By James X. Stobinski
James X. Stobinski
The American Hospital Association (AHA) informs us that, “A talented, qualified, engaged and diverse workforce is the heart of America’s healthcare system.”1 But, American health care continues to face a number of significant challenges to include denials and delays in payments, sustained inflation and critical workforce shortages.1 Expenses for American health care facilities are growing faster than the increases in reimbursement from Medicare and a large contributing factor to these costs are labor expenses.1
In the AHA survey hospital CFOs state that labor-related expenses are the most common issues of concern. AHA members continue to be challenged by increases in staff time in seeking authorization approval from payers. These labor costs, while steadily increasing, add no value for the consumers of health care.1 Expenses for contract labor remain substantial and the health care workers still working are pressing for higher wages. Staff shortages which were exacerbated during the pandemic are not significantly easing which degrades the work environment for those who continue working. There are some potential solutions to these issues which do not directly require wage increases.
Recent research from a team led by Linda Aiken report on interventions that address some of the causes of labor shortfalls and lessen the number of staff leaving the health professions.2 Chief among the findings is that improvements in the work environment can decrease feelings of burnout in nurses and doctors and increase the favorability in which these providers view their facility and its quality of care.2 These respondents also stated that, “…reducing bureaucracy and red tape.” would be effective in improving their well-being.2 Aiken and her colleagues propose improvements to the workplace by instituting changes based on the principles of the ANCC Magnet program in the hopes of alleviating workforce shortages. They have established baseline data and now hope to institute changes and measure the improvements.
The enhancements of the Aiken study are revolutionary and have great potential if leaders are willing to redesign the workplace. These changes will be disruptive, but they are feasible. The survey respondents in Aiken’s study also emphasized the need to improve nurse staffing ratios which would increase labor costs but the AHA survey reports high contract labor expenses currently. If the money now spent on expensive contract labor were shifted instead to enhance staffing levels we would be funding a response with a firm basis in the research literature.
The AHA reports that RN turnover rates remain high as do vacancy rates. The RN workforce, secondary to changes wrought by the pandemic, is now markedly younger and better educated but it is also less experienced. Many veteran, skilled nurses left the workforce during the pandemic and will not return. The current nursing workforce skews younger and has different attitudes about work-life balance versus the experienced nurses who recently exited. The nature of the nursing work environment may be even more important to these nurses. A recent study of Michigan nurses reported that better work environments reduce the intent to leave for nurses.3 Thus, we have very current evidence on the persistent issues in nursing and we have increasing evidence of viable intercessions. What is missing is the willingness and commitment of health care leaders to implement the interventions.
We are at a crucial juncture in American health care as the labor market for nurses has fundamentally transformed with the pandemic. We are also faced with an interesting tension. We have higher expenses for contract staff but these current costs may preclude the vital residency and fellowship programs needed to retain early career nurses which are essential to replenish our ranks. These are formidable which ask much of our current leaders.
References
1. American Hospital Association. (2024, July 22). 2024 Environmental Scan | AHA. https://www.aha.org/environmentalscan
2. Aiken, L. H., Sermeus, W., McKee, M., Lasater, K. B., Sloane, D., Pogue, C. A., Kohnen, D., Dello, S., Maier, C. B. B., Drennan, J., McHugh, M. D., & Magnet4Europe Consortium (2024). Physician and nurse well-being, patient safety and recommendations for interventions: cross-sectional survey in hospitals in six European countries. BMJ open, 14(2), e079931. https://doi.org/10.1136/bmjopen-2023-079931
3. Friese CR, Medvec BR, Marriott DJ, et al. Changes in Registered Nurse Employment Plans and Workplace Assessments. (2024). JAMA Netw Open; 7(7):e2421680. doi:10.1001/jamanetworkopen.2024.21680
