Stop the Bleeding
#evolve Magazine
January 20, 2022
After nearly two years of living through the covid-19 pandemic, people are quitting their jobs at a higher rate than ever before. The physiological, physical and personal toll of the pandemic has especially affected health care workers, who continue to leave their jobs not only because of burnout but also because they feel “underpaid and undervalued” in their jobs.

A new survey by the American Association of Critical-Care Nurses revealed 66% have considered leaving their jobs because of the pandemic, and more than 90% believe that the pandemic will shorten nurses’ careers, according to an article by WebMD.

The U.S. Department of Labor Nov. 5 job report confirmed this trend, stating that “employment in health care is down by 460,000 since February 2020.” While the health-care industry did see a rebound of 37,000 jobs in October, most of these gains took place in home health-care services and nursing care facilities.

‘Underpaid and Undervalued’

A nurse from Atlanta, Georgia, who did not wish to be referred to by name, said that the lack of appreciation for the work she does and parity of pay with travel nurses — who work on temporary contracts for higher fees and move to different cities depending on the demand — has pushed her to think about quitting her job with a health-care facility and switching to a contractual job instead.

“We [regular hospital staff] showed up at work during COVID-19 and witnessed travel nurses or contractual nurses being paid three to four times more than the regular staff. This really led to a growing sense of injustice at the workplace where certain people were getting paid more for the same work,” she said.

Pointing to the increased load of work during the pandemic, which resulted in burnout among health-care professionals, she said that the regular staff was expected to take on more work for the same pay. “There were times when there was a pushback relating to this. Where, as a staff member, you were thinking, if I was given more money [like the travel nurses], I would take on this extra work, but not in the present circumstances,” she pointed out.

There was also a lack of flexibility relating to paid leave where the regular staff was only given 12 weeks of paid leave. “Even during COVID-19, when the regular staff was falling ill, we were expected to take care of ourselves using our paid leave. So, when a hospital wanted us, they used us, and when we needed them to take care of us, they washed their hands of this responsibility,” she said.

"A new survey by the American Association of Critical-Care Nurses revealed, 66% have considered leaving their jobs because of the pandemic, and more than 90% believe that the pandemic Will shorten the careers of nurses."

The lack of appreciation for what they did and are still doing during the ongoing pandemic has led to greater anger now, with some health-care workers feeling that their loyalty during the peak of COVID-19 has done nothing to change the attitude of the institutions for whom they work. “Even though we worked tirelessly during the pandemic, we weren’t rewarded with huge bonuses and hazard pay.

“In fact, as soon as the cases dropped, in certain instances, hospitals asked some health-care workers to use their PTO during this period. This has resulted in a lot of people leaving and looking for better opportunities, including working as contract workers,” she added. She says at least 13 people from her team of 100 have quit in the last three months and she is on the brink of quitting herself.

“I might look at contractual work ... with another hospital, since I have the option of having a good health-care plan under my husband’s health insurance,” she said. According to her, in states where there are unions looking after the interests of health-care professionals, the working conditions, pay and bargaining power that health-care professionals have are often better.

Union Strength

This has actually proven true for the health- care professionals who are part of the Oregon Federation of Nurses and Health Professionals (OFNHP). The union was supposed to go on strike on November 15 to protest the inaction by Kaiser to improve the situation for its health-care workers, but the strike was called off in favor of a settlement.

Shane Burley, communications organizer at the OFNHP, said that staffing has been a major issue for Kaiser, especially during COVID-19. An internal survey found 42% of OFNHP’s membership was contemplating leaving the profession entirely.

One of the main issues that has prompted union members to resort to striking is Kaiser’s proposal to introduce a two-tiered system, under which newly hired health-care workers were supposed to get lower wages and benefits. With the health-care sector already reeling under staffing shortages owing to a variety of reasons, including burnout during COVID-19, “the two-tiered system would have made it less attractive for new health-care workers to join and work here [Kaiser],” said Burley.

Besides the issues relating to remuneration, Burley also points out other issues that were addressed through the settlement, which included immigrant and racial justice issues that continue to be a part of the larger conversation about equity and equality in the workplace across various sectors.

“The health-care workers pushed back on Kaiser’s ‘two-tier’ wage proposal and won good wage increases, racial justice language and language to address the staffing crisis,” said Burley. The tentative agreement with Kaiser includes higher wages and wage scale improvements, racial justice improvements and a staffing committee that will begin to tackle the understaffing crisis at Kaiser.

The Vaccine Mandate

While COVID-19 and better pay have been the key drivers for health-care workers quitting their jobs, David Savitsky, CEO of medical staffing provider ATC  Healthcare, said that the compulsory COVID-19 vaccination mandate is another reason for many health-care professionals quitting or being laid off from their jobs at the moment.

“Six months into the COVID-19 pandemic, a majority of the hospitals were only carrying out critical surgeries. A lot of the surgeries that had to be canceled — as they were deemed nonessential — were the big moneymakers for these hospitals and institutions.”

This resulted in a larger number of health-care professionals, who were employed in departments that were no longer performing surgeries, being either furloughed or laid off. If they wanted to work, they were given the option of working in COVID-19 units. Some health-care professionals didn’t want to take these assignments and expose themselves and their families to the pandemic.

