A Public Health Crisis: Staffing Shortages in Health Care

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A group of tired nurses sit in a hospital hallway.

The health care provider shortage is more than an inconvenience, it’s a public health crisis. And it has been building since before the COVID-19 pandemic. Health care staffing shortages lead to poor patient outcomes that can include hospital-acquired infections, patient falls and increased chances of death, according to the American Association of Colleges of Nursing. Provider shortages in certain areas mean that large swaths of the population don’t have enough doctors or nurses to provide them with emergency care, treat their chronic illnesses or deliver their babies.

The issue of staffing shortages is one of the biggest challenges facing public health professionals. The problem is complex and has impacted the health care industry for decades. Yet it must be solved, because the alternative — poor health outcomes for patients across the country — is untenable.

Why Are There Staffing Shortages in Health Care?

Health care industry experts have been sounding the alarm about the staffing shortage for decades. Several factors have contributed to a perfect storm for the industry.

Aging Population

The U.S. Census Bureau reports that 16.8% of the population was aged 65 or older in 2021,  and it predicts that number will grow to 21% in 2030. Older people often require more care, whether in hospitals or nursing homes. They are more likely to have chronic illnesses such as diabetes, arthritis and heart disease and to need care for conditions such as dementia.

Burnout

Health care providers are vulnerable to burnout, defined as physical, emotional and mental exhaustion. Burnout can cause poor performance, which can lead to medical errors. It can also cause feelings of guilt and shame among providers.

The pandemic exacerbated burnout among clinical staff. In a study published in the Journal of the American Medical Association, just under 32% of doctors reported feeling burned out in 2019. In 2022, that figure rose to 40%. Nurses fared similarly. Nearly 41% reported burnout in 2019; by 2022, the number was a shade over 49%.

Burnout can lead directly to staffing shortages in health care, as people leave the profession. According to a survey by staffing agency Incredible Health, 34% of nurses said they would leave their jobs by the end of 2022, with 44% saying that stress and burnout contributed to their decision.

Lack of Nursing Faculty

The American Association of Colleges of Nursing has identified a lack of nursing faculty as a contributing factor to the nursing shortage. Nursing colleges turned away 80,407 applicants in 2019-2020 due to lack of capacity. Faculty pay is often too low and doesn’t attract qualified professors. With the nursing pipeline constrained at the beginning, the profession can’t keep up with rising demand.

Efforts to Help with Health Care Staffing Shortages

Concerns over staffing shortages and patient safety have risen to the federal level, most notably in response to the COVID-19 pandemic. There have been many governmental actions to fill staffing shortages and improve patient care.

Military Medical Personnel

At the beginning of 2022, the White House deployed 1,000 military medical personnel to supplement staff at hospitals across the country. The goal was to mitigate the impact of an expected surge of cases as the omicron variant spread. The administration also deployed clinical response teams around the country.

Assistance from FEMA

President Biden directed the Federal Emergency Management Agency to work with hospitals to expand their capacity. The White House also tapped FEMA to operate ambulances that can transport patients to hospitals with more beds.

CDC Guidance

In response to the omicron variant, the Centers for Disease Control and Prevention issued guidance to health care providers regarding appropriate staffing levels. In particular, the CDC changed the recommended timeline for staff to return to work after a positive COVID-19 test from 10 days to five. It also identified several contingency strategies. These include canceling nonessential procedures and being aware of personnel issues that might prevent employees from coming to work, such as transportation challenges or living with a high-risk family member.

Nursing Home Staffing and Oversight

Medicare has established nursing home staffing and oversight requirements. New regulations require nursing homes and long-term care facilities to boost staffing ratios, reduce resident crowding and increase incentives for quality-of-care metrics under the Medicare value-based purchasing program. Other requirements include expanding financial and other penalties for facilities that fail to meet these and other standards.

Staffing Shortages in Health Care Around the World

The U.S. is not the only country to suffer from a staffing shortage of health care workers. The World Health Organization predicts a shortfall of 15 million health care workers worldwide in 2030. The International Centre on Nurse Migration projects there will be a shortage of 13 million nurses alone by 2030, up from a shortage of 6 million before the pandemic.

According to the WHO, the worst shortages will likely impact Africa, the Eastern Mediterranean and the Middle East.

The reasons for these shortages are many.

Education and Training

The lack of investment in training a health care workforce is a major factor, especially in low-income countries. However, wealthy nations also suffer from a training shortage, as illustrated by the U.S.’s shortage of nursing faculty, which reduces the number of students who can enroll in training.

Remote and Underserved Areas

Deploying health care providers to remote regions can be difficult. These areas may have fewer amenities or may be far from providers’ families. They may not pay as well. They may be more dangerous or have fewer resources to treat patients. In the U.S., these areas are designated as health professional shortage areas (HPSAs). Some 83 million Americans live in a primary care HPSA.

