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Workplace Shortages, Burnout Strain Hospital HR Staff

A nurse is talking to a patient in a hospital hallway.

Headlines have chronicled the devastating impact of COVID-19 on health care workers. Since the pandemic began, 18 percent of health care workers have quit; another 12 percent were laid off. Employee engagement and satisfaction are down. Most distressing, COVID-19 has killed anywhere from 80,000 to 180,000 health workers worldwide.

"The past year has been a nightmare," said Kate Tulenko, a health workforce expert who is CEO and founder of Corvus Health in Washington, DC. "I saw my fellow health workers suffering from overwork, fatigue, burnout and psychological stress."

Health care HR staffs, too, were stretched to the max, coping with low staff morale, salary complaints, resignations, enforcing mask and vaccination mandates, policy changes, hiring more cleaning staff, and supply chain shortages. Many HR departments were not equipped with the skills to handle nursing strikes.

Above and Beyond

"It's been nonstop," said Maxine Carrington, senior vice president and chief people officer at Northwell Health in New York City. 

Carrington's team had to set up COVID-19 testing sites for staff, but at the eleventh hour, the supplier called to say they didn't have enough swabs. The health system's research institute was able to produce the swabs quickly via 3D printing.

Rebecca Mohiuddin, SHRM-SCP, chief human resources officer at Central Ohio Primary Care in Westerville, Ohio, had to get 2,300 employees at 80 sites vaccinated. In August, the company offered each employee $1,000 if they got vaccinated or cooperated with weekly COVID-19 testing. Today, 93 percent are fully vaccinated.

Recruiting Challenges

A shrinking workforce, especially in nursing, is the biggest crisis facing health care. It's all too easy for unhappy staffers to find new jobs for higher wages. The pandemic has laid bare the need for health systems to put resources behind staffing and workforce development.

Northwell fortified their recruiting with marketing, temporary staffing, higher salaries, national outreach, retraining programs, enhanced benefits and relocation assistance. In addition, Carrington set up an employee retention task force to look at roles in the health system that had high turnover. They held interviews and asked people why they stay and what would make them leave. Some things like compensation or leadership issues can be fixed if you know about them, she said.

An Epidemic of Burnout

Clinicians are overwhelmed by long shifts, more acutely ill patients and grieving families. Some doctors resent that administrators­—who aren't typically working weekends and extended shifts—are being paid more while their salaries were cut, or that nursing raises mean some earn more than they do.

As many as 60 percent to 75 percent of front-line workers report symptoms of exhaustion, depression, sleep disorders and PTSD, which are harmful for workers and can compromise patient care and safety. Likewise, essential nonclinical workers have had to put in extra hours and take on more responsibilities. People resigning say they felt unsupported and demoralized while being asked to take unnecessary risks. Hospitals with burnout reduction programs have fared better when it comes to retaining nurses.

Managers need to ask employees what they can do about burnout, Tulenko advised.

While offering online yoga and meditation sessions increase job satisfaction, they are not a solution, she noted. Don't blame the victim, in a sense, for being stressed, instead of acknowledging "this is a bad job," she said.

To address burnout, make comprehensive changes in team design, Tulenko continued. "You have to make the job more pleasant and humane." She recommends teams made up of people with different skills. This allows a workflow where nurses can focus on medical management and people without those skills take on lower-level work, for example.

At Central Ohio Primary Care, desk staff were upskilled to take patient vitals, Mohiuddin said. Cross-training employees helped to compensate for other staff shortages. COVID-19 screeners were hired to check employees and patients for symptoms at the door, which freed up staff. The company's employee-share program came to the rescue if one practice site could spare a medical assistant temporarily when another site was short.

"[Workflow optimization] falls in the hole between the chief medical officer and HR; no one is thinking about it," Tulenko said. It may cost more to hire lower-level support staff, but you have to look at the total cost to hire a new nurse and get that person up to speed, she added. "Don't be afraid to spend money or do things differently if it reduces turnover."

Culture and a New Hybrid Workplace

Organizational culture is getting a makeover during the pandemic. Flexible scheduling and providing child care support are more common. Northwell planted a "My Well-being" icon on every desktop and phone in the health system so employees could tap support resources easily­—hotlines, digital tools, chaplains, mental health services or healthy lifestyle tips. Northwell even has spa buses visit employees onsite to offer spa services.

"HR needs to normalize well-being activities and conversations," Carrington said. This means allowing an employee to pick up a child if the school is closing or to take time off if they are struggling. "[Improving the culture] will keep people with you in the long term, not the sign-on bonus," she said.

Central Ohio Primary Care offered perks to sweeten the pot. Free delivery on DoorDash meals was a favorite, Mohiuddin said. And if an employee was out with COVID-19, they were paid for that time. PTO "overage buckets" were created so those working tirelessly would not be penalized for not taking time off.

Northwell also implemented Workwell, which provides well-designed hubs across the health system's service areas. Employees can reserve a workstation at a hub near their home that's equipped with conference rooms, technology and cafés. Managers at Northwell have been trained on how to lead remote teams so engagement doesn't fall off. 

"Nothing will go back to the way it was," Tulenko said, noting that HR has to make adjustments for the new hybrid-work arrangements. "HR is struggling with how to hold employees accountable when you can't see them. More frequent communication and documentation is needed."

Mohiuddin is gratified that HR has been able to support and pull staff together throughout the pandemic. "We've been stretched in new ways, and I think we'll look back with pride on what we've done."

Eve Glicksman is a freelance writer based in Silver Spring, Md.


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