HRM 630 Southern New Hampshire University Staffing Crisis Analysis
A F T H E A L T H C A R E 16560_C1_4,P_01_20 2/14/03 4:05 AM Page c1 Empty Hallways The Hidden Shortage of Healthcare Workers 16560_C1_4,P01_20 1/27/03 11:42 PM Page C2 “Common sense tells us there are a limited number of patients a nurse can care for safely, a limited number of slides a tech can read without losing attention to detail, a limited number of hours a person can work without becoming too exhausted to function. Unfortunately, common sense rarely prevails” SANDRA FELDMAN AFT President 16560_C1_4,P01_20 1/27/03 11:50 PM Page 1 FOREWORD T HE FACT THAT THERE IS A SHORTAGE OF NURSES WILLing to work in hospitals in this country is well documented. Some hospitals are offering sign-on bonuses as high as $30,000 to lure experienced nurses away from other employers. The American Hospital Association (AHA) reports that 89 percent of hospitals report openings for RNs that are unfilled, and 75 percent of hospitals today are finding it more difficult to recruit nurses than in the past. The national vacancy rate for RNs is 11 percent, according to the AHA, and this shortage contributes to delays in care and makes it more difficult for some people to receive the care they need. But the nurse shortage is only part of the story. Less publicized, but equally important, is the shortage of other healthcare professionals. Hospitals nationwide report vacancy rates of 21 percent for pharmacists, 18 percent for radiology technicians, 12 percent for laboratory technologists, and 9 percent for housekeeping and maintenance staff. Every healthcare worker is an integral part of the healthcare system, and a shortage in any area creates problems for every other classification of worker. Industrywide shortages such as those we are experiencing today create possibilities for delivering substandard, even dangerous, care to patients. Shortages also create a work environment that is not conducive to retaining the most qualified and experienced healthcare professionals, resulting in a revolving door of workers. AFT Healthcare looked at problems with recruiting and retaining nurses in a survey conducted in spring 2001 by Peter D. Hart Research Associates. The survey showed that many 16560_C1_4,P01_20 1/27/03 11:51 PM Page 2 nurses who currently are not working in the profession would consider returning to direct patient care if certain conditions were met. Almost two out of three who had left said they would consider returning if there was better pay (23 percent), better staffing levels (21 percent) and better, more flexible, schedules (21 percent). The survey results also showed that without these types of changes, one in five current direct-care nurses plans to leave the profession within the next two years, exacerbating an already dire shortage of nurses in our nation’s hospitals. 2 E M P T Y H A L LWAY S 16560_C1_4,P01_20 1/27/03 11:51 PM Page 3 16560_C1_4,P01_20 1/27/03 11:52 PM Page 4 SURVEYING HEALTHCARE PROFESSIONALS B UILDING ON THE FINDINGS OF THE 2001 SURVEY, AFT HEALTHcare commissioned Peter D. Hart Research Associates to conduct parallel surveys among three groups of health professionals: respiratory therapists, radiology technologists and certified nursing assistants (CNAs) in spring 2002. The survey sought to determine if these health professionals were experiencing the same types of workplace problems as nurses and if recruitment and retention were problems of concern. Interviews were conducted with 308 respiratory therapists, 302 radiology technicians and 302 certified nursing assistants in states that require CNAs to be registered. While each group of professionals had a distinct perspective, what united them was their perception of a serious staffing crisis in their field. Here are the surveys’ key findings: 4 ■ All three groups of professionals express low satisfaction with current conditions for health professionals, and point to inadequate staffing as the number-one problem they face. ■ Professionals report that staffing shortages are compromising the quality of healthcare provided, and even putting patients at risk. ■ Beyond the staffing problems in their own facilities, respondents perceive a broader shortage of qualified professionals in their fields that is caused by unsatisfactory working conditions. Indeed, inadequate staffing has itself become a cause of recruitment and retention problems. E M P T Y H A L LWAY S 16560_C1_4,P01_20 1/27/03 11:52 PM Page 5 ■ The solutions to these shortages identified by professionals include mandatory maximum professional-to-patient ratios, higher pay, improved health coverage, more support staff, opportunities for continuing education and a stronger voice on the job. The staffing problem within these three professions mirrors that of nursing. The complex circle begins with inadequate staffing, which serves as an impetus for workers to leave the profession, resulting in an