The situation was similar for health-care professionals working for physicians who had private practices and stopped seeing patients during the peak of the pandemic. This led to health-care professionals being displaced during that time period.

“The turnover, especially among nurses, is surprisingly high now, as a pretty significant number of health-care professionals are not vaccinated,” said Savitsky, noting this as one of the shifting reasons that many health care workers are leaving their jobs now.

“Many of them have already been exposed and feel that they have immunity and don’t need to be vaccinated. In these cases, hospitals and institutions have had to let such people go to meet the mandate set by the government and internal hospital rules.”

Since most of the health-care facilities are covered under Medicaid or Medicare, they have to follow the government mandate.

“The situation will have to sort itself out eventually,” Savitsky added.

Also, many nurses are moving to jobs that are less strenuous, such as working at testing and vaccination sites, as that also affords them more job flexibility, according to Savitsky.

“Health-care professionals are moving away from medical facilities. A lot of them, like nurses, have had an extremely tough 20 months and have been in a situation where they have witnessed death very closely, which has led to depression for many of them, and now they want something that is easy to do and not as demanding as working 12-hour shifts in a hospital.”

Pointing out another issue that is plaguing the health-care sector and adding to the discontent among the highly burned-out medical staff is the remuneration paid to them. “During the peak of the COVID-19 pandemic, hospitals and other medical institutions were willing to pay twice as much to health-care professionals. For instance, if a nurse was making $50 for an hour, they were being paid anywhere between $75 to $100 during the peak.

“Travel nurses were making a bit more with other incentives added during this period. A lot of health- care facilities now want to go back to paying their staff the rates they were paying before the peak, which is not acceptable to the health-care professionals,” said Savitsky.

To retain their employees, medical facilities have to make sure they properly compensate their staff, said Savitsky.

“In all industries, there has been a rate hike. For instance, if a Walmart clerk is getting paid $15, then, to a nurse, who works a very difficult job for 12 hours, the relative value of going back to $50 does not make sense. Besides retaining a good pay scale, they also want flexible hours and need to be valued more.”

Meanwhile, the health-care industry has seen a change in hiring practices as a result of the pandemic. “In the past, health-care facilities wouldn’t hire anyone without an in-person interview. But this has changed during the pandemic, where there is more reliance on the written communication and interviews being conducted over Zoom.”

With an aging population to look after, medical facilities need to figure out the best way forward at this time, to prevent a bad staffing situation from getting worse, said Savitsky, noting that hospitals need to work with staffing companies more to help plug the holes in their system.

The Road Forward

John Derse, health-care industry leader at Mercer, pointed out that a Mercer whitepaper finds that “nursing shortages are projected to be uneven across the United States, but the exact deficit depends on the specific role and geography.”

For example, depending on location, a large majority of nurses are getting older and nearing retirement and there aren’t enough nurses in younger generations to fill those roles. COVID-19 has also accelerated retirement and impacted nurse willingness to continue with traditional patient delivery elements of nursing — likely due to burnout. According to a 2021 NSI Nursing Solutions report, “62% of hospitals [reported] a nurse vacancy rate higher than 7.5%,” stated an article in The Conversation.

According to Derse, agencies have helped offer nurses more flexibility in terms of where and how much they work, along with ensuring better pay.

“COVID-19 has placed tremendous demands on health-care workers, and many have opted to exit the profession, while others have opted to follow the travel nurse agency route. Agencies are offering nurses flexibility in when and where they work, in addition to greater pay. The pandemic has also exacerbated issues related to workplace safety. If you are a nurse who is underpaid and feels undervalued by the organization you work for, why should you put your health and safety at risk? The pandemic has provided nurses with leverage that they didn’t have before to address issues that have long existed,” he said.

"Employers should not wait to transform their retention models to accommodate for all demographics in their Workforce impacted by the pandemic, particularly aging skilled professionals considering early retirement. The exact deficit depends on the specific role and geography but if these issues are not addressed soon, there Will not be enough health care Workers to fill demand in the future."

To improve the present situation, health-care organizations need to take a step back, rethink their practices and determine strategies to address the workforce challenges they face, said Derse.

“The areas of review to consider are work redesign (focus on bending both the supply and demand curve), staffing, training, development, and learning and organization.”

If stringent steps are not taken to address issues in the health-care industry, “there will not be enough health- care workers to fill demand in the future,” said Derse.

“Employers should not wait to transform their retention models to accommodate for all demographics in their workforce impacted by the pandemic, particularly aging skilled professionals considering early retirement. The exact deficit depends on the specific role and geography, but if these issues are not addressed soon, there will not be enough health-care workers to fill demand in the future.”

The Northeast and the Midwest are expected to see exits from the health-care workforce as a result of having a greater aging population, but New York and California will have the largest labor shortages, each projected to fall short by more than 500,000 workers by 2026, he added.

In October, President Joe Biden announced a plan to invest $100 million designed to address the health care worker shortage, with the pandemic exposing the gaping holes in the health-care system. The impact of this initiative will take time to be visible on the ground. Meanwhile, all evidence indicates that health-care systems need to do better by their employees.

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