In March 2021, the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS) released results from a national survey conducted between February 22-26, 2021 of front-line hospital administrators at 320 hospitals across 45 states, the District of Columbia, and Puerto Rico.  The purpose of the survey was to assess how responding to the ongoing COVID-19 pandemic has impacted hospital administrators’ capacity to care for patients, staff, and the communities they serve.

The survey focused primarily on (1) the most difficult challenges administrators face responding to the COVID-19 pandemic right now and the strategies used to address those challenges; (2) each organization’s greatest concerns for the future; and (3) how the government can best support hospitals.

Employee Well-Being

Administrators specifically reported the pandemic had resulted in increased hours and responsibilities for staff, including longer hours, extra shifts, reassignments to COVID-19 related duties and tasks, and mandatory overtime, leading to exhaustion and mental fatigue. Importantly, they also reported concerns about the trauma experienced by staff members and the grave realities of the pandemic weighing on their mental health, including mourning the loss of colleagues from COVID-19, being on the front lines caring for dying patients in their last moments without any patient family members present, and facing separation from their families for extended periods of time in an effort to keep their family members safe from potential exposure.

Turnover and Staffing Shortages

Administrators also reported that hospitals have experienced higher than normal turnover among medical staff causing staffing shortages, especially in positions such as respiratory therapists, certified nursing assistants, phlebotomists, laboratory technicians, and support staff critical to hospital operations.  Hospitals attributed much of this turnover to the fatigue from pandemic care, prompting staff members to retire early or even leave healthcare altogether.  With potentially fewer financial resources and a smaller labor pool, smaller and rural hospitals reported that these shortages especially impacted them.

To address staffing shortages hospitals have relied more extensively on traveling nurses and staffing agencies to fill essential roles, although patient care concerns have resulted because individuals filling these roles are less familiar with individual hospitals’ protocols.  Administrators are also concerned that the COVID-19 pandemic has deterred interest in the healthcare industry for students–a staffing impact that could remain for years to come.

Vaccines

As vaccines are distributed across the country, healthcare workers were some of the first to receive them.  However, administrators reported challenges responding to vaccine misinformation amongst staff and communities, as well as ensuring vaccine access for rural and low-income communities.  Administrators face difficulties convincing staff members of the importance and safety of the vaccine.

Overcoming these Challenges

To combat these challenges, administrators noted that they are establishing employee assistance and mental health and social support programs for staff.  They are also leveraging resources to reallocate staff from other departments and trying to retain and attract talent with higher pay, overtime incentives, bonuses, and other benefits where possible.  Further, they are launching vaccine education campaigns to educate employees and their communities from which they are seeing results.

Certainly, the survey underscores that the strains of the COVID-19 pandemic–both physical and emotional–are far-reaching.