Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
While personnel shortages existed in the health care community before the pandemic, the pandemic exacerbated these shortages. Maintaining an appropriate level of personnel in health care facilities is essential to providing a safe work environment for health care personnel and quality care to patients. The Pandemic Response Accountability Committee’s (PRAC) Health Care Subgroup developed this report to share insights into personnel shortages across four select federal health care programs, or the providers they reimburse (hereinafter referred to as “federal health care programs”). Together, these four programs provide health care services to approximately 20 million individuals.
This report (108 pages) provides Congress, federal and state agencies, health care organizations, and other policymakers with information to inform and raise awareness on health care shortages across the four federal health care programs. Specifically, this report summarizes the types of personnel shortages most commonly reported; factors that contributed to personnel shortages; impacts most commonly encountered; and the incentives and strategies used to recruit and retain personnel, and minimize burnout for existing personnel across the four federal health care programs.
OIGs identified the following key insights across the four federal health care programs reviewed.
- Nurses and medical officers were the most commonly reported positions that experienced shortages during the pandemic.
- A limited labor pool, noncompetitive pay, COVID-19 requirements, and a challenging hiring process were the most commonly reported factors that contributed to personnel shortages.
- A decrease in patient access to care and patient satisfaction; and an increase in health care personnel work hours and responsibilities were the most commonly reported impacts resulting from personnel shortages.
- Monetary incentives were the most commonly reported strategy to recruit and retain personnel.
Even though the federal health care programs have incentives and strategies to attract and retain health care personnel, the programs still experienced personnel shortages throughout the pandemic. Consequently, additional action is necessary to staff normal operations and to strategically plan for future surges in personnel needed to respond to pandemics and other health care emergencies. The PRAC encourages policymakers to further explore the impacts of personnel shortages within the federal health care programs for possible strategies to mitigate staffing shortages and help ensure high quality, safe, and timely health care is provided to the individuals the programs serve.
The CARES Act created the PRAC to coordinate oversight of the federal government’s pandemic response and its historic level of emergency spending. The PRAC’s Health Care Subgroup consists of OIGs that oversee the federal agencies that provide or reimburse for health care services. By working together and sharing data, the Health Care Subgroup provides coordinated oversight across agencies and programs.
The four Departments and facilities reviewed include:
1. Department of Defense … Medical Treatment Facilities
2. Department of Justice … Federal Bureau of Prisons
3. Department of Veterans Affairs … Veterans Health Administration Facilities
4. Department of Health and Human Services … Medicare– and Medicaid–Certified Nursing Homes
Source: Scope of the four federal health care programs.
- Medicare– and Medicaid–certified nursing homes are not federally operated, but rather receive reimbursement for services they provide to enrollees in Medicare and Medicaid programs.
Health Care Personnel Impacts. Officials from the four federal health care programs reported impacts to their personnel because of personnel shortages. Officials from all 24 MTFs sampled stated that shortages of health care personnel resulted in increased duties and work hours for the remaining personnel, decreased morale, and decreased access to medical cases that are necessary for providers to gain or maintain their medical skills. BOP officials reported an increase in workload for health care personnel at BOP institutions because they handled large numbers of inmate illnesses due to COVID-19, as well as taking on new responsibilities, such as screening and testing for COVID-19 and monitoring quarantine and isolation units. Officials from Medicare– and Medicaid–certified nursing homes stated that the personnel shortages resulted in: (1) personnel increasing their workloads, often working longer shifts and covering the shifts of other personnel, and (2) more staff calling out of work to avoid increased workloads. Officials also stated that these conditions led to burnout and increased levels of stress, anxiety, and depression. Directors from the VHA’s Veterans Integrated Service Networks reported burnout among human resources personnel because of the unanticipated workload associated with the hiring surge to address personnel shortages caused by the pandemic.
I encourage you to review, share and discuss this report with your team and colleagues. The above excerpts are only part of the report. There’s a lot in here to learn from.
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