HAP Resource Center

Report: Addressing Member Hospital Workforce Needs, Executive Summary

BACKGROUND

The Pennsylvania health care workforce is at a crossroads. Shortages of medical providers are challenging the ability of hospitals across the state to keep up with the demand for health care services.

To better understand our hospital members’ needs, HAP launched a workforce survey in November 2021 to evaluate current health care workforce challenges in Pennsylvania. The survey was designed to identify the nurse and allied health professional staffing and physician recruitment needs in the health care community.

The survey results help to inform the ongoing efforts of HAP’s Health Care Talent Task Force. Early in 2020, HAP released a workforce report, Addressing Pennsylvania’s Health Care Workforce Challenges. This report was the culmination of a year-long process by HAP’s Health Care Talent Task Force to develop strategies to support HAP’s goal of assisting members to enhance their health care team talent pool.

Results from the survey are critical to HAP’s advocacy efforts supporting Pennsylvania’s hospitals and health systems. This includes documenting workforce challenges; advocating for solutions with legislators, state agencies, educators, and other stakeholders; and providing comparative analyses for member hospitals and health systems to use in their workforce planning, recruitment, and retention efforts.

METHODOLOGY

HAP’s workforce survey examined the following categories:

  • Direct care professional vacancy rates
  • Direct care professional turnover rates
  • Reasons for staff leaving the hospital's workforce
  • Retention and recruitment strategies
  • Barriers to employing staff
  • Use of agency nurses
  • Pronounced staffing needs
  • Physician vacancy rates

Individual hospital responses were requested. Members were instructed to coordinate the completion of the survey through their human resources departments.

The survey was conducted from November 10 to December 21, 2021.

Preliminary results reported included data from 63 responses. The report has been updated after receiving a total of 69 responses, which is a significant sample size encompassing hospitals across the state.

KEY FINDINGS

Responding Hospitals

Distribution of survey respondents among Pennsylvania regions:

Map showing the distribution of survey respondents among Pennsylvania regions.

Vacancy and Turnover Rates

The data provided by members helped us calculate vacancy and turnover rates for different categories of professionals. Findings from this information indicate that:

  • The vacancy rates for registered nurses (RNs) providing direct patient care between 2019-2021 increased from 21% to 27%
  • Nursing support staff (CNA, PCA, NA) vacancy rates increased from 32% to 45%
  • Clinical nurse specialists (CNS) vacancy rates jumped from 15% to 32%. Whereas, the certified nurse-midwives (CNM) vacancy rates dropped from 21% to 16% during this period
  • The turnover rates also increased for RNs providing direct patient care between 2019-2021 increased from 11% to 14%, nursing support (CNA, PCA, NA) 20% to 23%, clinical nurse specialists (CNS) 7% to 13%

Areas of Physician Need

Members identified the following areas of greatest physician need:

  • Neurology
  • Psychiatry and behavioral health
  • Internal medicine
  • Endocrinology
  • Pulmonary/critical care
  • Family medicine
  • Pediatrics

A total of 29 percent of survey respondents indicated they are experiencing delays in onboarding physicians under the J-1 VISA program administered by the Pennsylvania Department of Health.

Retention and Recruitment Strategies

Retention and recruitment strategies were also shared. Respondents (66%) identified the following bonus tactics as their top strategy for retention/recruitment:

  • Recruitment incentives
  • Increased commitment incentives
  • Extra shift incentives
  • Sign-on bonuses
  • Short staff bonuses
  • Additional shifts

Additional strategies included:

  • Flexible work schedules (64%)
  • Increase in base compensation (56%)
  • Retention bonuses (38%)
  • Professional development/tuition reimbursement (28%)

Other retention and recruitment strategies that were mentioned include:

  • Shift differentials
  • Promotion/career ladder advancement
  • Increased personal time off for experienced nurses

Bar chart of top three successful retention and recruitment strategies

Barriers to Employing Staff

Hospitals had the opportunity to identify more than one key barrier to employing staff. The key barriers identified included:

  • Finding qualified individuals (90%)
  • Wages/benefits associated with hospital financial constraints (44%)
  • COVID-19 related concerns (26%)
  • Timeliness of processing criminal background checks (15%)
  • Timeliness of processing/approval of licensure applications (13%)
  • Unavailable/inadequate child care (8%)

Other barriers identified by 56% of the respondents included:

  • Competitive compensation pressures
  • Rural population
  • Available individuals

Chart showing the top three barriers to employing staff

Use of Staffing Agencies

Respondents shared their experiences with staffing agencies and how hourly rates have gone up between 2019 and 2021 because of the workforce shortage and instability in the market. Hospitals responding to the survey reported that, on average, since 2019:

  • Hourly rates paid to staffing agencies for registered nurses providing direct patient care in medical/surgical and other units have increased by 108 percent from $59 per hour to $123 per hour while the average number of shifts per day worked by temporary staff increased from five to eleven
  • Hourly rates paid to staffing agencies for registered nurses providing direct patient care in specialty units have increased by 82 percent from $66 per hour to $120 per hour while the average number of shifts per day worked by temporary staff increased from four to nine
  • Hourly rates paid to staffing agencies for nursing support staff (such as certified nurse assistants, patient care assistants, and nurse assistants) have increased by 444 percent from $9 per hour to $49 per hour while the average number of shifts per day worked by temporary nursing support staff increased from three to five

Areas of Critical Staffing Need

Survey participants identified the following top areas for critical staffing needs:

  • Emergency (83%)
  • Medical-surgical (78%)
  • Intensive care unit (59%)
  • Surgical (31%)
  • Other areas, including respiratory, behavioral health, telemetry, and surgical services (10%)

Workplace Violence

Hospitals reported a significant increase in workplace violence against:

  • Front-line staff (64%)
  • Emergency room staff (77%)
  • Medical-Surgical staff (70%)
  • Staff in other patient-serving areas (36%)

CONCLUSION

HAP’s Workforce Task Force, comprised of hospital administrative and clinical leaders and health professional educators, will review the workforce analysis and utilize this data to help guide HAP in developing key public policy priorities to address the issues outlined in the survey findings.

 

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Topics: Access to Care, Workforce

Revision Date: 2/17/2022

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