We all knew it was coming – but the shortage of healthcare workers is quickly becoming worse than predicted. Let’s look at industry trends to better understand the post-pandemic 2023 healthcare landscape.
In a March 2022 letter to the House Energy and Commerce Committee, the American Hospital Association declared the workforce shortage in hospitals a “national emergency”, predicting the overall shortage of nursing to reach over 1 million by the end of the year, joined by other shortages in areas like laboratory workers and paramedics.
U.S. News and World Report writes that “staffing shortages are now the nation’s top safety concern, forcing Americans to endure longer wait times when seeking care, even in life-threatening emergencies, or to be turned away entirely.”
Surveys of current workers reveal that up to 25% of them are still looking at ways to leave the field altogether. As conditions worsen, and more of the remaining staff are working short-handed, the situation seems to be on a downward spiral.
Nursing Supply and Demand
What is driving this staff shortage snowball effect? Demand is up, and supply is going down. The crisis is particularly disturbing in nursing, known as the heart of healthcare. The US Department of Labor Statistics projects that 500,000 nurses have left the profession in 2022, boosting the current shortage to over one million nurses. Nurses are needed everywhere – across the entire continuum of care – from the office setting to urgent care, hospitals, home health, long-term care, and hospice.
According to the American Nurses Association (ANA), more registered nurse jobs will be available through 2022 than in any other profession in the United States.
The reasons for this dramatic shortage are complicated, but it comes down to a lack of potential nurse educators (master’s degree prepared), high turnover, and inequitable workforce distribution. The nursing workforce is aging, with one million RNs older than 50 and retiring in the next 10-ish years. This number includes nursing faculty, which in turn limits the number of new nursing students that can enroll.
The pandemic has also exacerbated the shortage issue by creating the ideal environment for burnout and dissatisfaction with career choices. Many nurses discover that the job is both physically and mentally taxing, more so than they expected. Other factors like health risks, violence in the healthcare setting, and worsening staffing ratios often lead nurses to pursue non-clinical roles or change professions altogether.
At the same time, the population’s demand for healthcare is increasing due to the aging baby boomer generation. This generation presents the highest number of Americans over age 65 in history – resulting in a 73% increase in Americans aged 65 and older by 2029.
Quality and Safety Implications
Staffing ratios – the number of patients allotted to each nurse for care – are directly tied to patient outcomes, medical errors, and overall safety and quality of care. The New England Journal of Medicine quantified this danger by comparing 2020 patient outcomes to those in 2019 – pre-pandemic.
In 2Q 2020, compared to the same period in 2019:
- The number of central line-associated bloodstream infections increased by 28%.
- Rates of patient falls rose by 17%.
- Pressure injuries (also called bed sores or decubitus ulcers) increased by 42% at skilled nursing facilities.
The balance between human resources and clinical outcomes is a delicate one – often requiring facilities to shorten hours, close down units or blocks of patient beds, and consolidate resources to keep the doors open. This all equals longer wait times for patients, less access to care, and fewer community resources.
For example, in April 2022, Memorial Hospital serving rural Carbon County in Rawlins, WY had to end its labor and delivery services due to staffing challenges. Now the closest facility for residents is about 1.5 hours away at Ivinson Memorial Hospital in Laramie, WY. Labor costs have also increased, as hospitals compete for scarce nursing resources. Many rely on travel nurses for staffing, which poses a higher cost and can be challenging operationally. Hospital labor costs rose 37% between 2019 and 2022, according to the latest Kaufman Hall report.
The challenges may be great, but healthcare must be provided. Necessity spurs innovation, and the industry is seeing some major changes on that front.
Support for current staff. In an effort to reduce burnout and address mental health concerns, many healthcare systems are providing additional services for their employees. For example, at Mount Sinai Health System in New York, staff have been offered 14 individual behavioral health counseling sessions, plus group workshops at no charge.
Alternative working environments. For non-bedside staff, many organizations are embracing remote work and hybrid arrangements. Customer service, scheduling, coding, and billing departments can effectively complete their duties remotely with the right technology in place. This arrangement often increases engagement and retention of these critical roles, while at the same time saving overhead and administrative costs.
Cross-training and internal float pools. Organizations have also mitigated losses in heavily stressful departments by cross-training clinical staff to work in multiple roles. Internal staffing pools that “float” to needed areas are offered premium pay and flexible schedules in return for their willingness to take on tough assignments.
Maximizing non-licensed workers. Non-RN clinical staff can work on teams with RNs to perform duties that do not require a license. This model has often been used, but some hospitals are intensifying it or adding LPNs to the team to stretch RNs further. Everyone should work at the “top of their license” – in other words, not expending valuable staff resources on tasks that could be done by someone else with a lower skill level.
Moving care virtually. Telehealth has become the norm, but few realize that it requires fewer staff to maintain, especially in primary care and urgent care environments. Some facilities are even using virtual triage in the ED to maximize the on-site staff.
Real-time staffing analytics. In a people-based service, the needs and capacity can change rapidly – even hourly. Virginia Mason Franciscan Health in Washington State implemented a centralized mission control center and virtual hospital to provide real-time, system-wide surveillance to help deploy personnel to departments experiencing capacity issues while decreasing patient wait times.
Partnering with school systems and universities. Early partnerships and internship programs can influence students to make their careers in healthcare. Establishing those ongoing connections can provide a synergy that enables a steady stream of staffing for the future.
Efficient software solutions. Finding staff to fill open shifts or last-minute needs is exhausting for everyone. Managers tire of calling staff on their off days, and staff feel guilty and burned out. Implementing a staff management software that sends alerts for open shifts to all eligible staff, allowing them to simply accept or deny, simplifies the process, and empowers teams to reduce travel nurse spending.
You don’t have to meet these challenges alone – the right strategic partnership can reveal new possibilities. The Rise Family of Companies supports staffing efforts, revenue cycle, and daily operations with innovative solutions tailor-made for your needs. To find out more contact us HERE and discover the solutions waiting for your organization.