For months, hospitals large and small have sounded the alarm bells about a work crisis that threatens their ability to maintain health care services and jeopardizes their long-term financial stability.
Hospital employment nationwide has fallen by nearly 94,000 people since February 2020, with about 8,000 of those workers missing from August through September of this year, according to the Bureau of Labor Statistics.
Unit turnover has fallen from 18% before the pandemic to 30%, while overtime pay and the cost of contract workers will likely cost hospitals an additional $ 24 billion for clinical work in 2021, according to a recent analysis by Premier Inc ..
“For every healthcare leader, every hospital CEO, this is the most important issue we deal with,” said David Zaas, MD, CEO of MUSC Health-Charleston Division and Clinical Director of MUSC Health, at the meeting. ‘a virtual policy briefing hosted by the American Hospital Association on Tuesday. “We have seen the results. We have seen fatigue. We have seen the challenges he has faced at work and at home as COVID has impacted our communities. “
As workers leave the field or move into higher paying positions, small hospitals are placed in the difficult position of competing with well-funded systems for a limited pool of skilled workers.
“What kept me awake at night was when I lost a nurse… or I lost a professional in an urban center. There wasn’t much I could do, ”said Leonard Hernandez, CEO and President of the Susan B. Allen Memorial Hospital, a 48-bed rural facility outside of Wichita, Kansas. “Now I lose them in hospitals everywhere. I’m losing them to critical access hospitals because they are able to pay more than us, and obviously [to] urban hospitals and contract labor.
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The situation for frontline workers themselves has also changed since the early days of the pandemic, noted Mary Beth Kingston, chief nurse at Advocate Aurora Health. About 18 months of overtime and tense – even violent – encounters with patients and families over COVID-19 interventions such as masking and visitation restrictions have exhausted clinicians.
“Public support is not as visible and our healthcare workers are feeling it. The increased division that we see in society, we also see in health care, ”said Kingston.
The labor shortages have spread beyond clinical staff and into additional roles such as patient carriers, technicians and nutrition service specialists, Zaas warned. Stress too, said Hernandez, who recounted a conversation he had earlier in the morning with an office worker on the verge of tears.
“What happened? How come we went from health heroes to now, to the point where nobody really cares?” They just want to know why we can’t do our best work, why can’t we hire more people, why can’t we take care of what we were doing before COVID? ”the worker told Hernandez.
With labor shortages and COVID-19 curveballs not set to go away anytime soon, hospital leaders and lawmakers have an ‘obligation’ to support more programs and policies to build resilience of their workforce, executives said.
Compensation may be the immediate goal for many, but bonuses and similar payments are more of a short-term response that does nothing to address the broader labor shortage, they said.
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A more effective strategy is to consider the work environment itself and tackle any barriers that complicate the home life of healthcare workers or prevent them from thriving personally during their day-to-day care, the group said. Overall, this means hospitals need to offer their employees more flexibility in scheduling and working remotely, offer more peer support and wellness training, or take a more active role in family benefits such as childcare.
“A high percentage of our people in the workforce have children and the whole issue of child care is critical,” Kingston said. “We have a child care allowance in place, whether it is children who cannot go to school or who are at home for their forties. This ended up being a very real issue for our workforce. “
Lawmakers hold the keys to faster relief funds, additional training
Most of these workforce resilience efforts require increasingly hard-to-find funding. Kingston and Zaas pointed out that new pharmaceuticals, personal protective equipment, screening procedures and immunization programs that hospitals have adopted over the past 18 months have put many organizations in dire financial straits, not to mention higher margins. thin and shrinking elective care hospitals. are preparing in the months and years to come.
“Our financial challenges, our work challenges that we are talking about will last much longer [than COVID-19]”Zaas said.
Here, leaders looked at the uncertainty of 2020, when workers’ leaves and department closures led lawmakers to funnel an unprecedented amount of relief funds to hospitals that Hernandez called “the most thing.” influential that Congress has ever made ”for the industry.
Leaders said the government was once again able to offer struggling hospitals a much needed lifeline. First, about $ 25 billion of those relief funds have yet to be distributed to rural hospitals and those whose incomes are still hammered by COVID-19.
“They talked about it for a week and two weeks later the funds were in the hospital accounts,” said Hernandez, whose hospital increased its allocation until August. “So when you talk about the $ 25 billion that’s still out there, still available, I don’t see any reason why it shouldn’t be kicked out.”
For small hospitals like his, Hernandez said lawmakers could reignite initial pandemic discussions on relaxing or removing criteria to qualify as a critical access hospital or similar designations that could “level the playing field. of the game ”in terms of reimbursement and, consequently, of hiring high-cost workers.
But as time is running out, he continued, lawmakers should also consider whether hospitals would be better off keeping the billions of dollars that have already been distributed through the Centers for Medicare’s Accelerated and Advance Payments program. Medicaid Services (CMS). .
“In my opinion, the biggest thing the legislation could do would be to convince CMS to cancel the advance payments,” he said. “These funds are already in the hospitals, they are deposited in accounts awaiting repayment over the next two years and they cannot be used for anything else.
“CMS won’t close if they don’t get these funds back, but hospitals could,” Hernandez said.
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Aside from relief funds and reimbursement, leaders said the government could solve problems with the supply of clinical and non-clinical manpower by increasing its support for education programs.
Kingston called on the federal government to provide more financial support to community colleges, universities and other institutions offering nursing or clinical education programs, “particularly in the area of faculty expansion.” Likewise, canceling student loans from employers and government could help more interns and new employees seek other opportunities, she said.
“Training has been cut off for a lot of students and we’re seeing more nurses leaving in their freshman year,” Kingston said. “Tens of thousands of qualified applicants are denied nursing programs each year due to shortages of faculty and lack of clinical sites. I think creating teaching incentives, scholarships for students, promoting simulation[ulation] centers – these are some of the things federal and state governments can focus their efforts on.
Along with legislation such as Dr Lorna Breen’s Healthcare Provider Protection Act, which aims to reduce burnout, suicide and other behavioral health issues among healthcare workers, Zaas has called for broader support for congressional education and recruitment efforts, such as reducing the shortage of medical residents. Law and the Ways and Means Committee Pathway to Practice training programs (PDF).
The Resident Physician Shortage Act is expected to add 14,000 new graduate medical education slots, offsetting the only 1,000 that have been added since 1996 despite continued growth in the US population and healthcare system, Zaas said.
The legislation on Pathway to Practice training programs would be a “top-up” program that provides medical scholarships to minorities and others living in areas of medical, rural, or healthcare professional shortages. health, who will then complete their residency and practice in these same regions.
“We recognize that the shortage of doctors, the shortage of interns exacerbate our health disparities,” Zaas said. “This has a disproportionate impact on our rural and underserved areas where we are struggling to recruit doctors amid scarcity. … [Pathway to Practice Training Programs are] truly ensure that our healthcare workforce of the future reflects our communities.