even worse staffing situation. With proper staffing levels, workers tend to be more satisfied and less likely to leave. This is evidenced in the Australian province of Victoria where mandatory nurse-to-patient ratios recently were negotiated. Not only have more than 3,300 nurses who left the profession returned, but the use of agency nurses has almost ceased, and morale among Victoria’s working nurses has improved exponentially. NO DEBATE: THERE ARE SHORTAGES Health professionals experience the staffing crisis directly and personally. Every day, it reduces the quality of their work lives and constrains their ability to deliver quality healthcare. Yet given these results, it is clearly not a problem limited to certain facilities, professions or regions. There is a shortage of qualified professionals in all of these fields, and those working in the field clearly recognize it. Seventy-four percent of respiratory therapists report that there is a shortage of therapists in the area in which they live, including 33 percent who say the shortage is severe. Among CNAs, 79 percent report a shortage in their area, with 27 percent describing it as severe. The worst shortage appears to be in radiology, with 82 percent perceiving a shortage and fully 43 percent a severe shortage. Clearly, the healthcare system faces a widespread crisis in terms of hiring an adequate number of professionals to meet the needs of patients. E M P T Y H A L LWAY S 5 16560_C1_4,P_01_20 2/14/03 12:32 AM Page 6 WHO ARE THESE WORKERS? RESPIRATORY THERAPISTS There are about 100,000 respiratory therapists in the United States. They work with patients of all ages and in many different care settings. Respiratory therapists are members of the healthcare team that provides respiratory care for patients with heart and lung disorders. Most respiratory therapists work in hospitals where they perform intensive care, critical care and neonatal procedures. They typically are also a vital part of the hospital’s lifesaving response team that handles patient emergencies. Of the more than 7,000 hospitals in this country, about 5,700 have respiratory care departments. RADIOLOGY TECHNICIANS Radiology techs are the medical personnel who perform diagnostic imaging examinations and deliver radiation therapy treatments. They may specialize in a specific area of radiological technology – such as mammography, magnetic resonance, nuclear medicine, sonography, cardiovascular- interventional technology, radiation therapy or diagnostic radiography. Although the majority of radiological technologists practice within a hospital setting, many now work in private clinics or mobile facilities. There are more than 220,000 registered radiology techs practicing in the United States today. CERTIFIED NURSING ASSISTANTS There are more than a million certified nursing assistants (CNAs) working in hospitals and nursing homes around the country under the direction of nursing and medical staff. They perform essential routine tasks such as serving meals, making beds and helping patients eat, dress and bathe. CNAs may also take temperatures, pulse, respiration and blood pressure. They often help patients who need assistance walking, and they observe patients’ physical, mental and emotional conditions, reporting changes to nursing or medical staff. In nursing homes, CNAs are often the primary caregivers, having far more contact with the residents than any other members of the staff. Some nursing home residents may stay in one facility for months or even years and develop ongoing positive relationships with the CNAs who care for them. 6 E M P T Y H A L LWAY S EMPTY HALLWAYS 1/28/03 3:25 AM Page 7 Shortage of Health Professionals Is there a shortage of [people in your profession] where you live? 82% 79% 74% Yes, minor shortage Yes, moderate shortage Yes, severe shortage Respiratory Radiology therapists technologists CNAs FIG. 1 A shortage can reflect problems in both recruitment and retention. It appears that both factors are at work in all three fields, but with notable differences. Radiology techs report that retaining qualified techs is a problem (44 percent categorize it as being major or moderate), but consider recruitment to be the greater problem (64 percent). Similarly, respiratory therapists perceive a greater recruitment challenge (66 percent) than retention problem (44 percent). The situation is reversed for CNAs: Forty-six percent report a problem recruiting qualified CNAs, but 59 percent see a problem in retaining them. The fact that fully 29 percent of the CNAs have been working in the field for four years or fewer – compared to 6 percent of the respiratory therapists and less than 1 percent of the radiology techs – also suggests that high turnover is a problem in the CNA ranks. The survey sheds some light on the underlying cause of these retention and recruitment problems by exploring the E M P T Y H A L LWAY S 7 16560_C1_4,_01_20 1/28/03 3:27 