Report: Addressing Member Hospital Workforce Needs, HAP's Workforce Shortage Survey Executive Summary, January 2023
The hospital community continues to face many challenges due to the COVID-19 pandemic. Shortages of providers and staff are challenging the ability of hospitals across the state to keep up with the demand for health care services.
To better understand our member hospitals’ needs, HAP launched a workforce survey during November 2021 to evaluate the health care workforce challenges in Pennsylvania at that time. The survey results helped to inform the ongoing efforts of HAP’s Health Care Talent Task Force.
Early during 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 with enhancing their health care team talent pool.
HAP launched a follow-up workforce shortage survey during late 2022. The survey was designed to identify the current nurse and allied health professional staffing and physician recruitment needs in the health care community.
Results from the survey are critical to HAP’s advocacy supporting Pennsylvania’s hospitals and health systems and the health care workforce. 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.
HAP’s workforce shortage 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; however, health system responses were accepted if parallel workforce trends were evident across each hospital within the system. Members were instructed to coordinate the completion of the survey through their human resources departments.
The survey was conducted from November 1 to November 18, 2022. Seventy responses were received, which is a significant sample size encompassing hospitals across the state.
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 between 2019 and 2022:
- The vacancy rates for registered nurses (RN) providing direct patient care increased from 20.5 percent to 30.7 percent
- Nursing support staff (CNA, PCA, NA) vacancy rates slightly increased from 31.5 percent to 32.3 percent
- Clinical nurse specialists’ (CNS) vacancy rates slightly increased from 15.3 percent to 17.2 percent and the certified nurse-midwives (CNM) vacancy rates increased from 21.3 percent to 28 percent during this period
- Certified registered nurse practitioners’ vacancy rates increased from 21.5 percent to 31.7 percent
- Respiratory therapists’ vacancy rates jumped from 19.7 percent to 32.4 percent
- Medical technologists/lab technicians’ vacancy rates increased from 9.9 percent to 24 percent during this period. Additionally, vacancy rates for medical assistants increased from 29.7 percent to 42.2 percent
- The turnover rates also increased for RNs providing direct patient care (10.4 percent to 15.3 percent), nursing support (CNA, PCA, NA) (19.5 percent to 21 percent), respiratory therapists (9.7 percent to 11.6 percent), and medical technologists/lab technicians (9.3 percent to 15.7 percent). The turnover rates decreased for clinical nurse specialists (CNS) (from 7 percent to 5.3 percent)
Areas of Physician Need
Members identified the following areas of greatest physician need:
- Primary Care
- Hospital Medicine Services
- Critical Care Medicine
Additionally, 21 percent of survey respondents indicated they are experiencing delays 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 identified the following strategies among their top three most successful for retention/recruitment. Increasing base compensation was the most common retention and recruitment strategy identified by respondents as being among the top three most successful.
Additional strategies included:
- Sign-on bonuses
- Extra shift bonus
- Increased shift differential
Other retention and recruitment strategies that were mentioned include:
- Increased engagement
- Internal travel agency created
- International labor
Barriers to Employing Staff
Hospitals had the opportunity to identify more than one key barrier to employing staff. Finding qualified individuals and financial constraints that limit the wages/benefits hospitals can offer were the most common barriers hospitals identified among their top three barriers to employing staff.
Other barriers identified by the respondents included:
- Low number of applicants
- Competition with other facilities
- Negotiated union rates
- Rural location
Areas of Critical Staffing Need
Survey participants identified the following top areas for critical staffing needs:
- Medical-surgical (73%)
- Surgical (38%)
- Emergency (37%)
- Respiratory (32%)
- Medical technologists (29%)
- ICU (27%)
- Other areas, including behavioral health, surgical services, skilled nursing and telemetry, and surgical services (24%)
- Labor and delivery (8%)
HAP’s Health Care Talent Task Force, comprised of hospital administrative and clinical leaders and health professional educators, will review the workforce analysis and use this data to help guide HAP in developing key public policy priorities to address the issues outlined in the survey findings.
Topics: Access to Care, Workforce
Revision Date: 1/23/2023
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