As the COVID-19 delta variant grips the nation and workforce shortages impact every industry, the effects on healthcare providers and the implications on quality of care are urgent.
Public discourse around this issue has largely focused on increased costs to healthcare institutions as the great resignation hits healthcare. Indeed, hospital expenses per discharged patient have increased by over 15% year-to-date compared to 2019, and much of that increase relates directly to contract temporary labor, the cost of which has skyrocketed by over 100% for both full- and part-time staff.
But the downstream impacts of our healthcare workforce shortage present more direct challenges to patients and families. University Hospital is projecting a 17.5% overall turnover rate this year, an all-time high driven mostly by nursing and technical staff resigning or taking lucrative agency opportunities. Meanwhile, our agencies tell us that even updating our pay schedules to “crisis” levels still may not allow them to fulfill more of our requests.
The result has been an all-hands-on-deck effort to fully staff clinicians and support staff in critical units of our hospital. Our ideal nurse staffing level in the emergency department has been difficult to achieve. And while we have kept up safe staffing standards in our intensive-care units, we often must exhaust every temporary or agency staff option to do so, and we are very concerned about staffing as increases in census are expected during the winter months. Unfortunately, our experience is not unique—this is on the agenda of local and national hospital associations across the country, as it represents the biggest systemic risk to hospital performance this year.
National workforce trends could pose safety risks to individuals presenting for care at any hospital in 2021. Nurse staffing shortages in key areas of the hospital can increase your risk of death, cardiac arrest, failure to rescue and hospital-acquired infections, especially in the ICU. Moreover, as high-reliability frameworks come to dominate our collective thinking on how best to achieve zero harm in healthcare environments, experts agree that team training and dynamics are crucial. I know firsthand that the basic elements of high-functioning teams—trust, psychological safety in identifying problems, and a shared understanding of policies and procedures—are exceedingly difficult to achieve in environments of high turnover.
While I share the hope that a post-delta abatement in cases could offer relief in hospital workforce challenges, there are reasons to be skeptical. A Centers for Disease Control and Prevention study published in September highlighted significant increases in hospital-acquired infections throughout the pandemic, and offered that staffing challenges against increased patient caseloads were a major reason. Even as COVID-19 abates, hospitals are still extremely busy with patients who have other conditions because of deferred or delayed care, with some indications that EDs are more filled now than they were pre-pandemic.
There is much we can do from a policy standpoint to stem these challenges. First, the federal government should expand recruitment and deployment of the U.S. Public Health Commissioned Corps, a program under the Surgeon General that consists of healthcare professionals who are uniformed officers and can be deployed in a manner similar to National Guard or military reservists. These professionals have already done much to support health systems and localities during case surges throughout the pandemic, and should be funded even better.
Second, governments at all levels should increase their investment in the healthcare workforce pipeline, with an eye toward encouraging folks in vulnerable communities to enter educational and training tracks that will fill critical vacancies.
Third, the Justice Department and Federal Trade Commission should consider investigating the behavior of contract staffing firms to ensure that the bulk of their higher prices are transferred to staff themselves, rather than to agency profits. The implications for patient safety and quality of care warrant such scrutiny.
Finally healthcare leaders must focus on workforce burnout and support clinicians who have worked through an unprecedented time over the last 20 months. We offer peer-to-peer support, chaplaincy services and direct mental healthcare to employees who need it most. This is the right thing to do, but could also do much to improve retention.
As healthcare leaders, we would do better to frame the healthcare workforce shortage debate around the downstream effects on patients and families. This is a strategy that is more likely to lead to solutions that both our communities and our employees deserve.