Patient safety’s new perils: Lack of medical staff and their mental wellness
The coronavirus pandemic and the wrenching demand this public health nightmare has put on the U.S. health care system and its people have become such a worry that staffing shortages and workers’ mental health have become top safety concerns in 2022.
That is the evidence-based view of ECRI, aka the nonprofit, independent Emergency Care Research Institute. It has provided rigorous research to the public and parties in health care to better safeguard patients and their medical care for more than a half century.
The organization issues a Top 10 annual list of patient safety concerns, which is “typically dominated by clinical issues caused by device malfunctions or medical errors,” ECRI reported. But the group is raising different alarms this year about “crises that have simmered, but [that] Covid-19 exponentially worsened.”
The rapid, divisive politicization of public health measures to quell the pandemic, and, indeed, increasing attacks on health workers and institutions significantly worsened the nation’s already significant challenges in keeping and expanding the force of frontline caregivers, ECRI found:
“Health care professionals’ mental health was already at crisis level before the Covid-19 pandemic; both physicians and nurses were at risk of burnout, emotional exhaustion, or depression prior to 2020. The pandemic has now forced a reckoning with health care workers’ mental health needs. A survey of physicians published in June 2021 captured the following data: 20% experienced burnout, 29% were previously diagnosed with or treated for anxiety or depression, 6% experienced depression, [and] 7% experienced suicidal ideation. A survey of nurses published in February 2021 found the following: 35% experienced poor-quality sleep, 28% demonstrated heightened anxiety during unexpected events, 25% experienced unintended negative memories, 13% reported trauma, 25% working in critical care units reported high levels of emotional exhaustion [and] 24% working in dedicated Covid-19 units reported high levels of emotional exhaustion.”
The relentless stress and strain of working in overwhelming, demoralizing conditions due to the pandemic will drain already depleted and difficult to fill health worker positions, making staffing challenges a top concern in ’22, ECRI reported:
“Even before the Covid-19 pandemic, there was a persistent shortage of clinical and nonclinical staff across the continuum. Staffing shortages have continued to increase throughout the pandemic. In 2020, hospital registered nurse (RN) turnover was 18.7%. A high proportion of nurses are at or near traditional retirement age, raising concerns that nursing shortages will greatly increase in the coming years: The median age of RNs in 2020 was 52 years. Nearly 20% of RNs are 65 years or older. The median age of licensed practical or vocational nurses in 2020 was 53. Nursing schools are unlikely to be able to supply enough nurses to replace retiring nurses, much less alleviate existing gaps. In 2019, 80,407 qualified nursing school applicants were turned away due to insufficient resources (faculty, clinical sites, classroom space, clinical preceptors, and budget).
“Over a 10-year period (2016 to 2026), nursing assistants will be the top staffing need in long-term care. There will be 678,300 job openings. But 368,100 workers will move to another occupation. More than 61% of chief executive officers noted a shortage of technicians, such as medical and laboratory technicians. By 2034, the physician shortage is projected to reach 17,800 to 48,000 in primary care and 21,000 to 77,100 in other medical specialties, raising concerns about access to care, disparities, and physician burnout. In early 2021, many states predicted shortages of critical care doctors, hospitalists, respiratory therapists, and pharmacists.”
Besides the health worker toll, ECRI identified other major concerns, as laid bare by the pandemic, including:
- issues with vaccines, notably big, desperate gaps in getting them into patients arms to protect them from an array of debilitating and deadly infections, including the coronavirus
- bias and racism, challenges that became even starker with disproportionate infection, hospitalization, and deaths among blacks and Latinos due to the coronavirus
- “cognitive biases and diagnostic error,” notably clinicians’ “anchoring” diagnoses or blaming patients’ illnesses on the coronavirus and missing other, serious, and treatable respiratory or cardiovascular conditions
- and potential problems in the rapid adoption of telehealth, a technology-based, remote care popularized during the pandemic but with many clinical and technical bugs to be worked out still
Not good. In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access safe, affordable, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
The pandemic has upended the world for at least two years now in a once-in-a-century mess that has claimed more than 1 million American lives and infected 80 million of us. But this outbreak has been worsened by what the World Health Organization some time ago dubbed an “infodemic,” a tsunami of disinformation that has inundated this country through nihilistic, science-denying political partisans, notably the former president and the Republican Party.
This has riven the country, still, and as patients flock back to medical care during another period of relative pandemic calm, it poses sustained challenges to the quality, safety, affordability, and access we all have to excellent medical services, as well as to continuing, needed efforts to quell the pandemic. Patient safety advocates have warned that the pandemic’s slamming of the U.S. health care system has led to regrettable and understandable declines in safeguards for those receiving medical services, problems that need urgent addressing.
As ECRI and others have underscored, terrific medical pros — doctors, nurses, aides, lab techs and more — don’t fly off magical shelves. And subjecting them to relentless falsehoods and verbal and even physical attacks is unacceptable and detrimental to all of us.
Voters need to wake up and to see the evidence that, at the state level and more, the extremists who ignore facts, research, and evidence are abetting the sickness and deaths of far too many. Really, do Republicans want to keep seeing huge mortality gaps between their own red and Democratic blue areas of the country? Is that what they want to sell their constituents in upcoming electoral contests — the “personal liberty” to be sick, suffer, end up in the hospital, incur huge medical debt, and even die a needless death? Do those who are unhinged domestically about health care not see how quickly red lines can be crossed, leading to the reprehensible assaults by Russian forces on Ukrainian health care workers and facilities?
We have much work to do to protect patients and those who provide them health care and to ensure that medical institutions are as safe as possible, in their practices as well as in their security for all.