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A ‘deep’ hospital workforce crisis looms

Missouri health officials said this week that with “unprecedented levels of turnover and vacancy” in hospital staff, current trends in health care are unsustainable.

The Missouri Hospital Association’s (MHA) 2022 Annual Workforce Report shows that a “perfect storm” of early retirements, job changes and transfers to other occupations is contributing to staffing shortages.

According to the MHA report, the challenges facing hospitals today are profound.

To make matters worse, many nursing schools (Lincoln is one exception) turn away potential students because the schools don’t have the staff to meet full enrollment.

For years, hospitals have struggled to attract and retain staff.

Data from an MHA annual report shows that the COVID-19 pandemic may have exacerbated challenges for hospitals: vacancies for nurses (key positions in hospitals) have doubled in the past five years .

According to the 2022 workforce report, the nursing turnover rate in hospitals increased from 19.5% in 2019 to 24.7% in 2022. And the vacancy rate increased from 8.9% in 2019 to 17% in 2022. It has increased 87 percent since 2020 and has more than doubled since 2018, when the rate was 7.3 percent.

As of Friday, St. Mary’s Hospital in Jefferson City had 73 nursing openings; shifts include day/night/weekend, full-time, part-time, locum and PRN or pro re nata or on-call nurses, said Janet Wear-Enloe, director of business development and marketing. The hospital also has six openings for respiratory therapists.

Travel staff are filling in the gaps, Wear-Enloe said.

The Capital Region Medical Center, like other hospitals in the region, has several openings for nurses, said Emily Mantle, director of marketing.

It has 41 open positions for registered nurses (and fills 32 of those positions with agency registered nurses). Agency nurses are those provided by outside sources for hospitals in need of staff.

Vacancy rates are most troubling, MHA spokesman Dave Dillon said, though the “turnover” represented by turnover is a big problem.

“Essentially, a vacancy means that despite finding qualified candidates, there are none available,” Dillon said. “There are structural issues that pre-exist the pandemic – the average nurse is in her 50s – and that means that, just as the latest baby boomers are starting to need care at a much higher level, a large part of the working population will reach retirement age.

The MHA said turnover and vacancy levels pose immediate and long-term risks to care delivery and workforce sustainability. He describes the challenges facing hospitals as profound.

“The pandemic has been very disruptive to hospital staff,” MHA President Jon Doolittle said in a press release. “As we exited 2021, indications of a full-fledged hospital staff crisis were emerging.”

The annual report, he continued, highlights that several frontline caregiver positions remain at record vacancy levels. And, many jobs supporting hospital operations, such as housekeeping or dietary aides, have “astronomical” turnover rates.

Current trends are not sustainable, Doolittle said.

The workforce crisis is a major operational issue — statewide and nationally — according to the report.

The pandemic has caused “significant disruption to healthcare personnel,” he says.

Registered nurses are the busiest positions in Missouri hospitals, according to the report. However, vacancies for these positions are the highest they have been since the MHA released the statistics, and stand at 19.8% this year (up 12% from 2021).

“Missouri has 33,692 nurses working in hospitals and 8,334 vacant nursing positions,” the report said.

Many are leaving the field, he said.

The report says a “perfect storm” of early retirements, job changes and departures for other professions has contributed to staff shortages.

“Frontline healthcare workers are facing exhaustion after nearly two years of responding to the pandemic,” he says. “According to a national study by McKinsey & Company, 32% of nurses indicated that they could leave their current position, where they provide direct patient care, in the next year.”

McKinsey & Company is a consulting firm established in Chicago in 1926 that advises on the strategic management of businesses and governments.

In addition to nurses considering changing careers, the number of employees choosing to become traveling nurses during the pandemic has hit record highs.

“To meet the greatest demands, hospitals are scrambling to reassign and retrain nurses and other staff,” the report said. “Some hospitals are reassessing their skill mix — working toward team-based and virtual models of care, and promoting career ladders and professional development. Additionally, they are using tools to recruit, retain and reward staff, including financial incentives, new workplace flexibility and support systems, and personal programs.”

