In 2006, a roundtable of healthcare experts convened to examine the many critical issues facing hospitals today. Among these issues are the growing elderly population, greater demand for emergency care, increased numbers of those suffering from chronic conditions, increased costs, and the need for access to care.

The roundtable’s goal was to examine current healthcare issues such as socioeconomic trends, the physical care environment, technology, patient-centered care values, staffing challenges, and how those issues impact the hospital of the future. Following is a summary of the discussion and conclusion on the topic of the staffing challenge:

Workforce Shortages

Though the healthcare industry has contributed more jobs to the U.S. economy than any other industry in the past few years, the demand for certain health professionals still outstrips supply. According to the American College of Healthcare Executives, the shortage of staff has ranked among the top five issues facing hospital CEOs.

Vacancy rates for physical, occupational, and speech therapists exceeded 11% by the end of 2006, and have been increasingly difficult to recruit. Registered nurses, pharmacists, nursing assistants, license practical nurses, and laboratory and imaging technicians have vacancy rates from 6% to 8% for technicians and RNs, respectively. Physician shortages are a problem in several states already, with expectations that it will worsen. There is a high turnover of hospital executives as well, with as many as 50% of nurse executives and 14-18% of CEOs leaving their jobs within their first year.

The ability of hospitals to perform even the most basic functions is challenged by staffing issues. According to studies, there is an association between RN staffing and hospital-related mortality, failure to rescue, and an increased risk of complications. Beds that are not staffed cannot be filled, thereby decreasing the number of admissions, particularly those from emergency departments. The top-cited reason for diversion–a hospital closed to incoming ambulances–is a lack of staffed critical care beds.

Staffing shortages also lead to job dissatisfaction. Hospital-based nurses express job dissatisfaction at rates three to four times the national average for U.S. workers. Those employed in Magnet status hospitals, those facilities recognized by the American Nurses Credentialing Center (ANCC), report increased satisfaction. Those facilities also enjoy strengthened nursing recruitment and retention. In addition, patients in Magnet hospitals have lower mortality rates, shorter lengths of stay, and higher satisfaction.

The average voluntary turnover rate of new hospital nurses is 27% during the first year on the job. This may be a reflection of inadequate educational preparation for the realities of hospital practice as well as work environment issues. Included in those issues are long hours and persistent fatigue, lack of empowering leadership, unavailability of supportive technologies, and lack of innovation in improving the role of the nurse.

Almost one-third of a medical-surgical nurse’s time is spent on documentation and only one-fifth is spent on direct patient care, which also contributes to job dissatisfaction. This indicates a need to examine the role of the nurse and the inherent processes of the job.

An increasing shortage of nurse faculty is increasing the gap between supply and demand in the nursing workforce. In 2007 alone, over 30,000 qualified applicants were denied entry into baccalaureate nursing programs due to lack of capacity.

The Food and Drug Administration (FDA) has approved more than 500,000 new medical devices since the late 1990s, while concurrent technological developments in pharmaceuticals, biologics, and genomics are increasing the knowledge demands of practitioners. The addition of new developments in robotic preparation and automated distribution has had an effect on the hospital pharmacist and the level of technological expertise now required. In answer to this, the profession raised the entry-level degree for a pharmacist to a doctorate. The negative aspect of the higher standard is a roadblock created for new pharmacy students, resulting in an 8% vacancy rate for pharmacists in 2006.

Team-Based Care

To address the issue of staffing shortages, hospitals are faced with accomplishing more with less. Studies have shown that well-functioning teams can accomplish more with fewer errors than individuals, with a positive impact on patient safety.

The team-based care models may be expanded by the potential payment model proposed by the Medicare Payment Advisory Commission (MedPAC), which advocates a bundled Medicare payment approach. At present, hospitals and physicians are paid separately under different payment schemes. It is thought that a bundled approach, one that pays hospitals and physicians a fixed payment, will reduce cost variations and encourage joint accountability. This concept is being tested, as of January 2009, with its Acute Care Episode demonstration, offering bundled payments in 4 states for 28 cardiac care and 9 orthopedic inpatient surgical services. The expectations include influencing physicians and hospitals to more closely integrate their services, which is required to accept bundled payments.