Working in Kotzebue, Alaska, is one of those assignments that leaves a mark—the kind you don’t even fully realize until you’ve left. Sure, it was remote, but what made it unforgettable was the way Maniilaq Health Center completely shifted how I thought about OB nursing. It was a style grounded in trust, genuine connection, and a level of autonomy I hadn’t experienced before. For starters, the OB unit at Maniilaq is run entirely by midwives. This was my first time working in a midwife-led unit, and I absolutely loved it. There was something so organic and empowering about how births were handled here. A midwife-run unit means there are no obstetricians for moms…the midwives do it all. They also take care of the babies. There is a pediatrician available either on-site or in a nearby village or via consult with Anchorage if babies need extra support. Since Maniilaq is a critical access hospital with no OR, we only did low-risk deliveries—patients had to go into labor naturally, and if things looked like they might get complicated, we transferred them out to Anchorage.
That also meant no epidurals, but we did offer nitrous oxide for pain relief (just like in Barrow.) I actually got to be the labor nurse for about eight deliveries during my time there, which was pretty significant considering they only do around 30–40 births a year. There were a few more patients I cared for postpartum, but those labor experiences—being right there, one-on-one with the midwives and moms—were truly special.
The midwives were amazing. Supportive, knowledgeable, and collaborative. They made me feel valued and welcomed from day one. More important than how they made me feel, however, was the way they obviously made the patients feel. Being a small community, these midwives work very closely with their patients. They develop relationships that go far beyond the typical provider-patient relationship, which was evident in all the births I was a part of. Many of the patients have had the same midwife deliver multiple babies. When a woman goes into labor here, a midwife is always on the unit. And they are not just on the unit…often the midwife is at the bedside offering support and encouragement through every contraction. It is a genuinely beautiful relationship – a kind that I have not seen anywhere else.
It was inspiring to witness that level of connection and continuity of care—something I’ll always carry with me. But as heartwarming as the OB side was, life in a small, remote hospital means being ready for anything, as well as wearing many hats. When we had no OB patients, I floated to med-surg and psych. That was definitely outside my comfort zone, but I’m glad for the experience. The team was so understanding—most of us OB nurses came in with minimal experience outside of our specialty, so they tried to give us lower acuity patients and were always willing to lend a hand. I never felt like I was being thrown to the wolves, which is such a relief when you’re in a new place learning new skills.
Psych nursing was a different kind of experience altogether. Maniilaq isn’t a dedicated psych facility, but patients in crisis sometimes had to stay for extended periods while waiting for a spot to open elsewhere in the state. The transfer process could take days—or even longer—not due to delays at the hospital but because of a statewide shortage of inpatient psych beds.
It was tough at times, especially knowing that we couldn’t offer the full spectrum of care these patients really needed. But what stood out to me was how committed the staff were to keeping patients safe, stable, and supported through those uncertain waits. Even without specialized resources, the team brought compassion, patience, and consistency to each shift. It was eye-opening and, at times, emotionally intense—but it also deepened my respect for the resilience required in rural healthcare.
Workload-wise, I was guaranteed 36 hours a week, but overtime was a hit-or-miss. Some weeks, I’d be scheduled for four or five shifts and get to work them all, and other weeks, I’d be put on call for all the extras. Fortunately, Maniilaq also had other opportunities to pick up hours. I got to do a few shifts in the women’s health clinic—my first time working in an outpatient setting—and even spent a day doing chart audits. It felt good to stay productive (and paid) without always being tied to bedside care.
The hospital cafeteria, by the way, was surprisingly solid. Not only was the food reasonably priced (a miracle in rural Alaska), but they even had a little Starbucks! It was a modified Starbucks, but it still scratched the itch when I needed a fix.
Now, let’s talk housing. Of everything in the assignment, this was the most challenging part. Maniilaq offers a few housing options, but only one includes a private unit with a bathroom, laundry, and mini-kitchen. The rest are either shared trailers or a dorm-style setup with eight rooms, three bathrooms, and one small kitchen.
I ended up in one of the dorm units and had some ongoing maintenance issues—including a sewage problem that, thankfully, was fixed, though not until right before I left. Dorm-style living in my 40s definitely wasn’t ideal. That said, everyone has different tolerance levels when it comes to shared spaces. Some travelers didn’t mind it at all, so your experience may vary depending on what you’re used to and what you’re comfortable with.
As for the town of Kotzebue—it’s small. Like, population-of-3,500 small. You can walk the whole town in a couple of hours. That said, I never found myself bored. I’m one of those people who can always find something to do, whether exploring the shoreline, watching the sunset over the sound, or just wandering the streets and taking it all in. But if you’re someone who needs a lot of options or a fast-paced social scene, this probably isn’t your place.
By the time I left, I realized Maniilaq had given me something I didn’t even know I needed—real connection. To the patients, yes, but also to the heart of birth work, and to a slower, more thoughtful rhythm of nursing that reminded me why I started in this field to begin with. It challenged me, stretched me outside of OB, and reminded me that sometimes, the smallest hospitals offer the most significant learning opportunities.
If you’re an OB nurse with a sense of adventure, an open mind, and a willingness to float a bit outside your specialty, Kotzebue might just be the place you’re looking for.