CRMC recently raised its minimum wage and implemented a 5% raise across the organization, Mantle said.

“Our goal is not just to hire great employees, but to retain our dedicated staff. care unit) patients,” she said. “We also look to the future by working closely with nursing school programs on mutually beneficial partnerships.”

CRMC will continue to think of inventive ways to overcome staffing challenges and provide excellent care, Mantle said.

However, it is not just in nursing that there are shortages.

Cole is one of 20 central Missouri counties that the MHA considers a core region (bordered on the north by Audrain, Boone, and Howard counties and on the south by Dent, Laclede, Phelps, and Pulaski counties).

In this region, more than 1,670 people work in practical nursing positions (care technicians, certified practical nurses or non-licensed assistant personnel), according to the report. However, another 441 of these positions remain open in the region. And the turnover rate is 40.9%, which is equal to the state rate.

There has been growth in many areas of health care.

As of 2020, area hospitals employed 100 full-time sterile processing technicians (whose job is to sterilize surgical instruments). In 2022, there are 124 such positions (including part-time positions, hospitals employ 137 people for the position). Twenty-eight of the positions remain open.

The positions that continue to be the most difficult to fill are those in housekeeping or food services, where employees are constantly changing at a rate of more than 40%.

Physicians remain in positions with the least turnover. Statewide, there are only 1.5% of vacancies, according to the MHA report. And, only 14 salaried doctor positions are open (out of 965 available).

Occupational therapists, pharmacists and medical record coders also show little turnover.

The Pipeline

The pandemic is affecting the training of health personnel, according to the report.

“Schools are struggling to access clinical rotations essential for student training due to a shortage of hospital staff. And growing shortages of nursing faculty are preventing schools from accepting all interested students,” says the report.

The Missouri State Board of Nursing’s 2020 annual report showed that even then, in the 90 state pre-licensing nursing programs, at least 45 full-time nursing assistant positions and 44 at part-time jobs remained vacant.

At that time, 10,424 students were enrolled in nursing, but schools turned down 1,296 qualified applicants.

“The number of qualified applicants who cannot be accommodated is staggering,” according to the MHA report. “Missouri Nursing Programs reports that 87 additional full-time faculty positions would be needed to accommodate all applicants deemed qualified for admission.”

By the way, the report points out that at least 126 nurse educators in Missouri plan to retire in the next five years.

Ann McSwain, an associate professor in the University of Lincoln’s department of nursing, said in an email to the News Tribune that the university is working with MHA and the American Association of Colleges of Nursing to study insight into the expected demand for nursing graduates.

“The shortage of nurses is nothing new,” she said. “This is an ongoing issue, however, the pandemic has highlighted the need for qualified nursing teachers in the classroom and competent nurses at the bedside.”

Educators have expected for years that as baby boomers age, the RN deficit will grow.

Aging baby boomers have created a growth in comorbidities and long-term care needs, McSwain said. These challenges also lead to an increase in the need for specialized health care.

Unlike many other nursing programs, Lincoln hasn’t had to turn away students due to staffing shortages, McSwain said. However, because the institution admits students, it must plan the number of clinical instructors needed based on the number of students in each clinical course.

“It has been difficult at times, as we have struggled to staff ourselves,” she said. “Additionally, some of our specialty clinical sites only allow small groups of students, requiring clinical instructors to schedule extra days to ensure all students get enough clinical experiences.”

The university tries to maintain excellent nursing education for students, while facing staffing challenges.

The number of nursing applications at Lincoln University tends to fluctuate, she said. And there is competition for the best students.

“We are happy to be back at area high schools (after the pandemic) to present at recruiting events,” McSwain said.

However, nursing competes with other career options for high school graduates, who carefully consider pay rates, work-life balance, promotion potential, and other factors students may find attractive.

Courtesy of the Missouri Hospital Association

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