Health care workforce ‘in disarray’ even as COVID-19 pandemic subsides

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The COVID-19 pandemic highlighted existing problems in the workplace culture of hospitals.

Those conditions are not getting better, and that’s at the hospitals considered good places to work.

A new study surveyed thousands of physicians and nurses at dozens of top hospitals across the country and found: “The hospital workforce remains in disarray despite the ebbing of the COVID-19 pandemic.”

“Physicians and nurses largely agree about what hospital management could do to address their burnout, job dissatisfaction, and plans to leave their current jobs; they want improved staffing, modern working conditions in which they can spend more time in direct patient care, greater control over their workloads and work schedules, and a higher priority on patient safety,” lead author Linda H. Aiken, PhD, said in a news release. Aiken is professor of nursing and sociology, founding director of the Center for Health Outcomes and Policy Research, and senior fellow of the Leonard Davis Institute for Health Economics at the University of Pennsylvania.

Nurses needed now

Nurse staffing is reaching critical mass, with 45% of physicians and 87% of nurses describing it as very important for their own mental health and well-being. The study found they also want health breaks without interruption and less time spent on paperwork and documentation.

“Many clinicians are downright hostile to programs – like resilience training – that are designed to adapt them to poor work conditions,” Aiken said. “Clinicians want the working conditions improved.”

The results

The survey results aligned with previous studies that have catalogued burnout and workplace dissatisfaction among health care workers.

• 32% of physicians and 47% of nurses reported high burnout.
• 23% of physicians and 40% of nurses said they would leave their current hospital within a year if they could.
• 13% of physicians and 25% of nurses reported high anxiety.
• 43% of physicians and 53% of nurses said they have a great deal of job-related stress.
• 28% of physicians and 54% of nurses said there were not enough nurses to care for patients.
• 39% of physicians and 63% of nurses said the work atmosphere was chaotic or tends to be chaotic.
• 74% of physicians and 57% of nurses said they spend moderately high to excessive amounts of time in electronic health records.

Are patients safe?

Regarding patient safety and quality of care, 33% of physicians and 39% of nurses said they felt mistakes were held against them. Physicians (29%) outpaced nurses (23%) in not feeling free to question decision of actions of authorities of their facilities.

Regarding quality of care, 9% of physicians and 16% of nurses rated it as poor or fair, although “in some hospitals those percentages rose to more than one-quarter of physicians and half of nurses.” Up to 75% of physicians and nurses “in some hospitals were not confident that patients could manage their care after discharge,” the study said.

“The culture of patient safety is not usually discussed in the context of clinician well-being; however, our study found it to be significantly associated with physician dissatisfaction and intent to leave and with all nurse outcomes,” the study said.

Getting along

Regarding management, 42% of physicians and 47% of nurses said they were not confident management would act to resolve problems in patient care that clinicians identify.

But doctors and nurses seem to get along: 94% of physicians and 89% of nurses said they had a good working relationship.

The survey says

The original investigation, “Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice – Factors Associated With Turnover, Outcomes, and Patient Safety,” was published by JAMA Health Forum.

The electronic surveys went out as part of a multisite collaborative study in 2021. Surveys were sent out to clinicians at 60 hospitals, averaging 100 physicians and 262 registered nurses per hospital, with response rates of 22% for doctors and 27% for nurses. The hospitals were selected based on voluntary credentials by the Magnet Recognition Program, which the American Nurses Credentialing Center awards based on nursing excellence and quality of health care.