2024-03
Addressing the Staffing Crisis in the Healthcare Workforce
Sponsored by
Sen. Wlnsvey Campos (OR), Asm. Jessica González-Rojas (NY) and Rep. Louis Ruiz (KS)
Reported to the Caucus by the NHCSL Healthcare Task Force
Rep. Alma Hernández (AZ), Chair
Unanimously ratified by the Caucus on November 23, 2024
WHEREAS, nursing staff includes an entire care team comprising multiple disciplines and ancillary staff; and,
WHEREAS, non-nurse disciplines, including physicians, physician assistants, pharmacists, physical therapists, respiratory therapists, and all other non-nurse specialties are crucial to delivery of high-quality care; and,
WHEREAS, workers in transport, environmental services and other healthcare titles are crucial to ensuring safe, high-quality care for patients; and unprecedented vacancies in these positions have been created due to safety concerns, inequitable compensation, and other poor working conditions, which are felt at the bedside; and,
WHEREAS, working conditions in clinical settings have deteriorated to the point where experienced professionals are leaving the bedside, new professionals are taking jobs outside of healthcare, and vacancies in ancillary jobs are critically unfilled; and,
WHEREAS, this situation is not only placing unconscionable strain on healthcare workers, it also has created a crisis that threatens the safety of patients and the overall stability of the United States healthcare system; and,
WHEREAS, nurses, professional associations, and unions have been advocating for safe staffing laws for decades. The lack of consensus among nursing groups and employers has stalled the discussion for too long, resulting in continued application of dangerous staffing approaches; and,
WHEREAS, mandatory overtime, misuse of on-call for staffing, overreliance on travelers and contract nurses, and unmanageable patient care assignments have become normalized. Staffing committees and other venues for nurses to vocalize staffing needs, while valuable, have not produced positive movement toward a standard that is safe; and,
WHEREAS, being responsible for unreasonable patient loads; relying on inexperienced and agency staff to supplement and care for these patients; and being expected to work more hours with fewer resources—putting their own health, the health of their patients and the health of their families at risk—have resulted in an adverse work environment wrought with ethical challenges that have left healthcare professionals feeling completely unsupported and morally injured, particularly during and since the pandemic;[1] and,
WHEREAS, research shows that minimum nurse-to-patient ratios improve patient outcomes, such as improvements in mortality, readmissions and length of stay;[2] and,
WHEREAS, efforts by the AFT and its healthcare affiliates, through their Code Red campaign, have resulted in an expanded number of states with safe staffing limits built into state law for all or some patient care units, such as the ones enacted via Oregon’s HB 2697 on Hospital Staffing Plans;[3] and,
WHEREAS, while the lack of enforceable standards has rendered healthcare staffing untenable for decades, the current situation is creating an existential crisis for the nursing profession. The consequence of unsafe staffing has a cumulative severe impact on the physical, mental, emotional and spiritual health of the nursing workforce; and,
WHEREAS, nurses and other health professionals are leaving the bedside because of unmanageable patient loads and the deplorable working conditions across the healthcare system. A 2022 survey reported that over one-third of nurses planned to leave their jobs by the end of the year, and nearly a third planned to leave the profession altogether;[4] and,
WHEREAS, pandemic-related pressures on healthcare accelerated this trend—the rate of violence in hospitals increased by 25 percent in one year alone from 2019 to 2020. And the correlation between inadequate staffing and higher incidence of violence in healthcare was well known even before the pandemic;[5] and,
WHEREAS, violence against healthcare workers is a serious and growing problem exacerbated by inadequate staffing. Healthcare workers experience 91.5% percent of all reported workplace violence[6] injuries in the American private labor force,[7] and the number of actual incidents of workplace violence is likely to be much higher; and,
