Imagine that you are now the CEO of a large hospital system. You decide
that the best way to manage the hospital is to be out and about. You take a
tour to meet and greet the employees and talk to patients. At first glance, it
looks like things are running quite smoothly. It’s hard to imagine that the
nurse you just met is on his third straight shift, running on empty. Or that
the physician you said hi to accidentally caused an overdose due to being
overworked. This situation could be played out in almost any hospital
throughout the United States and unfortunately is becoming more
commonplace.
Shortages exist in every branch of health care. In the next module, we will
discuss some of the ways that the field has addressed these shortages;
however, in this module, we will discuss some of the trends and review the
impact that these shortages have on the triangle of health care.
In our opening example, our first impression was that the staffing appeared
just fine. To most individuals who receive health care services, it is difficult
to ascertain just how short- staffed the system truly is. In fact, some
individuals who have been in their respective positions for a long time may
not truly know what a full staffing level would even look like. Let’s look at
another example to see just how convoluted it all can become. Imagine that
a hospital initially opened in the 1970s. As it was cutting-edge and new, the
need for a high level of maintenance personnel was simply unnecessary. In
most health care settings (if not all), payroll is the most expensive cost
center. As such, at first, there were significantly more overall hours and
dollars in the nursing category than in environmental services. As the
building aged, administrators (meaning well, of course) knew they had to
increase maintenance staffing to keep up with the gradual decay. An hour
here from this nursing unit, an hour from that one, two hours from trauma,
and so on, and eventually there were enough labor hours to run the
maintenance department effectively. It was such a small variance, no one
felt it or noticed. Now, multiply this a dozen times, if not more. As we have
learned, insurance monies have been decreasing, health care costs
increasing, and hospitals have also been taxed with doing more (remember
EMTALA from the previous module); therefore, staffing budgets are not
growing at a relative pace. Again, it is hard to tell what full staffing would
truly look like.
Over the years, within our community, where the aforementioned hospital
is located, medical advances and progress have created various new
delivery systems. Each new home health care, new long-term care center,
ambulatory surgical center, etc. has required additional staff. Unfortunately,
across the nation, the rise of qualified health care professionals has not kept
pace with the advances. An internal tug-of-war was started between health
care entities. The hospitals found themselves competing with others for the
first time. Historically, the top payer (the hospital) soon found itself being
outbid. Today, some hospitals are offering $30,000 or more sign-on
bonuses for entry-level nurses. Competition is at an all- time high.
Looming over the field is the health care reform. As discussed in the last
module, how is it possible that the field of health care will be able to take
care of an additional 32 million Americans? Is it even possible? Time will
certainly tell.
There are still even stormier waters ahead. As the baby boomers grow
older, they will be increasing their utilization of health services. Keep in
mind that many of the current health care professionals are among the baby
boomers, and they will be retiring sooner rather than later. Lastly, the
remaining staff has been asked to work longer and carry greater case
numbers. As such, employee morale is at an all-time low, making the field
even less attractive for would-be licensed professionals. In a recent survey,
over 50% of registered nurses reported that if they had it to all over again,
they would have chosen a different occupation. The shortages are
impacting every aspect of health care.
Reference
PRNewswire (2011). Healthcare staffing shortage poll: Rough waters ahead.
Retrieved from www.prnewswire.com/news-releases
