Health care workforce challenges, including burnout and staff shortages, are a top concern for America’s Essential Hospitals and its members. Essential hospitals face the critical task of resolving these challenges and ensuring staff resilience while navigating the effects of increased inflation and labor costs on health care spending.
Burnout
Burnout is a state of physical or emotional exhaustion specific to the workplace stemming from prolonged workplace stress. Key indicators include “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy,” according to the World Health Organization.
Provider burnout is associated with several organizational factors, including the combined effect of patient surges and workforce shortages, occupational hazards, and administrative burdens. Staff at essential hospitals are especially predisposed to burnout due to the unique responsibilities they hold as care providers for populations facing significant social and economic barriers to care.
It is critical that hospitals identify their patient populations’ areas of high social need and create connections and initiatives to facilitate screening, referral, care coordination, and work to change community conditions. These programs can improve patient outcomes and alleviate causes of provider burnout related to patients’ unmet needs.
Prior to the COVID-19 pandemic, in 2019, between 35 and 54 percent of physicians and nurses reported substantial symptoms of burnout. By September 2020, the number of health care personnel reporting exhaustion and burnout had risen to 49 to 76 percent, and today, more than one-third of direct care health care professionals consider leaving the profession.
Workforce Shortages
The United States is experiencing a significant and pervasive health care workforce shortage, especially in underserved communities. Nurse shortages have raised nurse-to-patient ratios, further contributing to pressures placed on nurses and, in some cases, their departure from the health care workforce.
As a result, hospital facilities have been forced to rely on travel nurses to fill these employment gaps, especially at the height of the COVID-19 pandemic, and at a heavy price. Because essential hospitals care for a disproportionate share of patients who are uninsured, underinsured, or covered by Medicaid and Medicare, they operate under narrow margins and strained financial resources, making it harder to mitigate the challenges of rising workforce costs. Essential hospital staff also are often paid less compared to staff at private hospitals or health systems, leading to heightened protests in recent months as inflation continues to spike.
With labor costs already accounting for approximately 50 percent of the average hospital budget, these rising costs are becoming increasingly strenuous on essential hospitals. For example, the estimated labor expenses per adjusted discharge increased 37 percent from 2019 to 2022.
Recruiting and Retaining Staff
Recruitment and retention also have become urgent concerns as the demand for care and provider shortages have converged.
It is crucial that Congress expand and financially support training and residency slots for allied health care professionals, nurses, and physicians, not only to mitigate the current workforce shortage but also to meet the changing demands of tomorrow’s health care system.
Essential hospitals play a central role in training the next generation of health care professionals as three-quarters of essential hospitals are teaching institutions. Essential hospitals also train three times as many new physicians as other U.S. teaching hospitals.
Maintaining a strong physician training pipeline is key, and America’s Essential Hospitals has backed the Resident Physician Shortage Reduction Act of 2023. The bill increases the number of residency positions eligible for graduate medical education payments under Medicare for qualifying hospitals, including in health professional shortage areas hospitals and rural areas.
America’s Essential Hospitals also has backed the Safety From Violence for Healthcare Employees (SAVE) Act, which would provide legal penalties, similar to federal protections that exist for flight crews, for individuals who knowingly and intentionally assault or intimidate hospital employees. Health care workers are currently threatened by increasing acts of violence, further contributing to strain from shortages, burnout, and trauma related to the COVID-19 pandemic.
These threats, as well as the exhaustion and stress health care professionals experience, are detrimental to the mental health of America’s providers and the safety of patients. Health care professionals suffering from the mental health effects of burnout may be more likely to have impaired attention, memory, and executive function.
Although the indirect costs of burnout-related medical mistakes, malpractice suits, and lower patient satisfaction rates remain difficult to quantify, burnout-associated impairments have clear implications of quality, safety, and patient experience. Burnout is well-known to reduce patient safety, leading to increases in health care–associated infections.
While essential hospitals and health systems across the country remain active in their efforts to ease staff burnout and mitigate staff concerns, it’s clear that the road remains long. America’s Essential Hospitals continues to develop tools to help members develop their workforce and to advocate for essential hospitals on the Hill.
This blog is a part of a series focused on health care staff resilience. Future posts will highlight best practices from member hospitals to ensure a healthy workforce.
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