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Many of the healthcare workers who fought to contain the coronavirus pandemic for the past 20 months are now leaving the industry. On Tuesday, health system leaders explored ways to stop the labor crisis from snowballing, during a webinar sponsored by the American Hospital Association.

About contemplated leaving their roles, and 61% said the pandemic had negatively impacted their mental health, according to a Kaiser Family Foundation/Washington Post survey.

"We've seen the stress on our care teams," who through two waves of the pandemic have "stretched" and "extended themselves," said David Zaas, MD, CEO of MUSC Health Charleston division and chief clinical officer of MUSC Health, serving facilities across South Carolina.

Now health systems are seeing the consequences of that unrelenting pressure as labor shortages mount, he said.

"We've seen vacancy rates in all of our critical positions increase," Zaas said, adding that the crisis isn't only about a shortage of physicians and nurses, it's having an impact on patient transporters, operating room technicians, and sterile processing workers as well.

Mary Beth Kingston, PhD, RN, chief nursing officer of Advocate Aurora Health, serving Wisconsin and Illinois, cited a recent Department of Labor report that found that left their jobs in August.

"Our September data just for nursing shows that we have more than 1,600 RN staff openings," a fraction of the roughly 22,000 nurses in her health system, but still a concerning number, she said.

For Leonard Hernandez, president and CEO of Susan B. Allen Memorial Hospital in Kansas, however, even a small number of vacancies at the rural hospital matters.

"We have 265 [full-time employees] and as of this morning, we have 33 posted positions," he said. "So I mean, it's real ... it's very real."

When asked whether health systems would be able to maintain access to care if new demands occurred, Kingston shared that her health system is already seeing an increased volume of patients, which coupled with shortages has led to increased wait times, especially in emergency rooms.

"Think of where we have nurses," said Kingston. "In the hospital, in the homecare, in that community -- and if we don't have enough, it will impact services."

Zaas said that MUSC is doing well compared to many others, but the lack of "redundancy" in his hospitals is a concern because he doesn't want to deny services to patients. "There's very little that we do in hospitals that's elective care. Right?"

Early in the pandemic, health systems "delayed a lot of medically necessary care, and we know it had a detrimental impact," he said.

Addressing Shortages

Panelists spoke of ways to help mitigate the labor crisis, from addressing child care needs, to preceptor payments, and funding from Congress.

With regard to nursing in particular, Kingston said it isn't just a shortage of nurses that matters, it's the skill level and experience of the nurses that are leaving that has an effect. "When we bring in five new graduates -- new nursing graduates -- that does not equate to five nurses with 35 years of experience leaving," she said.

Her health system offers preceptor pay to try to retain those skilled nurses who can pass their training on to newer nurses.

Child care is also a huge issue for a lot of hospital staff, noted Kingston. To address issues like children being quarantined or school closures, her health system implemented a childcare stipend.

Attending to hospital staff's well-being is also critical, she said, highlighting her health system's peer-to-peer programs and its support for the Dr. Lorna Breen Bill and other legislation that aims to promote and protect the health and well-being of the workforce.

"If we don't have a healthy workforce, we are not going to be able to provide the care to those who we serve," said Kingston.

Pipeline Concerns

For his part, Zaas emphasized the need for loan repayment programs, which acknowledge student debts and help to establish long-term relationships with an institution.

Kingston voiced her support for such programs, adding that she'd like to see more funding from the federal government to expand faculty at community colleges, colleges, and universities with nursing programs.

"Tens of thousands of qualified applicants are being turned away from nursing programs every year due to faculty shortages and lack of clinical sites," she said.

Similarly, Zaas noted that graduate medical education (GME) funding has been flat for decades and the number of GME slots has not increased since 1996. Zaas said his health system is very supportive of over a 7-year period.

Hernandez took a slightly different view, advocating for returning to hospital-based training programs rather than junior college or even bachelor's degree programs for nursing, which can cost $50,000 to $60,000 -- a "big deterrent."

Finally, all of the panelists agreed that Congress should be doing more financially to support hospitals and health systems.

Congress still has $25 billion from the Provider Relief Fund that has not been distributed, the panelists noted.

After furloughing 1,000 workers, Zaas said his health system was able to bring them back using funding from earlier disbursements. "We're committed to care in the community and the best care is local, but to do that right we all need that support," he said.

One of the best things the government can do right now to help hospitals, Hernandez said, is to forgive CMS . "CMS is not going to close if they don't get those funds back, but hospitals could," he said.

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