Opinion: How the Workforce Shortage Is Affecting Patient Care

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Alarms beeped and monitors flashed as nurses rushed to the corner of the neonatal intensive care unit. I heard the commotion, and I immediately knew they were dashing to our sickest baby, who had been born after just 26 weeks of pregnancy. The baby had survived for 35 days. But now, my little survivor was in peril.

I am a pediatric intern at Harbor-UCLA Medical Center, a safety-net hospital in Los Angeles. I was on call in the NICU that night, when the hospital was understaffed due to COVID-19 and the nationwide workforce shortage. 

I remember that frightening night vividly. I had swiftly made my way to the baby’s incubator to find his vital signs crashing right before my eyes. He wasn’t breathing on his own and his heart rate was dropping. I called for my supervisors, who quickly made their way to the baby, who I’ll refer to as K. We aren’t using his full name, because he’s a minor.

Like a well-oiled machine we all knew our jobs. The neonatal fellow (a pediatrician doing higher level training in neonates) placed a breathing tube to get oxygen to K. The supervising neonatologist softly barked orders, nurses handed over supplies before being asked, and respiratory therapists set up the ventilator at just the right strength for a fragile, two-pound preemie. My jobs were to enter urgent medication orders into the electronic record and to call for support services, including radiology, for much-needed help.

Despite my best efforts, I failed in the latter. With each phone call I was told that department didn’t have anyone to send to another emergency. Everyone was short staffed.

It was in this moment that I realized just how drastically COVID-19 had affected the entire health care workforce. Despite the overwhelming demands for medical care, health care jobs weren’t immune to the pandemic, and perhaps, they were even more vulnerable.

COVID-19’s overall effects on unemployment has received a lot of attention. But there hasn’t been enough focus on the devastation of the health care workforce. So many workers have been lost to economic cuts, early retirement, burnout and even death.

More than 3,600 frontline health care workers died in the United States due to COVID-19 in the first year of the pandemic, according to a Kaiser Health News report. Few new workers are available to fill those permanently vacated positions. 

Early in the pandemic, with closures of medical facilities and cancellations of elective procedures, some jobs were eliminated with little notice. Other medical professionals simply walked away from their jobs — some out of frustration and some from exhaustion. Health care workers quit at rates 35 percent higher than they did pre-pandemic, compared to 29 percent for workers in non-medical professions. 

In a survey, U.S. health care executives cited personnel shortages as the second most pressing challenge facing community hospitals, a higher ranking than before COVID-19. 

The biggest need is for nursing personnel, primary-care physicians and medical technicians, including for radiology and laboratory departments. Sadly, the workforce shortage for these positions began before the pandemic and has worsened since, with little hope for improvement in the near future.  

Given this nationwide shortage, medical professionals are in high demand. Some health care workers, such as registered nurses, are leaving their current positions for temporary,  higher paying positions in high-need areas through travel nursing agencies. 

Hospitals are coping with unprecedented turnover. Staffing turnover has increased from the pre-pandemic rate of 2 percent to 20 percent during the pandemic. 

For the workers who have persevered, many are facing burnout. Burnout is defined as a long-term — almost debilitating — stress marked by emotional fatigue, depersonalized care and the loss of a sense of accomplishment.

Some workers with burnout have quit, but others trying to struggle through are exhausted, physically and mentally. The system is demanding even more from these weary workers. Staff have been asked to work longer hours and more shifts, while taking on increased responsibilities. Some even have mandatory overtime, further straining an already strained system. All of these factors can end up increasing health care costs for everyone. 

Staffing shortages can also impact patient care and safety, as in the case of baby K.

If K’s care had been delayed, he could have suffered complications. For example, if his breathing tube wasn’t in the right place, he might not have had enough oxygen. We often rely on a chest x-ray to check the tube’s position, but with a stethoscope we were able to hear the air moving in-and-out of his lungs beautifully. Soon, his vital signs stabilized. 

Fortunately, K didn’t have any new problems. His immature lungs just needed ventilator support a little longer. 

But I learned something from the experience. 

My takeaway lesson is that our health care workforce cannot sustain these “survival mode” working conditions forever. We need policymakers, elected representatives and health care industry leaders to improve working conditions and compensation for this essential workforce, or our patients could suffer.

Dr. George Hyde is completing his pediatric residency training at Harbor-UCLA Medical Center.

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