The Healthcare Worker Shortage and the Impact It Has on Patient Safety

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Healthcare Shortages and COVID-19's Impact

Before the deadly COVID- 19 outbreak, health officials warned of shortages in nursing staff. In the 2012 Study titled, United States Registered Nurse Workforce Report Card and Shortage Forecast, researchers predicted a shortage of Registered Nurses (RNs) growing between 2009 and 2030.1

Later in 2019, before the pandemic, the American Association of Colleges of Nursing (AACN) issued a report2 that found while the workforce was expected to grow 7%, concerns with an RN shortage remained. They noted:

  • The average age of a nurse was 50 years old
  • Approximately 175,000 nurses would be retiring
  • Aging Baby Boomers would require more geriatric care
  • Nursing school faculty were experiencing their shortage
  • Nursing school enrollment did not meet the demand

Did we mention this was pre-pandemic?

Fast forward to 2020, when the U.S. president proclaimed a state of emergency concerning the coronavirus, the concerns increased and expanded to all healthcare workers, not just nurses.

"Shortages in the healthcare workforce and mental health challenges were broadly known and well-documented for years. Both physicians and nurses were at risk of burnout, emotional exhaustion, and depression before 2020, but the pandemic worsened both issues."
- Marcus Schabacker, MD, Ph.D., president and CEO of ECRI3

According to the Bureau of Labor Statistics, employment in healthcare has been down by 524,000 since 2020.4 Providertech highlighted some other staggering statistics:5

  • Nearly 16% of hospitals faced critical staffing shortages
  • By 2026, we will lack an estimated 3.2 million healthcare workers

So, what does this mean for our hospitals?

The Impact on Hospital Systems

Many dissatisfied nurses are leaving their full-time positions to become travel nurses. Travel nursing has grown 35% since the beginning of the pandemic. While these nurses are mitigating some of the acute staffing crunches, the increased cost of travel nurses contributes to the additional labor costs that hospitals are facing. According to data gathered by Premier, clinically qualified labor is costing hospitals 24 billion dollars more per year than pre-pandemic.6

But labor costs are not the only aspects of healthcare on an uptick. Healthcare-Associated Infections (HAIs)7 are on the rise, as well. When epidemiologists at the Centers for Disease Control and Prevention (CDC) analyzed HAI data reported in the National Healthcare Safety Network (NHSN), most HAIs saw a decrease in the number of events reported in Q1 2020.

Unfortunately, this didn't last long, and increases were rapidly seen.

"Hospitals need to double down on quality improvement efforts. Many have done the opposite, for good reason, because they are so focused on COVID-19. Because of that, quality improvement efforts have been reduced."
- Leah Binder, president, and CEO of the Leapfrog Group8

The Impact on Healthcare Workers & Patients

"Because of lags in data reporting and analysis, the healthcare industry lacks clear insights into the pandemic's effect on national safety trends."
- Becker's Hospital Review8

Despite the delay in data reporting and analysis, there is ample evidence that staffing shortages have proven to decrease morale in units and increase the occurrence of medical errors.

Pie chart displaying 4 out of 5 healthcare workers being affected by staffing shortages.

Patients can then have a higher risk of mortality and poorer outcomes in units that are short-staffed. 9,10

Increasing a nurse's workload by just one patient increases patient mortality by 7%.11

Top Ten Patient Safety Concerns 2022

While the Emergency Care Research Institute's (ECRI) annual list is typically dominated by clinical issues caused by device malfunctions or medical errors, the 2022 report differed significantly.

Healthcare Purchasing News summarized the yearly report,12 which noted the top ten patient safety concerns for 2022 as:

  • Staffing shortages
  • COVID-19 effects on healthcare workers' mental health
  • Bias and racism in addressing patient safety
  • Vaccine coverage gaps and errors
  • Cognitive biases and diagnostic error
  • Nonventilator healthcare-associated pneumonia
  • Human factors in operationalizing telehealth
  • International supply chain disruptions
  • Products subject to emergency use authorization
  • Telemetry monitoring

Who Pays the Labor Shortage Price?

"A patient dies once. They can die from COVID-19 or C. diff. It isn't enough to prevent one."
- Leah Binder, president, and CEO of the Leapfrog Group8

The U.S. public population has and will continue to pay the price for this staffing shortage. Already, we've seen increases in HAIs during the pandemic, erasing much of the preventative progress that was made over the last ten years.13

Until we find a way to properly educate and compensate nurses, we believe that this trend will only continue, placing the health and wellness of U.S. citizens receiving healthcare at greater risk.

Recommendations

Travel nurses report increased job satisfaction and impressions of fair compensation for their challenges. To minimize the use of travel nurses and improve nurse satisfaction long-term, hospitals need to develop initiatives to retain nurses. Some of these strategies include

  • Increased Compensation
  • Additional Time off From Work
  • Safe Staffing Ratios
  • Improved Benefits

None of these strategies are novel ideas, but serious consideration needs to be given to some of these possible solutions to stem the hemorrhage of seasoned nurses who are leaving.

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