The group representing most health systems in Pennsylvania says hiring and retaining more health care workers is the top priority for hospital leaders in the commonwealth as they deal with acute staffing issues. This, along with a focus on the need for behavioral health services, emerged as top issues at the group’s first in-person gathering since the pandemic halted most conferences two years ago.
Shortages of nurses, doctors and other qualified workers was a challenge before the coronavirus strained hospitals, said Andy Carter, president and CEO of the Hospital and Health System Association of Pennsylvania. However, the virus accelerated the need for action, as burned-out nurses fled intensive care units flooded with COVID-19 patients.
Carter pointed to his group’s recent survey of health systems, which estimated that 27% of nurse positions went vacant last winter in Pennsylvania.
“COVID has placed extreme stressors on our workforce,” Carter said. “Demand on frontline workers has been extraordinary.”
The virus also consolidated support for change among health care executives, who are working on short term solutions that include more pay, benefits and perks, as well as longer-term ones such as more access to nursing school. He applauded a $225 million federal relief package passed by the legislature and signed by Governor Tom Wolf that is routing funds to health systems for these efforts.
Pennsylvania State Nurses Association, CEO Wayne Reich said he is in favor of increasing pay and benefits, but he says nurses also want rules that limit how many patients a nurse can be expected to care for during a shift.
Reich said that mandating more nurses when there are already not enough available may sound counter-intuitive, but in the long-run it would keep exhausted workers from leaving the field.
“When nursing staffing becomes an issue, or a shortage becomes an issue, they throw money at nurses and don’t fix the underlying causes, and I think in the end it’s hard to put a price on what you go through during a shift when you have to care for all those patients,” Reich said.
He supports a bill to address nurse-patient ratios that has sat dormant in the Republican-controlled House Health Committee for a year. The health system association opposes that bill.
In addition to staffing issues, health systems are looking to address an increase in people showing up at emergency rooms in the throes of a mental health crisis, Carter said.
He noted that emergency departments end up taking care of people who would be better served in a behavioral health inpatient bed or with outpatient services.
Once in the emergency department, doctors cannot discharge a person in crisis until they have access to the appropriate level of behavioral health care. As a result, people with acute mental health issues end up in emergency rooms for days or even weeks, using up resources that are intended to help people who are having a life-threatening medical emergency.
Some health systems have responded to this problem by setting up inpatient beds of their own, Carter said. Recently, Penn Medicine-Lancaster General and Main Line Health in Delaware County added acute mental health beds to move people out of emergency rooms.
The group has called on leaders in the state general assembly to improve access to mental health services. Carter said the hospital association supports Governor Tom Wolf’s proposed budget increase that would route more funding to county mental health departments.
“I mean, these would be resources that would not go directly to hospitals, but we’re hugely supportive of it, because we know that the underlying architecture of the system is very much county driven,” Carter said.
Carter said the association’s third priority is to find solutions for a projected increase in costs that is expected to strain some health systems in coming years.
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