The Healthcare Staffing Crisis: The Need for a Workers-First Approach

Sahngwie Yim

Abstract

Healthcare staffing shortages have been a major cause for concern, only exacerbated by the onset of COVID-19. Factors such as burnout, stressful environments, an aging workforce, fewer educational resources, and increased need for healthcare workers have all contributed to this staffing crisis. COVID-19 increased both the need for patient care and hospitalizations, and coupled with healthcare professionals contracting the virus themselves, staffing shortages were at an all-time high. This led to widespread delays in patient care, even after the pandemic started to settle down, causing long wait times and crowding. Current solutions have included increased mental health and financial support measures for education and healthcare workers. However, a more comprehensive approach that improves conditions for healthcare professionals and increases efficiency of the healthcare system—one which puts healthcare workers first—is needed in order to not just treat the symptoms of healthcare staffing shortages, but address their root causes.

Introduction: The Kaiser Permanente Strike

The voices of workers holding up purple and yellow signs with “Patient Care!” and “Respect and Value Healthcare Workers” filled the air. 1 On October 4, 2023, over 75,000 Kaiser Permanente workers went on a three-day strike, walking out of facilities across the US. 1 This walkout—the largest ever in US healthcare—reflected the high tensions between workers and healthcare companies, which were only worsened by the COVID-19 pandemic. 2 The Coalition of Kaiser Permanente Unions hoped for a $25 minimum wage, health benefits, and stable retirement plans for all Union members. 3 This strike was not simply a one-time occurrence—it represented the spilling over of the long-time brimming US healthcare staffing crisis. Staffing shortages have long posed a concern in US healthcare, especially for nurses. 4 Before the pandemic, healthcare consultancy Mercer projected a shortage of 446,300 health aides, 98,000 clinical lab technicians, and 11,000 physicians and surgeons by 2025. 5 A 2016 study predicted a shortage of over 500,000 nurses by 2030. 4 However, the pandemic significantly intensified these projected shortages. According to the Pandemic Response Accountability Committee (PRAC), over 85% of DoD medical treatment facilities and over 90% of Veterans Health Administration facilities and nursing homes reported a staffing shortage during COVID-19. 6 In addition, a 2023 report by Physician Thrive expected a shortage of 124,000 physicians by 2024, and the Health Resources and Services Administration's Bureau of Health Workforce predicted a primary care physician shortage in 37 states by 2025. 4,7

Contributing Factors: Burnout and Aging

Several factors contribute to the staffing shortage, the most common one being burnout. Additionally, PRAC identified a limited labor pool and noncompetitive pay as other common contributors for the shortages in federal health care facilities. 6 COVID-19 further negatively impacted workers’ mental health and prompted staff to quit to prevent exposure. 6 A 2023 National Council of State Boards of Nursing study found that around 100,000 registered nurses (RNs) left during the pandemic due to stress, burnout, and retirement. Moreover, an additional 600,000 RNs reported an “intent to leave” by 2027, together leading to one-fifth of RNs being projected to leave the workforce within three years. 8 A study in 2021 identified demanding workloads, poor staffing ratios, stressful work environments, and excessive work hours as the main causes of nurse burnout. 9 By comparison, for physicians, administrative duties, which takes up around 25% of time away from patients, primarily contributes to burnout. 10 Resolving these issues requires a bottom-up, role-specific approach, influenced heavily by healthcare workers themselves. As the US population ages, with an expected 73% increase in Americans ages 65 and older by 2029, utilization of health services will continue to expand. 11 Furthermore, as more and more nurses are needed to care for the aging population, the older the nursing workforce becomes, exacerbating the nursing shortage. 11 Over one-third of nurses will reach retirement age in the next ten to fifteen years which would lead to not only a shortage of nursing staff, but also a shortage of faculty and educational resources to train future nurses. 11 Thus, expanded financial and educational support to encourage current and prospective nurses to stay and join the workforce is necessary.

The Effect on Patient Care

The most significant impact of the US healthcare staffing shortage is compromised patient care, resulting from lengthened delays, overcrowded emergency rooms, and increased medical errors, all of which increase patient mortality rates. Kaufman Hall reported that during the pandemic, nearly two-thirds of healthcare organizations revealed that they were struggling to meet patient demand. 12 Wait times have only gotten longer: from 2017, OB-GYN wait times increased by 19%, cardiology by 26%, and orthopedic surgery by 42%. 13 Not only does this delayed care increase risk to patients, but it also leads to crowded emergency rooms, increasing wait times and hospital costs while making high-quality, individualized care difficult. 13,14 The shortage also increased medical errors, with the Joint Commission finding a 19% increase in adverse medical events in 2022, compared to 2021. 15 In 2022, Survey Health Global and Apollo Intelligence reported that over 30% of doctors observed increased medical errors due to staffing shortages. 16 Addressing the healthcare staffing shortage is crucial to ensure high quality, timely, and safe patient care.

Current Solutions and Future Progress

Both healthcare facilities and the federal government have implemented solutions attempting to address these staffing issues. Initiatives like Kaiser Permanente's Rise and Renew program and Mount Sinai Health System’s Center for Stress, Resilience, and Personal Growth were created to mitigate the mental and physical burden on healthcare workers. 17 To address patient care, hospitals redeployed staff to critical areas, launched nursing care teams, and used virtual care. 17 Policy solutions have been implemented as well, such as the Biden Administration’s investment of $1.5 billion to financially support scholarship and loans for healthcare students. 18 To address care in nursing homes, President Biden has also implemented a federal floor for nursing staffing levels, and CMS committed over $75 million to encourage nursing workers. 19 State programs, like California’s mandatory nurse staffing ratios, have also been tested, despite disagreement over their efficacy. 20 While these measures offer short-term relief for the crisis, they do not address the root of why such shortages exist. While these solutions offer a good starting point for the staffing crisis, patients, policymakers, and healthcare providers must treat its fundamental causes. A comprehensive remedy requires prioritizing healthcare professionals, granting them more time, energy, and motivation, ultimately enhancing patient care. American Medical Association President Jesse M. Ehrenfeld, M.D., MPH, outlined five potential steps to take in addressing these root causes, including: “reduce administrative burdens like the overused, inefficient prior authorization process,” “pass bipartisan legislation to expand residency training options, provide greater student loan support, create smoother pathways for foreign-trained physicians,” and “ensure physicians are not punished for taking care of their mental health needs.” 21 Providing financial educational support, higher wages, and more benefits can retain and attract more workers, ameliorating concerns about retirement of the aging workforce. 10 Furthermore, delegating roles to administrative staff and social workers and using technology like artificial intelligence can address worker burnout and enhance efficiency. 10 These solutions target the fundamental causes of the problem. Staffing shortages only grow more and more vital to address and we must take a workers-first lens to truly solve the problem and finally put not only patients, but also workers first.

Reference

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