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The United States is facing an unprecedented health care staffing shortage by the end of 2022. As a result, we have seen a recent increase in federal and state legislative activity focused on addressing these shortfalls. Several states have passed new laws or proposed laws, Congress has introduced a bill aimed at transparency around the nurse staffing agency payment model, and lawmakers have focused on the Federal Trade Commission (FTC) and the White House’s COVID-19 Response Team. Pressurized to start price investigation. Cleaning by nurse staffing agencies.
The Massachusetts Health and Hospital Association (MHA) recently released a survey raising similar concerns about the health care workforce shortage in Massachusetts. The survey, titled An Acute Crisis: How Workforce Shortages Are Affecting Access and Costs, provided a clear overview of the challenges facing health care workers in Massachusetts, citing staffing shortages, rising labor costs and lack of capacity .
According to a Home Office survey, there are currently an estimated 19,000 open acute care hospitals in Massachusetts. These position vacancies exist across practice areas and disciplines including nursing, behavioral health, technicians, laboratory personnel and clinical support staff. The Ministry of Home Affairs reported an average vacancy rate for these positions of 17.2%. Nurses are facing some of the highest percentage of vacancies, with a 56% vacancy rate specifically for licensed practical nurses. The vacancy rate for mental health workers and technicians is 32% and the vacancy rate for pulmonary work technicians is 35%.
The shortage of health care workers at the national level began during the COVID-19 pandemic itself. According to U.S. News & World Report, an estimated 1.5 million health care jobs were lost in the first two months of the pandemic, and those job numbers have not returned to pre-pandemic levels. In a letter to the US House of Representatives in March 2022, the American Hospital Association (AHA) addressed the growing workforce shortage, reporting that: (i) 500,000 nurses will leave the workforce in 2022; (ii) 23% of hospitals are operating with severe shortage of staff; and (iii) 95% of health care facilities had to hire employees from contract labor firms. In September 2021, the American Nurses Association (ANA) wrote a letter to Secretary Becerra at the US Department of Health and Human Services, urging immediate action to address the national nursing shortage. The letter elaborated on the impact of the then new COVID-19 delta variant, shortage of nurses in various states and proposed policy solutions.
Labor Cost and Capacity Constraints
These workforce shortages are reportedly putting a huge financial burden on Massachusetts hospitals. On average, 70% of hospital overhead is spent on labor costs, according to a Home Ministry survey, but the compounding effects of COVID-19, health care provider fatigue, and the exit of health care providers Because of this, hospitals are having to spend even more money to keep staff and maintain safe operating levels for patients. Hospitals are spending more on sign-on bonuses and retention packages and relying more heavily on travel nurses than before the pandemic. The MHA reports that in FY 2022, Massachusetts hospitals will spend $445 million on travel nurses, a significant jump from the $133 million spent in FY 2019.
The AHA letter notes that the average hourly rate for travel nurses at national hospitals has more than tripled since January 2019. Some hospitals are paying rates of $240 an hour or more to retain travel nurses. In addition to staff shortages and increased costs, hospitals are struggling to meet the needs of patients. Emergency room waiting times are longer than normal and patients awaiting discharge to acute care facilities face longer wait times, sometimes up to 30 days, according to a Home Ministry survey.
The Home Ministry has recommended steps that stakeholders can take to de-escalate tensions at both the state and federal levels. These steps include:
- providing additional federal funding to hospitals and affiliated providers,
- Investing in training for behavioral health, substance use disorders, and trauma-responsive workers,
- launching a statewide campaign to encourage entry into the health care workforce with direct connections to employment, education and training,
- Maintaining public emergency flexibility at the state and federal levels that allows for telehealth capabilities, and
- Passing stronger workplace protections for violence against health care workers.
The AHA suggests a focus on recruitment and diversity in the health care workforce:
- removing limits on Medicare-funded physician residencies,
- providing loan waivers and scholarships,
- encouraging work visa relief for foreign trained nurses,
- increasing support for nursing schools and faculty, and
- Providing behavioral health funding to address, prevent and treat burn-out.
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