International Migration

Wealthy countries have been partly solving their staffing crisis by hiring workers from other countries. However, by providing economic incentives for health care workers to emigrate, they add to the shortages in workers’ home countries. Since poorer countries can’t compete on salary, professionals make the decision to leave for better compensation and financial opportunity for themselves and their families.

Strategies for Filling the Shortages

Health care facilities have been operating in crisis mode for a while. They have to solve their provider shortage now to meet immediate needs. However, leaders must consider both short- and long-term plans to ensure they have the staff they need to work every shift, not just today but into the future.

Short-Term Strategies

Most hospitals already have strategies in place to hire and retain clinical staff. They hire travel nurses and other temporary staff (called locum tenens) for short-term needs. However, experts agree that what may have worked in previous years may no longer be effective. In the short term, employers need a new approach to addressing staffing shortages in health care.

Potential solutions include:

  • Customized recruitment and retention. Hospitals are looking at different ways to attract and keep clinical staff. This means going beyond signing bonuses and competitive salaries. Employees may want flexible scheduling and a supportive work culture.
  • Engagement and job satisfaction. Workers are looking for opportunities to be heard, to do their best work and to feel a sense of ownership and independence.
  • Scheduling. Workforce planning and scheduling are both fine arts. Providers are turning to scheduling tools including artificial intelligence (AI) to staff each shift appropriately and avoid overworking staff.

Long-Term Strategies

The health care staffing shortage can’t get by with quick fixes. The industry needs to consider long-term strategies that will require private sector and government initiatives. For example, if the lack of nursing faculty has closed off the student-nurse pipeline, it may take a joint effort from colleges, universities and health care providers to ensure that more students enroll in nursing classes and make it through the program.

Other solutions include:

  • Investing in public health. Spending on public health programs and initiatives can help communities improve the health of their citizens, reducing the burden on hospitals.
  • Nurse practitioners. Most states require nurse practitioners to practice under the authority of a physician. Allowing NPs to have full practice authority can help alleviate shortages in HPSAs.
  • Diversity and equity. Recruiting more minorities to become nurses and doctors can help fill the pipeline. Health care professionals who have the same cultural background as patients can improve the quality of care to those populations.
  • Telemedicine. existed before the pandemic. It was successful in facilitating health care when patients couldn’t see doctors in person. It may be part of the solution to the staffing crisis. People who live in HPSAs can access doctors via telemedicine more easily than in person.

Staffing Shortages in Health Care: A Public Health Challenge

Public health professionals have a big role to play in solving the health care staffing crisis. If you are interested in how a master’s in public health can prepare you for an exciting career in health care policymaking, explore USC’s online Master of Public Health program. Find out how you can play a part in improving health care for all.

 

Recommended Readings

5 Public Health Technologies to Revolutionize Health Care Delivery

10 Public Health Issues We Must Solve in 2022

What Can You Do with a Master’s Degree in Public Health?

 

Sources:

American Association of Colleges of Nursing, Nursing Shortage

American Association of Nurse Practitioners, Issues at a Glance: Full Practice Authority

American College of Healthcare Executives, Top Issues Confronting Hospitals in 2021

American Hospital Association, “5 Ways to Ease Staffing Shortages Now and Into the Future”

American Medical Association, “As Pandemic Enters Third Year, Take These 5 Actions to Move Ahead”

Avalere, “How Healthcare Staffing Shortages Are Changing the Labor Market”

Center for American Progress, “How to Ease the Nursing Shortage in America”

Centers for Disease Control and Prevention, “Promoting Health for Older Adults”

ECRI, “ECRI Reports Staffing Shortages and Clinician Mental Health Are Top Threats to Patient Safety”

Healthcare Dive, “Biden Administration to Send Military Medical Personnel to Overwhelmed Hospitals”

Healthcare IT News, “How Telehealth Can Help Solve the Physician Specialist Shortage”

Incredible Health, “Study: 34% of Nurses Plan to Leave Their Current Role by the End of 2022”

International Centre on Nurse Migration, “New Report Calls for Global Action Plan to Address Nursing Workforce Crisis and Prevent an Avoidable Healthcare Disaster”

Journal of the American Geriatrics Society, “COVID-19 Infections and Deaths Among Connecticut Nursing Home Residents: Facility Correlates”

Journal of the American Medical Association, “Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021”

Kaiser Family Foundation, Primary Care Health Professional Shortage Areas (HPSAs)

MedCity News, “How AI Is Helping to Address Staffing Shortages in Healthcare”

National Academies Press, The Future of Nursing 2020-2030

NaviHealth, “Being a Senior in 2030: The Impact of Staffing Shortages, Rising Costs”

U.S. Census Bureau, QuickFacts: United States

U.S. Census Bureau, “The U.S. Joins Other Countries with Large Aging Populations”

U.S. News & World Report, “Staff Shortages Choking U.S. Health Care System”

White House, “Fact Sheet: Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes”

World Health Organization, Global Strategy on Human Resources for Health: Workforce 2030: Reporting at Seventy-Fifth World Health Assembly

World Health Organization, Health Workforce