Low healthcare worker supply and high costs are front of mind for hospitals and health systems amid yet another wave of COVID-19, but industry groups have some disagreements about what—and who—is fueling the issue.
Late last week, National Nurses United (NNU) pointed its finger directly at provider organizations and hospital administrators.
“The hospital industry is crying false tears over the lack of nurses willing to stay in direct care when these untenable working conditions are entirely of their own making,” the national union said in an Aug. 26 statement.
Hospitals “deliberately” failed to staff units with an appropriate number of nurses to ensure safe and optimal care and cut back on other safety measures “to maximize profits and excess revenue,” the union wrote. As a result, NNU said much of the nursing workforce made a “difficult decision” to walk away from hands-on care.
“Hospitals cut and laid off staff from units that had temporarily low patient census, and canceled [registered nurse] traveler contracts,” NNU wrote. “Again, the industry was shortsightedly looking for immediate ways to cut costs and boost profits instead of planning for patient and public health needs. Hospitals’ actions, and inaction, have resulted in a lack of critical care staff during COVID.”
To bolster its case, the union pointed to a 2017 Department of Health and Human Services report suggesting that nurse shortages are regional and that the U.S. as a whole has an adequate supply of registered nurses. Any nationwide shortage would not be of those with degrees, NNU wrote, but of those “willing to risk their licenses or the safety of their patients by working under the unsafe conditions the hospital industry has created.”
The union capped its statement with a call for hospitals to increase the number of nurses scheduled on each shift and to implement appropriate infection control.
These “accusations” received a sharp rebuttal Friday afternoon from Federation of American Hospitals (FAH) President and CEO Chip Kahn.
“[NNU] must be experiencing a different reality than the rest of us,” he said in a statement. “All over the country stressed frontline caregivers, including nurses, are performing valiantly in the face of an ongoing tragedy. But the truth is these heroes are in short supply.”
Kahn said the country’s hospitals “are doing everything possible” to ensure patients receive care and “are meeting the challenge” of providing sufficient staffing, protective equipment and supplies.
“But, to deny the headwinds we are facing with staffing reflects a regrettable lack of understanding of the unimaginable stresses the COVID-19 pandemic continues to place on caregivers, hospitals and the patients that depend on us,” Kahn said.
In earnings calls and industry reports alike, hospital executives have pointed to mounting labor costs as a substantial burden.
In a recent McKinsey survey of 100 large private sector hospitals, for instance, 84% of respondents said nursing workforce coverage was a continuing pandemic challenge. The respondents collectively indicated a nearly 5 percentage point increase in nursing turnover rates during the second quarter of 2021 and a 3.7 percentage point change in the quarter’s nursing vacancy rate. To maintain their nursing workforce, 31% of respondents said their hospitals offered a wage increase, 30% a recruitment increase, 16% a one-time bonus, 10% upskilled their nurses and 4% implemented flexible scheduling during the prior three months.
At the same time, staffing and safety concerns have been a consistent rallying cry for NNU and others in the workforce. These issues were at the forefront of a protest planned during Tenet Healthcare’s annual shareholder meeting and are among the core complaints of a nearly six-month-long nurses strike at St. Vincent Hospital in Massachusetts.
In a contrast to the FAH, representatives from other healthcare industry groups were more diplomatic in their responses to NNU’s claims.
Replying to a request for comment, Robyn Begley, senior vice president and chief nursing officer for the American Hospital Association (AHA) as well as the CEO for the American Organization for Nursing Leadership, highlighted 2018 Bureau of Labor Statistics data predicting 200,000 annual openings for registered nurses through 2026.
The industry has generally advocated for policies to support nursing education payments, she said, and worked with frontline staff to tackle the “unimagined challenges” of COVID-19 “while confronting numerous challenges outside the control of hospitals and health systems” such as the delta variant and public health politicization.
“With COVID-19 cases and hospitalizations now rising again in most of the country due in large part to the delta variant and not enough people being vaccinated, our health care workers’ crucial life-saving roles have never been more evident, which is why their safety, protection and well-being, including mental health, remain a top priority,” Begley said.
The AHA declined to comment further on NNU’s claims that hospitals’ cost-cutting efforts have impacted safety and driven staffing shortages.
Beth Feldpush, senior vice president of policy and advocacy at America’s Essential Hospitals, similarly focused her organization’s response to NNU’s statement on the pandemic efforts of hospital staff.
“Essential hospitals value and appreciate their frontline staff for their vital role in responding to the COVID-19 pandemic,” Feldpush said in an email statement. “Recognizing the strain that front-line workers face during the pandemic, essential hospitals are taking all steps within their ability to ensure that staffing shortages do not compromise access to care for the nation’s communities in need.”
Hospitals’ staffing shortages are being felt most acutely within states on the front lines of COVID-19’s summer resurgence, many of which have called for government intervention so they may open more beds and keep treating patients. So far, these measures have included Georgia’s $125 million investment into hospital staff employment and California’s executive orders waiving licensing requirements for out-of-state medical personnel.