By James X. Stobinski
This month, I will speak about two recent and timely articles on the continued challenges with nurse staffing. Linda Aiken (2023) presented findings from a recent nationwide survey of nurses and doctors working at ANCC Magnet recognized facilities. Aiken reports that each of those professions are experiencing a high level of burnout and frustration in the workplace. Data reported by the assistant secretary for planning and evaluation (ASPE) from the Office of Health Policy (2022) reinforces the Aiken research findings.
Staffing shortfalls may be attributed in part to the demographics of these professions. The ratio of both nurses and doctors who are age 50 and over is much higher than the overall American workforce (ASPE, p. 3). We cannot quickly increase the supply of either of these professions with limitations for schools, clinical sites and instructors. Many experienced clinicians were lost during the pandemic to include early deaths and some who still suffer from long COVID-19 symptoms.
Burnout in the health care workplace was becoming problematic immediately prior to the pandemic but the impact of the COVID crisis acutely exacerbated existing issues. Nurses leaving the profession during the pandemic accentuated staffing shortfalls and fed into more burnout in a spiraling effect. A key point raised by Aiken is that nurses and doctors are losing confidence that senior leaders are willing to address what they see as important patient safety issues. That is, facilities are misdirecting precious resources.
Programs to build resiliency among health care workers and resources such as meditation rooms are becoming more common in health care. As Aiken reports these initiatives have a common ingredient – each places an emphasis on the worker and their behaviors. This places the burden on the worker for action. These initiatives, however well meaning, do not address fundamental issues such as nurse-patient ratios which doctors and nurses rate as a significant issue.
We have a disconnect between measures which the clinicians deem to be effective and what administrators are willing or able to fund in the workplace. This disconnect causes clinicians to believe that senior leaders are not attuned to patient safety and work environment concerns that are well known to those rendering care. Senior health care leaders, to include many senior nurse executives, are adamantly opposed to potential solutions such as mandatory staffing ratios or meaningful changes to the work environment such as allowing more control to the workers providing care.
What is the connection between the data presented in the Aiken paper, the ASPE Issue Brief and perioperative nursing? Many, perhaps most, facilities will hire new RN graduates for orientation to perioperative nursing. But the current nursing workforce remains a significant source of staff who could be recruited and eventually become perioperative nurses. If this pool of nurses continues to decrease the staffing shortfalls in perioperative nursing could worsen.
As Aiken and colleagues state, “Disruptions in the hospital clinical workforce threaten quality and safety of care and retention of health professionals.” Although there have been some small recent improvements in staffing levels in health care staffing significant issues remain. The potential peril is that we reach a tipping point where even dramatic interventions cannot restore adequate and safe staffing levels. That scenario might then further impede recruiting into the health professions.
The time seems ripe for bold initiatives to address staffing issues. Mandatory staffing ratios, advocated by many clinicians, is one example. There are also opportunities for new collaborations between stakeholders such as education providers and employers. If, as the old maxim goes, “Necessity is the mother of invention,” American health care now has some rich opportunities in this recruiting and retention of health care workers.
– James X. Stobinski, Ph.D., RN, CNOR, CNAMB(E), CSSM(E), is the director of education at the National Institute of First Assisting.
References
- Aiken, L. H., Lasater, K. B., Sloane, D. M., Pogue, C. A., Fitzpatrick Rosenbaum, K. E., Muir, K. J., McHugh, M. D., & US Clinician Wellbeing Study Consortium (2023). Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice: Factors Associated With Turnover, Outcomes, and Patient Safety. JAMA health forum, 4(7), e231809. https://doi.org/10.1001/jamahealthforum.2023.1809
- Assistant Secretary for Planning and Evaluation (ASPE). (2023, May 3). Impact of the COVID-19
pandemic on the hospital and outpatient clinician workforce: Changes and policy responses. https://aspe.hhs.gov/sites/default/files/documents/9cc72124abd9ea25d58a22c7692dccb6/aspe-covid-workforce-report.pdf
