Health Systems and Hospitals Grappling With Workforce Shortages

By Christopher Cheney

Healthcare workforce shortages were one of the key pain points identified at the recent HealthLeaders Chief Medical Officer Exchange.

The coronavirus pandemic has highlighted workforce shortages at health systems and hospitals across the country. On Sept. 1, the American Nurses Association urged the federal Department of Health & Human Services to declare a nurse staffing crisis and to take immediate steps to implement solutions. Last week, Dartmouth-Hitchcock Health announced that the Lebanon, New Hampshire-based health system had raised its minimum rate of pay for all positions from $14 per hour to $17 per hour to address workforce shortages.

Chief Medical Officer Exchange participant Erik Summers, MD, CMO and vice chair of internal medicine at Wake Forest Baptist Medical Center, in Winston-Salem, North Carolina, recently told HealthLeaders that his organization is experiencing widespread workforce shortages.

“We are experiencing significant nursing shortages and that is impacting the hospital, but it’s more than that. We are experiencing workforce shortages in care coordination, social work, nursing assistants, and respiratory therapists. We are not seeing as many shortages among physicians and physician assistants, but we are having some challenges in our staff in general,” he said.

The workforce shortages are affecting operating capacity at the medical center, he said. “The biggest impact is that if you do not have the staff that you need, you cannot keep your beds open. We have had some closure of beds. We realize that we need all of our staff, especially at the time of a pandemic, to help as many patients as we can. That is the biggest impact—the inability to put patients in beds.”

Chief Medical Officer Exchange participant Donald Whiting, MD, MS, CMO of Allegheny Health Network and president of Allegheny Clinic in Pittsburgh recently told HealthLeaders that AHN is also experiencing significant workforce shortages.

“Nursing shortages are the most notable because that’s what keeps us from opening available beds for patients. We have bed availability, but we just don’t have enough nurses to cover those beds. However, we have workforce shortages across the board. In nursing, we are competing against other healthcare providers. But across dietary roles, environmental services, ward clerks, and other non-professional roles, we are competing with McDonald’s, Target, PNC Bank, and others because they are all increasing their starting pay rates, too. That is a big workforce toll,” he said.

Whiting estimates that 15% of AHN’s inpatient beds are closed because of workforce shortages.

Chief Medical Officer Exchange participant David Battinelli, MD, senior vice president and CMO of Northwell Health, recently told HealthLeaders that the New Hyde Park, New York-based health system is facing more limited workforce shortages.

“There have been workforce shortages evolving in specialty-specific competency areas for a long time that we will always have because we are constantly innovating and changing technology. It falls largely in all the types of technical workers that we need. For example, we have workforce shortages in information technology because of competing industries vying for the same people. We have workforce shortages in specialty-specific areas from radiology and imaging technicians to ultrasound technicians to laboratory workers. These are all specialty-specific technological areas,” he said.

With the exception of coronavirus patient surges, Northwell has been spared nursing shortages, Battinelli said. “In the nursing area, we have workforce shortages during pandemic surges, but we do have adequate numbers of nursing applicants.”

Rising to the challenge

Wake Forest Medical Center has been trying to boost recruitment and employee retention in response to workforce shortages, Summers said.

“We have looked at our salary structure—we want to be competitive in the market. Then we looked at supporting our nurses with appropriate nurse-patient ratios in the hospital. It is easy to tell nurses to see more patients, but we need to hold to not only what is going to keep our patients safe, but also what is going to keep our staff from burning out. We have been hesitant to increase our ratios on the floors or in the ICU,” he said.

AHN has made a concerted effort to address workforce shortages, Whiting said. “We have tried every trick in the book. We have raised pay rates. We have given retention bonuses. We have given hero bonuses for working through COVID. We have added bonuses if an employee refers workers to us. We are giving sign-on bonuses. We have worked on making childcare available or covering childcare costs. We are looking at redesigning what nurses do to use others to do some of that work.”

Employee retention is a priority at AHN, he said. “We celebrate every single event—we make people feel appreciated in every possible way. We have pizza parties. We acknowledge people with events on the nursing floors and elsewhere in the hospitals. We are doing things to create camaraderie. We are focusing on wellness—we have serenity rooms in each of the hospitals. We want people to feel appreciated and to have a sense of belonging as well as focusing on their wellness.”

Northwell is focusing on culture to address workforce shortages, Battinelli said. “We want to be able to give people not only the job that they want but also the environment where they want to work. We want to have an adequate amount of respect, collegiality, and engagement. We spend an enormous amount of time on employee engagement. During the pandemic, we have enjoyed the highest employee engagement scores that we ever have had—up over the 90th percentile. We have been recognized as being one of the Top 100 places to work for by Forbes.”

Workforce outlook

Workforce shortages at health systems and hospitals are likely to linger for many years, Summers and Battinelli said.

“I always tend to see light at the end of the tunnel—I believe that we can improve our employment efforts through recruiting and having people stay because I believe in the organization. But I also cannot deny that these workforce shortages are going to go beyond the COVID pandemic and will be around for a while. So, I do expect workforce shortages to persist long after the COVID patients go away,” Summers said.

“As you emerge with new technical competencies, you will always be faced with workforce shortages. If you cannot retrain and refocus certain jobs that are going to become less prevalent, you will end up with more shortages. It takes an investment in people. When you do the financial analysis of this process, even though it is an investment, it does pay to educate and train staff rather than to find new people, which invariably does cost more money,” Battinelli said.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.