AM Page 8 job satisfaction of health professionals. All three groups express low levels of satisfaction and report poor morale among their professional peers. Clearly, these are not factors conducive to successful recruitment or to retaining the services of qualified professionals. There are certain aspects of professionals’ work situations with which they express particularly strong dissatisfaction, and which therefore are likely to be important factors in causing professional shortages. As Figure 2 reveals, these three groups of professionals express low levels of satisfaction with regard to a number of critical issues. Clearly, there are serious compensation concerns: professionals are not satisfied with salaries or – ironically enough – their own healthcare coverage and costs. A rather lukewarm endorsement of retirement benefits is also offered by CNAs (42 percent satisfied), respiratory therapists (47 percent), and radiology techs (53 percent). Low Satisfaction With Key Conditions I am very/fairly satisfied with this aspect of my job: Respiratory Radiology therapists techs Salaries 48% 47% 31% Workload 46% 56% 42% Health coverage/costs 41% 46% 38% Job-related stress 39% 39% 46% Staffing levels 36% 46% 42% FIG. 2 8 CNAs E M P T Y H A L LWAY S 16560_C1_4,P_01_20 2/14/03 2:12 AM Page 9 THE STAFFING CRISIS Health professionals paint a rather gloomy picture in describing their current work environment. Only about half of respiratory therapists (53 percent), radiology techs (53 percent), and CNAs (50 percent) are very or fairly satisfied with the conditions facing people in their profession today. Similarly, they report low morale among their fellow professionals. Just 38 percent of respiratory therapists say morale is excellent or good, while 62 percent say fair or poor (radiology techs: 49 percent fair/poor; CNAs: 45 percent fair/poor). These professionals are more likely to feel that conditions for healthcare workers are getting worse rather than better: respiratory therapists (15 percent better, 56 percent worse), radiology techs (24 percent better, 47 percent worse), CNAs (26 percent better, 31 percent worse). Respiratory therapists—Those in large hospitals (over 250 beds) are less satisfied with conditions and report lower morale than those in smaller hospitals. Radiology techs—Morale is disproportionately low for those working in hospitals, and lower still for those in large hospitals. CNAs—Sixty-two percent of those who see 12 or fewer patients per day report good or excellent morale, compared to 44 percent among those who see 13 or more patients per day. Excellent Poor Good Fair FIG. 3 E M P T Y H A L LWAY S 9 16560_C1_4,P_01_20 2/14/03 3:53 AM Page 10 Getting better Staying about the same Getting worse FIG. 4 A number of factors contribute to this bleak outlook, including concerns about compensation, benefits and voice on the job. However, the single most important problem facing health professionals is inadequate staffing levels. As Figure 5 shows, all three groups report that understaffing is the number-one problem they face. Many also point to not having enough time to spend with patients and job-related stress, both of which are closely linked to the staffing problem. Only a minority in all three groups report that they are very or fairly satisfied with staffing levels at their facility, while a Inadequate Staffing Is #1 Problem What are the two biggest problems for [your profession] today? Respiratory Therapists Radiology Techs CNAs Staffing 49% Staffing 41% Staffing 46% Time with patients 36% Pay, benefits 27% Pay, benefits 46% Pay, benefits Advancement opportunities Autonomy 22% Workload 45% 12% Job-related stress 24% Time with patients 22% Advancement opportunities 22% Scheduling Delegation of duties 8% Physical work 8% Scheduling 7% Unsafe conditions 1% Time for breaks 6% 14% Time with patients Asked to perform duties not trained for Time for breaks Autonomy FIG. 5 10 E M P T Y H A L LWAY S 9% 6% 6% 5% 5% 16560_C1_4,P01_20 1/27/03 11:54 PM Page 11 majority of respiratory therapists (63 percent), CNAs (57 percent), and radiology techs (52 percent) say they are just somewhat or not satisfied. For respiratory therapists, this is the lowest level of satisfaction recorded among 15 different aspects of their job. Respiratory therapists—Seventy-four percent of those who work in large hospitals, and 67 percent of those who see 13 or more patients per day, express low satisfaction with staffing levels. Radiology techs—Just 38 percent of techs in hospitals are satisfied with staffing levels. The staffing crisis is a function of two powerful factors working together. First, professionals are simply being called upon to serve more patients. Majorities of respiratory therapists (72 percent) and of radiology techs (69 percent) report that their patient load has increased in the last couple of years, while among CNAs a significant 35 percent minority say their patient