1 year of COVID-19 has changed what it’s like to work in healthcare

This article is part of a series on what the healthcare industry looks like one year after the novel coronavirus was declared a pandemic and life in the United States began to drastically change.

Healthcare workers have been pushed to their limits during the COVID-19 crisis, and some are considering a change in profession or setting as the country marks one year into the pandemic.

Hospitals faced with higher turnover and shortages are paying more for those who still want the jobs.

“Our workforce is tired, people are leaving nursing,” Tucson Medical Center CEO Judy Rich said.

The pandemic has caused massive short-term disruptions to the U.S. economy and labor market, with 14.7 million jobs overall shed between February and June of last year, according to the Bureau of Labor Statistics. The healthcare industry was no exception, and still has about 500,000 jobs to recoup to get back to pre-pandemic levels.

While some industries may never completely recover from those losses, healthcare will. But burnout could strain supply, and demand for healthcare workers will only grow post-pandemic, according to BLS.

A year of working on the front lines brought a heightened focus on the challenges on the workforce. Nurses and physicians especially are reporting increasing rates of burnout, and a lack of trust and engagement with the organizations employing them. Turnover has long been a problem for the industry, though some fear the pandemic is exacerbating it.

In other parts of the industry, changes in care delivery, including the rapid adoption of telehealth, could alter post-pandemic employment, specifically for physicians’ offices and dentists.

New employment projections taking the pandemic into account offer two new trajectories: one where COVID-19’s impact on consumer and firm behavior is moderate, and one where the impact is strong.

In both situations, healthcare job growth predictions deviate minimally from pre-pandemic estimates, and are still projected to add about 2.4 million new jobs by 2029, much faster than the average for all occupations.

In the strong impact scenario, increasing automation coupled with avoidance of interpersonal contact is expected to accelerate the use of online appointment booking systems and check-in kiosks, leading to declining demand for receptionists and information clerks.

“But the actual healthcare practitioners, the physicians and nurses would be relatively unaffected by that,” Michael Rieley, a BLS economist and co-author of the report, said.

Demand for nurses, who make up the largest chunk of the healthcare workforce, is expected to grow 7% from 2019 to 2029 — 7.1% in the moderate scenario and 7.2% in the strong impact model.

That’s much faster than the average for most occupations, and means about 175,000 registered nurse jobs will be open, on average, each year over the next nine years, according to BLS predictions.

Surge in turnover, burnout

Beyond increasing demand, a need to replace workers who leave for different jobs or retire will contribute to the boost, according to BLS.

Throughout the pandemic, temporary travel nurses saw record demand as systems raced to secure enough staff amid local COVID-19 surges. That has since dwindled back near pre-pandemic levels, according to data from staffing firm Aya Healthcare.

But permanent nurse vacancies are up, with hospitals and health systems posting about 20% more permanent vacancy replacement jobs than at the start of the pandemic, April Hansen, Aya’s executive vice president, said.

That’s in part due to nurses accelerating their retirement plans, or simply looking for other work outside of clinical care. Scheduling conflicts are another challenge drawing nurses with families to other jobs.

“Some have had to cut back so that they can home school, some have had to make changes, maybe into a different type of schedule where previously they could work a night shift at the hospital and maybe now they need to work remotely for an insurance company,” Hansen said.

In a 2020 survey of 1,490 registered nurses from NSI Nursing Solutions, 22% of respondents said they would like to retire sooner while 21% said they would like to transfer to a non-patient care area. And 10% said they would like to leave the profession.

“If they were contemplating leaving to try something different, after the year they just endured, I am pretty sure they have the motivation to go and do that,” Hansen said.

At Tucson Medical Center, a community hospital in Arizona, all of those challenges coupled with sheer exhaustion among nurses is exacerbating turnover.

The hospital’s nursing turnover rate was 9% in 2019, then jumped to 17% in 2020, Rich said during a call with reporters organized by the American Hospital Association last month.

“It’s a very emotional and debilitating decision for a nurse to say, ‘I’d rather go into an outpatient setting, I’d rather go work in an ambulatory surgery center, I’d rather go work for an insurance company, but acute care is just not where I want to stay,'” Rich said.

In 2019, about 60% of registered nurses worked in hospitals, while the remaining worked in ambulatory, nursing care, or government and education services. Nurses accounted for 30% of hospital employees in 2019, according to BLS.

What it’s costing hospitals

While rates for travel nurses hit record levels during the pandemic, so did salaries and signing bonuses for permanent nurses, according to another healthcare staffing platform, Incredible Health.

Signing bonuses increased 12% during the pandemic from an average of $8,200 to $9,190, an Incredible Health report that analyzed data from more than 60,000 nurse profiles found.

Average annual salaries for nurses using the platform increased from $112,000 pre-pandemic to $122,000 by the end of 2020.

“The market is as competitive as it has ever been in the history of U.S. healthcare when it comes to competing for talent and competing for nurses,” Incredible Health CEO Iman Abuzeid said.

When it comes to retaining existing nurse workforces, “the pressure is on,” Abuzeid said.

After a year of working on the front-lines of a pandemic that took many nurses away from their specialties, dissatisfaction about advancing in their careers is a problem employers can try to tackle to boost retention.

Adequate staffing levels matter too, and are “a top reason nurses quit,” Abuzeid said. Finally, employers need to offer more support services for nurses struggling with mental health issues and exhaustion from their jobs.

“What we’re seeing is that the health systems that have invested heavily in these three areas are seeing much better retention rates than others,” Abuzeid said.

Nurses have also been active on the labor organization front in wake of the pandemic.

While union membership among healthcare workers hasn’t risen dramatically in recent years, it’s held steady, unlike most other industries, according to BLS data.

Throughout the pandemic, healthcare workers have staged protests and informational pickets over what employers were doing to keep them safe. Many threatened to go on strike and workers at HCA Healthcare and a handful of other big systems did last year.

Currently, 800 nurses at Tenet’s St. Vincent Hospital in Worcester, Massachusetts, are on strike without an end date in sight. They’ve been negotiating a new contract with the hospital for over a year, and cite staffing concerns worsened by the pandemic.

The hospital spent over $5 million on replacement nurses during the first week of the strike, which began March 8, according to a statement from St. Vincent.