Mar 28, 2022 - Health

Health workforce shortages begin to weigh on patient safety

Illustrated collage featuring a Spanish fireman, paramedics transporting a patient to an emergency room.

Photo Illustration: Sarah Grillo/Axios. Photos: Angela Weiss/AFP via Getty Images, Bruce Bennett/Getty Images, and Europa Press News/Europa Press via Getty Images

The COVID-19 pandemic and the strain it has put on healthcare workforces is threatening patient care.

Why it matters: Years of progress reducing medical errors and preventable hospital-acquired infections were reversed in medical centers and skilled nursing facilities during the pandemic.

  • But ongoing health care workforce disruptions — including early retirements, nurses shifting to travel positions and increased workloads for those who remain — threaten hospitals' ability to get back on track.

"There's the cognitive overload, the emotional fatigue that makes us, honestly, worse healthcare providers," Megan Ranney, academic dean at the Brown University School of Public Health told Axios, speaking about the industry.

The big picture: A number of recent studies and analyses have linked workforce shortfalls to quality concerns.

  • A study published in the American Journal of Infection Control earlier this month examined two Illinois hospitals and found a correlation between the reliance on traveling nurses and increased infection rates.
  • It came just weeks after an analysis published in the New England Journal of Medicine found years' worth of improvements in patient safety in hospitals and skilled nursing facilities — as measured by preventable hospital-acquired infections, falls resulting in injuries and pressure sores — were wiped away at the start of the pandemic.
  • Staffing shortages and healthcare workers' mental health were the top two patient safety concerns for 2022, according to healthcare safety organization Emergency Care Research Institute, Healthcare Dive reported.

What they're saying: "The increase in the rates has been a real wake-up call across the United States and internationally," said Linda Dickey, the 2022 president of the Association for Professionals in Infection Control and Epidemiology.

Between the lines: "We lost about 20% of nurses," said Michael Ramsay, CEO of the Patient Safety Movement Foundation, who ran a large anesthesiology department until he retired last year. He's also on the board of Baylor University Medical Center.

  • "Certainly, the senior ones who could retire retired. They were worn out and they were stressed out. It was really hard work," he said.
  • "But where we really got hurt were the sort of 'coach nurses'" who mentored junior colleagues, he said. "They'd been with us for 10 years. They were now the leaders. They went to become travel nurses."
  • That took some important institutional knowledge and experience from many hospitals, many of which had to backfill by hiring itinerant travel nurses who may only stay one or two months.
  • Temporary nurses are highly capable and can fill critical staffing gaps. But the constant churn can disrupt the team dynamic, Ranney said. "You trust each other. You know each other. You're able to call each other out. You have the confidence to say when you think something is wrong, which is critical to safety in medical care," Ranney said.

Zoom in: Shortages have affected patients' ability to get timely care. A CVS Health-Harris Poll National Health project survey found more than half of all Americans say they've directly felt the effects of health care worker shortages, from canceled appointments to delayed surgeries.

  • "Who else is being pushed off? It's going to turn into a domino effect. As someone who faces the result of that in the ER, that deeply scares me," Ranney said.

What's next: Some hospitals have started increasing pay and benefits and addressing issues that became major workforce concerns such as inadequate levels of PPE to protect health care workers.

  • Nursing unions have also called for minimum, nurse-to-patient ratios, an issue that's been a non-starter for many hospitals so far.
  • In the case of Baylor, Ramsay said they started asking nurses what hours they wanted to work or what departments they wanted to work in. In some cases, per their requests, nurses began to work across departments, allowing them to follow their patients through their care and adding to their job satisfaction and winning experienced nurses back. "It's not just throwing money at it," Ramsay said.
  • Hospitals also need to reprioritize their day-to-day infection control practices again, Dickey said. "It doesn't have to be a miracle to turn the ship. It's amazing how much those nudges add up," she said.

Editor's note: This story has been updated with the correct spelling of Patient Safety Movement Foundation CEO Michael Ramsay's last name.

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