Hospital staffing troubles, raging COVID-19 leave leaders eyeing service cuts

As healthcare systems struggle to keep up with the ongoing COVID-19 surge, leaders being are forced to make difficult staffing decisions.

Their already-strained teams are suffering from burnout, and some workers are leaving the profession altogether, worn out by the pandemic. Others have become travelers, lured by higher compensation and flexible scheduling. And a small number of employees are choosing to leave their jobs rather than get a mandatory COVID-19 vaccine.

"The physicians are concerned the longer this goes on and the more you ask of the nursing staff, the more likely it is they will burnout and take time off or leave. That is certainly something that weighs on our minds," said Dr. Mark Simon, chief medical officer of Ob Hospitalist Group, an obstetric staffing provider based in Greenville, South Carolina.

Juggling staffing concerns with providing care can force healthcare leaders to make tough calls about what they can offer patients.

Download Modern Healthcare’s app to stay informed when industry news breaks. 

Lewis County General Hospital in Lowville, New York has paused delivering babies by the end of the month, saying it can't safely staff its maternity department after dozens of workers quit instead of getting a vaccine. Other hospitals have had to ration care and delay nonessential surgeries, especially in hard-hit Western states. In some cases, health systems will have to decide if they need to temporarily shut down departments to handle the delta variant surge.

"There is an increased risk to smaller hospitals in particular. I also worry that some of these more rural institutions are also located in areas with higher rates of vaccine hesitancy," Simon said. "You lose a higher proportion of the staff in those locations. And in those locations, losing staff is a much bigger deal because you have less staff to begin with."

One approach to avoid shuttering services is to over-staff, if possible, before vaccine mandates are put in place, Simon said. Or hospitals could cross-train nurses so they can work in multiple highly specialized departments, such as labor and delivery.

"Even if we hire more people than we need, in healthcare, we can find a place for people to work," Simon said. "You do need to try to prepare for worst-case scenarios."

Administrators need to be proactive about gauging staff views on vaccine mandates and provide hesitant workers with quality information, Simon said. Leaders also need to listen to employees' overall concerns about the future of staffing.

Healthcare leaders need to understand why workers might quit, and if there are deeper, preexisting problems with management or workplace culture that influence their decisions and can be addressed, said Wayne Psek, a professor of health policy and management at George Washington University."You're understanding not only why they don't want to get the vaccine, but what else is going on," Psek said.

And as the pandemic drags on, more healthcare workers are likely to question their careers, further complicating administrators' challenges.

While some hospitals have been able to attract staff with recruitment bonuses and higher wages, smaller hospitals and those in rural areas may not have that option, Psek said.

These facilities either can't attract workers or don't have the financial resources to boost compensation. That leaves leaders to make strategic decisions about what services to offer.

"A lot of it is a financial issue. If you try to maintain a unit but it's not financially sustainable, you're pulling resources from somewhere else," Psek said. "One of the challenges they always face is: What's for the greater good? Do we close the maternity ward, which is maybe just seeing a handful of patients?… Or keep it open and drag my system down?"

Maternity wards, in particular, are in danger because they rely heavily on Medicaid, which pays less than private insurance, Psek said. Those units often are already "teetering financially," he said. "Anything like this can tip it over."

Any decision about closing units should be made with a clear communication plan in place to provide the community with information and direct patients to alternative sites, Psek said.