartum or, where midwifery care is not available, to suitable alternate care known to each client.
  • 23 Be accountable and responsible for clients in your care and for your professional decisions and actions.

These standards require that when a member of a midwife’s pod leaves, the remaining midwives in the pod are responsible for ensuring their own clients have 24-hour access to midwifery care. This may mean that the nature of the shared care call, clinic, and vacation schedule must change to accommodate the midwife’s own clients. If the shared care schedule cannot be changed then, the midwife must find their clients suitable alternate care when they are on not available. The midwife’s rationale for their clients not having access to 24-hour midwifery care must be reasonable.

Do you have a question about professional practice or standards? Email practiceadvice@cmo.on.ca.