Healthcare leaders are trying to find new ways to retain and recruit employees across the field as the labor shortage, which began in 2020, worsens nationwide. There are no clear solutions to the workforce shortage, and in Massachusetts, health professionals say it will take more than one.
In state hospitals alone, about 19,000 acute care positions are unfilled, and more than 70% of the average hospital dollar goes toward labor costs — “wages, benefits and purchased services” — according to an October report from the Massachusetts Health and Hospital Association. Travel labor costs — for overseas workers who keep hospitals running — are projected to reach $1 billion, MHA predicts.
The report outlines its own set of possible responses, which include additional spending and different methods to attract new workers, but the solutions will have to extend beyond acute care.
Labor advocates like Marlishia Aho, regional communications manager for 1199SEIU, which represents hundreds of health care workers in the state, said change must start with wages.
“It requires all stakeholders to be at the table and again, centering the voices of workers in that discussion,” Aho said. “One of the easiest things we can say is to talk about paying people more.”
Health care workers may have been labeled “heroes” during the pandemic, Aho said, but more action is needed. In particular, she said, low-wage workers — home caregivers and others not necessarily in the hospital setting — should be remembered, because the entire field is being affected, not just doctors and nurses.
“Many are burned out who have struggled and are not paid adequately to thrive outside of work and can go into a less stressful job like at a Target or somewhere where they can make the same amount of pay, unfortunately ,” Aho said.
Healthcare workers are ‘really struggling’ financially
On behavioral health, Diane Gould, president and CEO of Advocates, a human and social services nonprofit in Framingham, said employees are “really struggling.”
Workforce wages should be “front and center” in the conversation, she said, and reimbursement rates are an important component of pay. Often, she said, potential student loan debt — about $200,000 for the average public medical school student, the Association of American Medical Colleges reports — turns hopeful health workers away from such an important industry.
“The work that our people and our staff do is incredibly important,” Gould said. “Health care is the backbone of community health and well-being.”
“You can’t wake up a psych nurse”
Sen. Julian Cyr, D-Truro, chairman of the Legislature’s Mental Health, Substance Use and Recovery Committee, said he thinks “funding is essential” and the state has already made allocations, but the outcome is yet to be seen.
“It’s going to take a while for that to take root,” Cyr said.
Recruiting also takes time, Cyr added, and even in the best-case scenario, training often takes two years.
“You can’t imagine a psych nurse,” Cyr said. “So even though we desperately need nurses and psychiatric providers across the spectrum, it’s not like it can be done quickly.”
Meanwhile, patients in a mental health crisis are being sent to emergency rooms when hospitals already have their own staffing problems. Lown Institute senior fellow Paul Hattis said these kinds of domino effects are common because the health care system is so intertwined.
Nursing homes can’t have enough staff’
“Even if things improve for hospitals, if a the nursing home may not have enough stafff, they cannot admit the patient from the hospital,” said Hattis. “It supports.”
Hattis, a former member of the state’s Health Policy Commission, added that hospitals don’t have enough money to raise salaries and other labor costs, so the state has stepped in to provide some funding. Most recently, about $350 million from the economic development bill went to hospitals, but that only helps for the immediate future.
“The long-term solution is about pipeline issues,” Hattis said, which includes recruiting more workers and providing mobility pathways for current workers.
Patricia Noga, vice president of clinical affairs for MHA, said the short term should include supporting existing workers.
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“You almost have to customize your approach to the needs of the individual employee,” Noga said. “Seeing the other things in their lives that affect their work. I mean, can we help with babysitting? What about transportation? What about parking? What about the financial advice and guidance they may need?”
Kenneth White, dean of the School of Nursing at the MGH Institute of Health Professions, said the pandemic, the retirement of baby boomers and increased patient needs all combined to create the “perfect storm.”
White, also president of the American Academy of Nursing, said it’s impossible to gauge when the shortage might improve, but “it would be faster if we had more government policy supporting this issue.”
The state considers clinical placements for student nurses
One step in the right direction, he said, is for the Department of Labor to create a program it is currently considering that would give nursing students the opportunity for more clinical placements, which are essential for learning.
He called it just “a drop in the bucket,” however, and said, as with behavioral health and other areas, the government needs to provide funding, especially for loan repayments.
“I think there’s a lot that can be done on the policy front to accelerate these changes,” White said.
MHA Chief Communications Officer Sam Melnick said the organization has released a toolkit that includes case studies of current cases in Massachusetts hospitals. The goal, he added, is to provide resources for healthcare leaders as they chart their path forward.
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“Every hospital is doing something innovative right now to address these issues,” Melnick said.
After all, said Noga from the MHA, labor issues are not limited to the pandemic, and with so many efforts to resolve the issue, the results and evaluation of the results will not be immediately apparent.
“We need to see how many of these interventions and innovations shake out over time,” Noga said. “It’s almost like you have to wait and see every five years where are we? See where we are and where we’re going next.”
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