Mississippi Hospitals Navigate COVID Related Challenges

Supporting the Workforce

In addition to a financial toll, the pandemic has left an emotional toll on hospitals and the health care workforce in general. A 2019 report from the National Academy of Sciences, Engineering and Medicine demonstrated one-third to one-half of clinicians reported at least one symptom of burnout.⁴ Mental Health America reports that 93% of health care workers experienced stress during the pandemic.⁵ Eighty-six percent reported experiencing anxiety and 76% reported exhaustion and burnout. Thirty-nine percent of health care workers did not feel like they had adequate emotional support, and nurses were less likely to have emotional support (45%). Half of all physicians were experiencing burnout before the pandemic.⁶

During a March 2022 speech at the American College of Healthcare Executives Congress in Chicago, Melinda L. Estes, MD, President and CEO of St. Luke’s Health System and 2020 Board Chair for the American Hospital Association, noted that one in four of our colleagues has left the field due to COVID-19 – for many different reasons.⁷ Those reasons range from vaccine mandates to burnout to family responsibilities. This exodus has vastly changed the landscape of the health care workforce.

Workforce Shortages

Mississippi hospitals are facing a critical shortage of workers. Nurses, who are critical members of the patient care team, are one of the many health care professions currently in shortage. It is estimated that Mississippi hospitals currently have almost 3,000 nursing vacancies. Mississippi’s RN vacancy rate was 16% in 2021, with LPNs having a 20% rate and CNAs at a 14% rate.⁸

According to a February 2022 poll by USA Today, 23% of currently employed nurses are considering leaving.⁹ Turnover rates are already high in Mississippi – at 24% for RNs, 28% for LPNs, and 46% for CNAs.⁸

Nurses make up the largest portion of the health care workforce. In past years, more than 60% of the nurses worked in hospitals. Recent data show that less than 45% currently work in a hospital setting. This nursing shortage has resulted in an increased reliance on contract labor from health care travel staffing firms, driving up expenses for hospitals and further exacerbating hospitals’ financial challenges.⁸

In 2021, the median age of a registered nurse was 52 years of age. By 2030, it is estimated that one million RNs will retire from the profession.¹⁰ Burnout, vaccine mandates, and fear of becoming ill led many to retire early. While Baby Boomer nurses are retiring en masse, we need even more nurses to take care of the Baby Boomers.

In 2020, enrollment in baccalaureate and higher-level nursing degree programs increased, but colleges and universities still turned away more than 80,000 qualified applicants due to shortages of faculty, clinical sites, and other resources, according to the American Association of Colleges of Nursing.¹¹ This number does not even include those students turned away from community colleges.

The workforce shortages are not limited to nurses. Respiratory therapists, licensed practical nurses (LPNs), certified nursing assistants (CNAs), and pharmacy technicians are also in short supply. The U.S. could face a shortage of 37,800 to 124,000 physicians by 2034, according to data released by the Association of American Medical Colleges.¹² More than two in five active physicians will be older than 65 in the next decade.

These workforce shortages directly affect access to care by leading to decreased access to hospital beds, reductions in essential service lines, limited access to specialized care, longer wait times in emergency rooms, and discharge delays. These care bottlenecks are leading to increasing walkouts in emergency rooms and the need to reschedule surgeries. Delays in care often lead to additional emergencies or medical complications.

While there is much research on how patient safety suffers under nursing staffing shortages, there is a dearth of research on the patient safety impact of the increased and extended use of travel nurses. Temporary staff may lack training in hospital-specific quality protocols, and communication may suffer from a lack of relationships with the care team.¹³

The recent case of RaDonda Vaught, a former Vanderbilt University Medical Center nurse, who was charged with criminally negligent homicide for a medication error resulting in death, could also discourage potential students from considering clinical care as a career.¹⁴ This case could also reopen the door to charging physicians for acts assumed to be negligent that result in harm to a patient and could further exacerbate clinical staff shortages as nurses and physicians not willing to take personal risk exit the field.

In March of 2022, ECRI recognized staff shortages as the top risk to patient safety for 2022.¹⁵ To protect the quality of care, we must evolve. Our workforce care model – for both employees and patients – must evolve.¹⁵

Opportunities for Innovation

Long-term workforce and financial challenges for hospitals existed before the pandemic, and the challenges are expected to continue. These workforce shortages, combined with an aging population, have created a national emergency. Health care leaders and policymakers at every level of government must focus their attention on solutions.

There are just as many opportunities as there are challenges. The Mississippi Hospital Association has been convening critical partners, including hospital nursing leaders, Mississippi Schools of Nursing, and the Mississippi Board of Nursing to focus on nursing workforce issues. The care model has not changed in 30 years. Telehealth and hospital-at-home models may make the home rather than the hospital the epicenter of care in the future. Even during the pandemic, our care models evolved, and the health care field will need to focus on care delivery innovation and invention to thrive in this new and very different post-COVID world.