Time for Health System Leaders to Consider the Special Staffing Issues Posed by COVID-19

Nov. 7, 2020
The COVID-19 pandemic is exacerbating already existing patient care organization staffing issues; organizational leaders need to rethink staffing in a pandemic context, with all its special challenges

As we noted earlier this week, there are voices in healthcare that are sounding the alarm on an issue that could increasingly bedevil hospitals and health systems in the coming weeks and months, as the COVID-19 pandemic wears on and potentially intensifies its impact on patient care organizations: that of already-existing workforce shortages being exacerbated by the pandemic over time.

Healthcare researchers Eli M. Cahan, Lisa B. Levine, M.D., and William W. Chin, M.D. on Oct. 29 published a “Perspective” op-ed in The New England Journal of Medicine online, entitled “The Human Touch—Addressing Health Care’s Workforce Problem amid the Pandemic.” That article looked at some of the workforce challenges facing patient care organizations right now. On the one hand, the article’s authors acknowledged innovations taking place because of the pandemic, including “Covid-19 diagnostics, therapeutics, and vaccines,” which are being developed “at pandemic speed,” as well as the pioneering of “technological solutions for triage, prognostication, and allocation of constrained health system resources (such as intensive care beds).” But, they wrote, in the coming months, hospitals, medical practices, nursing homes, and rehab centers, are already facing workforce shortages. They note that, “Using data from Fastaff Travel Nursing, a national emergency health care workforce staffing company, we found that the company’s order volume (the number of nurses requested by health systems) was 2 to 14 times as high between March 2 and April 6, 2020, as it was at the beginning of February 2020 — and more than 7 times as high, on average, as it was during the same period in 2019. These pressures were clearly observed in New York State, where, at the end of March, Governor Andrew Cuomo issued an urgent plea for help to medical workers from less affected areas of the country.”

Even more alarmingly, they noted, “As Covid-19 has spread throughout the United States, regions with lower population densities have faced similar workforce gaps. Such gaps may be particularly severe in lower-resourced hot spots: Fastaff data illustrate that some states, including Louisiana, Michigan, and Arizona, have had especially acute needs for emergency workforce support in recent months. Staffing needs in these regions have been far higher than needs in previous years,” they noted. “Harsh health care delivery conditions during the pandemic threaten to exacerbate these shortages. The combination of infection risk, physical exhaustion, and mental burnout is putting immense strain on hospital workers. To the extent that projections suggest that the pandemic will persist well into 2021, workers in other parts of the health care system will probably be increasingly affected, as more patients with Covid-19 are cared for in subacute care and ambulatory care settings.”

The researchers recommend that patient care organization executives do the following: make use of volunteer corps of healthcare workers, including retired physicians and medical students; create and exploit registries of lay volunteers for such tasks as contact tracing; ease licensing restrictions, to allow clinicians to move more easily across state lines; and even facilitate the mobilization of National Guard members to help with tasks such as data entry and management, distribution of essential supplies, and transportation of the bodies of deceased patients.

Still, the article’s authors recommend that “a national platform that permits monitoring and allocation of the health care workforce in a harmonized way,” be created. “This type of platform will be especially useful as expansion of the public health workforce outside acute care settings becomes increasingly crucial to the country’s recovery and amid potential surges of Covid-19 cases,” they note. “As of September 9, 2020, a George Washington University team calculated that 240,000 contact tracers alone would be needed to curb the pandemic in the United States.”

And, they note, “The importance of matching supply with local needs is ongoing and may only grow as caseloads increase throughout the country. These platforms can collectively function as a throw blanket over the patchwork quilt — a cohesive second layer filling the gaps seen at the primary layer of state emergency responses to workforce shortages.”

So, it seems very clear that patient care organizations will continue to face workforce shortages for the foreseeable future, and what’s more, that those shortages will most likely worsen. There are actually several different dimensions to this. For one thing, the intensity of clinician staffing needs during periods when hospitals and other patient care organizations experience huge surges of COVID-19 patients, will inevitably force the need to seek out nurses and other clinicians to support surge-level staffing needs. That will be particularly difficult given both the existing shortages, particularly in smaller towns and rural areas, as well as two other factors. One is the fact that clinicians and other frontline healthcare workers are actually becoming ill, with a small number dying. The other factor is going to be burnout, as nurses, physicians, and other clinicians become physically and psychologically exhausted and unable to work the very long hours being required of them.

So senior leaders in all types of patient care organizations will need to think very carefully and strategically about how to handle this situation. What’s more, they will almost certainly have to try to figure out some broader solution, at least community-wide, if possible, to address these challenges. And there is dimensionality here. One key element in this will be data analytics: it will be incumbent on chief nursing officers and/or chief clinical officers, for example, to work in concert with the human resources leaders in their organizations, and will need to collaborate with their organizations’ data analysts, to figure out how to predict, as best as possible, day-to-day and week-to-week fluctuations in the need for floor nurses and so many other clinicians.

Of course, planning for fluctuations in nursing staffing has been a core part of staffing planning for forever in hospitals. But now? Things are demonstrably different. Nurses are working longer and longer hours and are becoming stressed and, in some cases, physically sick and unable to work (or even just COVID-19-positive and needing to be quarantined for weeks at a time); and having to hire agency nurses at a time when revenues were already hammered this spring, as hospitals had to stop all elective procedures for at least two months, must seem just prohibitively expensive.

So healthcare IT leaders will absolutely play a role in these processes, and can especially prove their value, as analytics will be needed to help optimize staffing in hospitals and health systems, at affordable levels of cost. And of course, the leaders of patient care organizations will need to continue to care for the well-being of their clinical and non-clinical staff members, and that will mean ensuring that those staff members won’t have to work excessive hours—if such a thing is possible.

As the researchers noted, some form of national collaboration needs to occur around all this, for data-sharing and ideas-sharing. For now, at the very least, the leaders of patient care organizations need to begin to think very seriously about the special staffing issues created by the COVID-19 pandemic—on top of all the staffing issues that had already existed for hospitals, medical groups, and health systems nationwide.

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