WHEREAS, healthcare workers have endured unfathomable strain at work during the pandemic, including inadequate personal protective equipment; ever changing care protocols; and administrators who were unprepared, not supportive and, often, not present; and,
WHEREAS, our healthcare workforce has increasingly experienced moral distress caused by ethically challenging situations, such as the perception of not always being able to provide the normal standard of care and emotional support to patients and their families;[8] and
WHEREAS, the compounding impact of experiences of moral distress, burnout, and impossible working conditions is exacerbated by environments with inadequate organizational support by employers and government;[9] and,
WHEREAS, the fatigue and overwork (resulting from poor staffing and other failures of employers to prioritize a positive work environment for those delivering patient care) serve to deteriorate the resilience and ability to cope with stress across our healthcare workforce, impacting workers’ health, personal relationships and families; and,
WHEREAS, increased incidence of depression, anxiety and suicide among healthcare workers signify an immediate need to act; and
WHEREAS, a survey of emergency health workers reinforces our members’ experience and found a strong association between a perceived adverse working environment and poor mental health and patient outcomes, particularly when organizational support was deemed inadequate;[10] and,
WHEREAS, unfair and inadequate pay practices, such as the refusal to increase wages for experienced nurses, low starting wages for hard-to-fill positions, and failure to pay ancillary staff a living wage; are contributing factors to both new and experienced health professionals leaving their jobs—a dynamic that is exacerbating shortages; and,
WHEREAS, the use of travel agencies to fill staffing holes (a more expensive replacement rather than a supplement) has skyrocketed, forcing stark and unjust disparities in pay among clinicians; this is a development that exposes a deeply broken labor market in the healthcare industry; and,
WHEREAS, consolidation in the healthcare industry has resulted in a reduced number of corporations competing for workers, which has resulted in practices like wage suppression, normalization of diminished working conditions, increased healthcare costs, and few resources spent to ensure health professionals have the tools needed to deliver safe, high-quality care; and,
WHEREAS, elimination of services by hospitals not only deprives communities of care in rural and underserved areas, it also leaves specially qualified healthcare professionals unemployed, a dynamic that creates economic harm to families and those communities; and,
WHEREAS, employers and industry stakeholder groups are actively working to maximize profits—by cheapening care delivery through efforts to deskill our professions and seeking out cheaper labor forces—which complicates delivery of care, erodes scope of practice for a multitude of health disciplines, and threatens our jobs; and,
WHEREAS, the COVID-19 pandemic exacerbated pre-existing pressures and strain on the healthcare system and its workforce to a critical breaking point; and,
WHEREAS, healthcare is a high-stakes environment with highly complex systems on the clinical and the business sides, and where factors like the evolution of different models of nursing care, reimbursement-driven documentation systems, and advances in research and treatment mean incessant change for direct care clinicians; and,
WHEREAS, equity in the healthcare workforce is a requirement for broader health equity and the time for authentic, meaningful efforts at addressing racism, diversity, equity and inclusion in our healthcare workforce; and,
WHEREAS, it is well settled that outcomes improve when the healthcare workforce reflects the population it serves. However, minority healthcare workers are currently underrepresented, and as the complexity of the positions and the salaries increase, the diversity of the workforce decreases; and,
WHEREAS, the role of health professionals is not only crucial to the stability of today’s patient care environment but is also critical to teaching the next generation of professionals. At the same time, education and training programs often lack the funding, facilities or faculty needed to address the workforce shortage. And in nursing programs, where the problem is particularly acute, low salaries for faculty make choosing teaching unaffordable for many nurses.
