Several employees at Tartu University Hospital say there is anxiety and uncertainty among staff over how work will be organized in the future, amid fears of layoffs. Some employees have even taken out legal expenses insurance out of concern that they could lose their jobs. Although no official notices have yet reached the maternity ward, staff there are prepared for the possibility that 14 people could be laid off. One daytime midwife position was already eliminated in the spring.

Saima Hinno, a member of the hospital's management board, confirmed that work arrangements are being reviewed and positions will be eliminated if necessary, but said she could not say whether layoffs would take place or how many people they might affect.

"I can't give a specific number at the moment because, on the one hand, some reviews are still underway, while in some cases people have already moved to other positions. Whether the number ends up being that high, lower or higher, time will tell, as will the funding model we have been given. We also can't keep more people in positions than we have the funding or volume of treatment to support," Hinno said.

Hinno did not specify which other positions and departments could be affected by the restructuring. She said, however, that demand for staff has increased in the mental health field. The hospital is therefore also offering employees the opportunity to move into positions where there is a greater shortage of workers.

"We can talk about specialist nurses and whether they need additional training, more experience or further studies, because that would allow them to provide services for which there is greater demand. Layoffs are always subject to discussions between both sides and must be justified, because presumably there was a need for a position before and now that need no longer exists. Employees are always offered work they can do within the scope of their qualifications or with additional training, and we will certainly offer that," Hinno said.

So far, maternity ward employees have been offered the opportunity to work as operating room nurses or move to the hospital pharmacy. Many, however, would prefer to continue working in the profession for which they trained and maintain their professional qualifications.

According to a board member of the Estonian Midwives Association (EÄÜ), the decline in the number of births has not actually reduced midwives' workloads, as the profile of the average person giving birth has changed over the years, making deliveries more complicated.

"A midwife's work in a maternity ward certainly can't be assessed solely by how many births they actually attend. You also have to consider how much midwifery care each person giving birth may need overall. If we eliminate one position, regardless of where maternity care is provided, the workload of the colleagues who remain will certainly increase significantly. It may also be that some issues only become apparent once the changes are actually implemented. If staffing is reduced and there is a very large amount of work within a very short period of time — maternity care is an emergency healthcare service — unfortunately, not all of the consequences can be foreseen," EÄÜ board member Käthlin Vahtel said.

Neither North Estonia Medical Center nor the Women's Clinic at East Tallinn Central Hospital is planning similar changes to positions or layoffs.

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