load has increased. Virtually no one reports patient load having decreased over that time. Fully two-thirds of respiratory therapists say they see more than 12 patients per day, and 57 percent of radiology techs see 20 or more patients. Greatly magnifying the impact of this increasing ratio of patients to professionals is the increasing acuity or sickness of their patients. As a result of multiple changes in the healthcare industry, the average hospital patient today is much sicker, and needs more care, than in the past. A majority of respiratory therapists (73 percent) and radiology techs (51 percent), as well as a 47 percent plurality of CNAs working in hospitals, say that the acuity of their patients has increased during the past few years. In addition to the shared experience of inadequate staffing, these three groups are also united when it comes to what they enjoy about their work as healthcare professionals. Over- E M P T Y H A L LWAY S 11 16560_C1_4,P01_20 1/27/03 11:54 PM Page 12 16560_C1_4,P01_20 1/27/03 11:55 PM Page 13 whelmingly, CNAs (81 percent), respiratory therapists (71 percent), and radiology techs (62 percent) point to “helping patients and their families” as the aspect of their job that brings them the greatest satisfaction. All three groups also cite challenging and interesting work and the opportunity to work with colleagues they like as important benefits. However, their primary motivation is clearly service to patients and families. Unfortunately, the ability of these healthcare workers to provide that service appears to be compromised by inadequate staffing levels. One immediate and important effect of staffing shortages is that professionals have less time to spend with patients. CNAs (60 percent) and respiratory therapists (58 percent) both say this is a very or fairly serious problem for them. (Direct patient contact is less relevant for radiology techs.) Indeed, CNAs consider their inability to spend time with patients to be as serious a problem as low pay or inadequate staffing, while respiratory therapists rank it second only to staffing. The Goal: Serving Patients/Families What do you enjoy most about [your profession]? Respiratory Radiology techs CNAs therapists Help patients and their families 71% 62% 81% Challenging/interesting work 25% 27% 17% Work closely with people I like 20% 25% 33% Professional autonomy 17% 11% 2% Continuously learning 8% 7% 19% Good salary and benefits 7% 13% 5% FIG. 6 E M P T Y H A L LWAY S 13 16560_C1_4,P_01_20 2/14/03 3:25 AM Page 14 QUALITY OF CARE SUFFERS, PATIENTS PLACED AT RISK Of even greater concern, a majority of professionals in all three fields say that as a result of poor staffing and increased workloads, the quality of care patients receive has suffered. Seventy-nine percent of respiratory therapists, 71 percent of CNAs and 70 percent of radiology techs report a negative impact on the quality of patient care. Moreover, substantial proportions in all three professions report that patients may have been placed at risk as a result of staffing shortfalls (58 percent of respiratory therapists, 46 percent of CNAs and 37 percent of radiology techs). Respiratory therapists—In large hospitals, 86 percent report an adverse impact on quality of care, and 67 percent say patients have been placed at risk. CNAs—Of those with 13 or more patients, 80 percent say quality of care has been compromised, and 60 percent report patients may have been placed at risk. Radiology techs—About 72 percent of those in hospitals say staffing has hurt quality of patient care. The Consequence: Quality of Care Suffers, Patients at Risk As a result of increased workload/poor staffing [in my profession]: Quality of care has suffered Patients may have been placed at risk 79% 71% 70% 58% 46% 37% Respiratory therapists FIG. 7 14 E M P T Y H A L LWAY S Radiology technologists CNAs 16560_C1_4,P01_20 1/27/03 11:55 PM Page 15 IMPROVING RECRUITMENT AND RETENTION Despite professionals’ concerns about conditions in the workplace, the survey results suggest that there are ways to improve recruitment and retention. One step endorsed both by respiratory therapists and by CNAs is establishing mandatory maximum patient-to-professional ratios. (This idea is not particularly relevant for radiology techs who generally see a wide variety of patients from various units and with varying degrees of acuity. Radiology techs supported increased staffing levels and workload limits that would provide a minimum timeframe for various procedures.) By an overwhelming margin, CNAs (88 percent to 7 percent) favor mandatory ratios. For CNAs in a hospital medical or surgical unit, the median suggested ratio is about 6:1. Fully 71 percent suggest a mandatory ratio of no more than 8:1. This stands in stark contrast to the current reality in hospitals, where fully 60 percent of CNAs say they currently care for more than ei…
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