Hospitals, senior care facilities, community health centers and other employers are competing to hire candidates to fill thousands of open positions at healthcare facilities in Northeast Ohio as burnout, career changes, geographic relocations and more contribute to growing job vacancies.
Nationally, employment in healthcare is down by 460,000 since February 2020, according to the latest figures from the U.S. Bureau of Labor Statistics.
In January, University Hospitals had about 1,500 vacancies — a figure typical for the health system. But that had doubled to around 3,000 by the end of October, said Kim Shelnick, UH's vice president for talent acquisition. That figure excludes Lake Health, which officially became a member of UH in April 2021. Lake Health currently has about 400 openings, also much higher than normal.
"It steadily has gone up every single week throughout the entire year," she said. "We are working so hard to fill positions ... but the numbers just keep escalating."
UH has been collaborating where possible with Cleveland Clinic and MetroHealth, Shelnick said, but they're all hiring candidates back and forth from one another because there simply aren't enough staff and new graduates to fill all open roles.
"This is unbelievable — and my colleagues say the same thing — this is an unbelievable volume of openings," Shelnick said. "We have to be extremely creative right now to maneuver through this."
The substantial number of openings across the state span clinical and administrative roles, and the competitive environment has necessitated creativity, said John Palmer, spokesman for the Ohio Hospital Association. In addition to re-evaluating benefits packages, he said more hospitals are examining sign-on bonuses, as well as looking at things employees may need in order to work, such as child care.
The pipeline for healthcare workers is just not adequate right now, he said.
"This isn't an Ohio problem — we have states, neighboring states that are competing regionally," he said.
It's not just hospitals, but also nursing homes and community health centers in every state in the country looking for healthcare workers.
Citing staffing challenges, Summa Health in late September began reducing its inpatient bed capacity by 22% and announced a series of other steps to align its inpatient hospital capacity with current levels of available staffing. In early November, Dr. David Custodio, president of Summa's Akron and St. Thomas campuses, said in a statement that the system is making progress toward its goal of reducing its bed count.
The McGregor Foundation, a nonprofit provider of residential and community-based care for seniors, currently has about 500 of its 600 positions filled. Vacancies range from administrative billing to social work to housekeeping to nursing and a physician, said McGregor CEO Ann Conn. The pandemic, initially expected to be a sprint, is now clearly a marathon, she said.
"Obviously the first component was around the health and safety of our residents and our staff, and as we learn more about the disease and we're able to pivot, now it's become much more about securing resources to support the seniors that we care for, and staffing is the biggest resource at this point in time," she said.
As everyone in healthcare competes for workers, it will come down to each institution, its mission, its work environment — and how those can help draw in staff, Palmer said.
Having faced projected and existing shortages in various clinical fields and specialties for years, employers have already implemented workforce development programs.
McGregor offers training programs, including paid apprenticeships and initiatives to introduce high school students to clinical care.
Hospitals across the region have worked with educational institutions at all levels to grow the pipeline of students and ultimately, graduates. For instance, UH is starting to see graduates from a program it launched with Cleveland State University. UH Nursing Scholars received $12,000 from UH, contingent on a two-year work commitment with the system.
The top reason employees leave UH is going to a competitor, Shelnick said. The second-highest turnover reason among nurses is relocation outside the region — for a rolling 12-month period, 151 registered nurses cited that reason.
Because the shortages "are so severe," Shelnick said they've teamed up with the Clinic, Metro and Team NEO to try to figure out that relocation statistic.
"We have got to come up with innovative solutions to produce more and retain more within Northeast Ohio," Shelnick said.
Expanding pipeline programs continues to be important, but won't fill immediate critical gaps hospitals are struggling to fill.
After accepting an offer, people have either not showed up or called last minute to say they found another job, Shelnick said. It has happened 70 times in the last two months alone.
Healthcare employers also are balancing using their existing staff to cover shifts and maintain patient safety and quality, while avoiding overworking them, as burnout continues to be a major concern and a factor in some separations.
UH's Helping Hands program — through which employees can volunteer to take shifts to help out in clinical areas — has been one way to alleviate some of that workload. Since September, 920 employees from 392 non-clinical departments helped fill 6,188 shifts in clinical areas. They do tasks such as running lab samples to allow clinical staff to stay at the bedside. Also through the program, 225 registered nurses in non-bedside roles received training to help in clinical areas, covering 770 shifts since September.
UH is offering sign-on bonuses of up to $8,000. Although it has offered sign-on bonuses at that level before, it's offering the $8,000 figure more often, compared with its typical range of $3,000 to $6,000 for certain areas.
McGregor increased wages and offered sign-on bonuses in some areas, but Conn said it's difficult to compete with other industries' resources as the nonprofit's reimbursement rates don't keep up with expenses.
So it found other ways to try to bring in more candidates.
Last year, recognizing the need for more staff, McGregor began recruiting international nurses, a practice hospitals have long employed that Conn would like to see others in the region begin to implement. Because the immigration process takes time, the five international nurses in the pipeline still are about a year out from being onboarded.
Also late last year, McGregor teamed up with a group of nonprofit aging services providers around Cleveland to pilot a nontraditional advertising recruitment program from last November through the first half of this year. Together, they tried to introduce individuals who may have been displaced during the pandemic to a potential career in senior living. For instance, Conn said, healthcare workers who were maybe seeking a more mission-based organization who hadn't thought of senior living as a career option.
"While I think we did see some success in that, some of the other forces in the community — around the extension of unemployment, the child tax credit, some of these other safety net systems — were headwinds that we didn't experience the same success we were hoping for, but it's probably something we will go back to in the future," she said.
The effort created partnerships with the other organizations that were working independently before, and rather than simply try to compete for limited employees, Conn said they opted to come together to try to broaden the candidate pool overall.
Collaboration across partners who are otherwise competing for talent in the labor market will be critical going forward, Shelnick said. It's the first time in her 15 years in her role that the health systems have worked so closely on workforce initiatives, but the hospitals, schools, workforce ecosystem and community have to come together to solve the larger issue.
"Those are some pretty big strategies to kind of maneuver through," she said. "How are we going to stop people from relocating out? How are we going to get more people interested in healthcare?"
This story first appeared in our sister publication, Crain's Cleveland Business.