Surabhi Dangi-Garimella, Ph.D.
Staffing shortages have hit diverse industries during the COVID-19 pandemic, but the healthcare industry has been particularly affected. In the first year of the pandemic, nearly 3,600 healthcare workers died due to COVID-19, and a significant number exited the workforce due to stress and burnout. While hospitals turned toward contract nursing staff to fill the void, it has led to financial strains. Reports indicate that hospitals are planning to cut certain essential services consequent to these staffing shortages.
Severe Access Issues for Patients
A review commissioned by the Office of Inspector General a year into the pandemic reported significant challenges with patient access to:
- COVID-19 care, primarily due to challenges with integrating COVID-19 care within routine hospital care. Hospitals also faced challenges with patient discharge following acute care due to staff shortages and other issues at nursing homes, rehabilitation hospitals, and hospice facilities.
- Routine care and treatment: Patient fear of catching COVID-19 persisted, resulting in delayed preventive and urgent care
- Mental and behavioral health care: Lack of capacity and resources meant hospitals were unable to meet patient demand for mental and behavioral health services, especially among seniors.
- Care in rural areas: COVID-19 compounded operational challenges of rural hospitals in terms of recruiting and retaining staff, limited capacity, and lack of access to specialized services.
These challenges from the early days of the pandemic have lingered and grown. Prior to the pandemic, rural hospitals were already struggling to recruit specialist clinical staff, and the situation has only worsened. Localized surges during the pandemic created lucrative opportunities for nursing staff, many of whom ended up leaving their permanent positions in home hospitals to work as contract-based traveling nurses, earning four-five times higher compensation. This has further strained hospital finances.
Consider this: maternity services in the labor and delivery department of Memorial Hospital of Carbon County in Rawlins, Wyoming, will end by mid-June to relieve financial pressure. The department lost five of its nurses and ended up spending $100,000 weekly on travel nurses. Another hospital in the state, South Lincoln Medical Center in Kemmerer, is also stopping labor and delivery services. Additionally, the hospital is scaling back its operating hours for emergency surgeries, which used to be open round the clock, due to a dearth of surgical nurses.
Policy Solutions and Varied Staffing Models for a Sustained Workforce
Some hospitals are giving their permanent nursing staff and their contract or temporary “gig” nurses a flexible working platform. Mercy hospital in Springfield, Missouri, has piloted a program—and expects to expand it to all its sites—that allows permanent and temporary nursing staff to sign up for shifts via an app. The flexible working hours give nurses better control over their work-life balance, even if for the “gig” workers it means restricted working hours (30), no benefits or paid time off, and no guarantee on shifts. In turn, the hospital can efficiently regulate shifts depending on patient numbers. This model seems to be working well for Mercy.
Certain states have created partnerships with medical and nursing schools where the graduates have to commit to working in the state for a predetermined period of time. This can help resolve some of the staffing issues, bigger and more sustained policies are needed.
Rick Pollack, President and CEO of the American Hospital Association, has the following recommendations:
- Boosting support for nursing schools and faculty
- Providing scholarships and loan forgiveness
- Expediting visas for highly trained foreign healthcare workers
Nursing experts recommend another strategy: force hospitals to implement safe nurse staffing within Medicare’s quality standards, replicating the success seen in the state of California.
Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.