THEREFORE, BE IT RESOLVED, that the National Hispanic Caucus of State Legislators supports state law that mandates staffing ratios, or safe patient limits, such as Oregon’s H.B. 2697 on Hospital Staffing Plans; and,
BE IT FURTHER RESOLVED, that the National Hispanic Caucus of State Legislators urges Congress to pass legislation that will secure staffing ratios in federal law, such as S.1113 - Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act,[11] and supports efforts to secure the same through all available regulatory means; and,
BE IT FURTHER RESOLVED, that the National Hispanic Caucus of State Legislators supports legislation banning mandatory overtime in healthcare in federal and state law; and,
BE IT FURTHER RESOLVED, that the that the National Hispanic Caucus of State Legislators supports protections in law that protect efforts by unionized healthcare workers to secure staffing ratios in collective bargaining agreements; and,
BE IT FURTHER RESOLVED, that the National Hispanic Caucus of State Legislators urges state legislatures and Congress to enact workplace violence protections, such as through passage of S.1176 - Workplace Violence Prevention for Health Care and Social Service Workers Act;[12] and,
BE IT FURTHER RESOLVED, that the National Hispanic Caucus of State Legislators supports laws that appropriate funding, programming, and other legal protections at both the federal and state levels to support health professionals in the areas of mental health, burnout and stress management, including addressing shortages in the mental health professions; and,
BE IT FURTHER RESOLVED, that the that the National Hispanic Caucus of State Legislators supports governmental efforts to secure resources and support to healthcare affiliates and members for student loan forgiveness programs and also workforce development funding, particularly in communities of color and in rural and other underserved areas; and,
BE IT FINALLY RESOLVED, that the that the National Hispanic Caucus of State Legislators supports workforce development programs in the law that increase diversity in the healthcare workforce, such as: addressing racism in healthcare workplaces; developing program models that help affiliates expand career outreach programs in communities of color to reach those who are underrepresented in healthcare jobs; and expanding targeted financial aid and loan repayment programs, including National Health Service Corps and the Nurse Faculty Loan Repayment program.
THE NHCSL HEALTHCARE TASK FORCE, AT ITS MEETING OF MARCH 18, 2024, UNANIMOUSLY RECOMMENDED THIS RESOLUTION TO THE EXECUTIVE COMMITTEE FOR APPROVAL.
THE EXECUTIVE COMMITTEE UNANIMOUSLY APPROVED THIS RESOLUTION AT ITS MEETING OF MARCH 24, 2024.
THE NATIONAL HISPANIC CAUCUS OF STATE LEGISLATORS UNANIMOUSLY RATIFIED THIS RESOLUTION AT ITS ANNUAL MEETING OF NOVEMBER 23, 2024 IN DENVER, COLORADO.
[1] Blanchard, J., Li, Y., Bentley, S. K., Lall, M. D., Messman, A. M., Liu, Y. T., Diercks, D. B., Merritt‐Recchia, R., Sorge, R., Warchol, J. M., Greene, C., Griffith, J., Manfredi, R. A., & McCarthy, M. (2022). The perceived work environment and well‐being—a survey of emergency healthcare workers during the COVID‐19 pandemic. Academic Emergency Medicine. https://doi.org/10.1111/acem.14519
[2] Rosenberg K. Minimum nurse-to-patient Ratios Improve Staffing, Patient Outcomes. Am J Nurs. 2021 Sep 1;121(9):57. doi: 10.1097/01.NAJ.0000790644.96356.96. PMID: 34438432.
[3] Oregon HB 2697. Available at https://olis.oregonlegislature.gov/liz/2023R1/Measures/Overview/HB2697
[4] Incredible Health. (2022, January). Nursing in the Time of COVID-19. https://www.incrediblehealth.com/wp- content/uploads/2022/03/IH-COVID-19-2022-Summary-1.pdf
[5] “Death on the Job: The Toll of Neglect,” 2022. https://aflcio.org/reports/death-job-toll-neglect-2022
[6] Defined as intentional or unintentional injury by another person resulting in days away from work, restricted activity, or job transfer.
[7] Bureau of Labor Statistics (BLS), Survey of Occupational Injuries and Illnesses (SOII), TABLE R4. Number of nonfatal occupational injuries and illnesses involving days away from work, restricted activity, or job transfer (DART), days away from work (DAFW), and days of restricted work activity, or job transfer (DJTR) by industry and selected events or exposures leading to injury or illness, private industry, 2021-2022. Available at https://www.bls.gov/iif/nonfatal-injuries-and-illnesses-tables.htm
[8] Blanchard, J., supra, n. 1.
[9] Ibid.
[10] Lake, E. T., Sanders, J., Duan, R., Riman, K. A., Schoenauer, K. M., & Chen, Y. (2019). A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes. Medical care, 57(5), 353–361. https://doi.org/10.1097/MLR.0000000000001109
[11] https://www.congress.gov/bill/118th-congress/senate-bill/1113
[12] https://www.congress.gov/bill/118th-congress/senate-bill/1176