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After reading Empty Hallways: The Hidden Shortage of Healthcare Workers, identify the two powerful factors that work together to create the staffing crisis. Briefly explain these two factorsi page

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16560_C1_4,P_01_20 2/14/03 4:05 AM Page c1
Empty
Hallways
The Hidden
Shortage of
Healthcare
Workers
16560_C1_4,P01_20 1/27/03 11:42 PM Page C2
“Common sense tells us
there are a limited
number of patients a
nurse can care for safely, a
limited number of slides a
tech can read without
losing attention to detail,
a limited number of hours
a person can work
without becoming too
exhausted to function.
Unfortunately, common
sense rarely prevails”
SANDRA FELDMAN
AFT President
16560_C1_4,P01_20 1/27/03 11:50 PM Page 1
FOREWORD
T
HE FACT THAT THERE IS A SHORTAGE OF NURSES WILLing to work in hospitals in this country is well
documented. Some hospitals are offering sign-on
bonuses as high as $30,000 to lure experienced nurses away
from other employers. The American Hospital Association
(AHA) reports that 89 percent of hospitals report openings for
RNs that are unfilled, and 75 percent of hospitals today are
finding it more difficult to recruit nurses than in the past. The
national vacancy rate for RNs is 11 percent, according to the
AHA, and this shortage contributes to delays in care and makes
it more difficult for some people to receive the care they need.
But the nurse shortage is only part of the story. Less publicized, but equally important, is the shortage of other healthcare professionals. Hospitals nationwide report vacancy rates
of 21 percent for pharmacists, 18 percent for radiology technicians, 12 percent for laboratory technologists, and 9 percent for housekeeping and maintenance staff. Every healthcare worker is an integral part of the healthcare system, and
a shortage in any area creates problems for every other classification of worker. Industrywide shortages such as those we
are experiencing today create possibilities for delivering substandard, even dangerous, care to patients. Shortages also
create a work environment that is not conducive to retaining
the most qualified and experienced healthcare professionals, resulting in a revolving door of workers.
AFT Healthcare looked at problems with recruiting and
retaining nurses in a survey conducted in spring 2001 by Peter
D. Hart Research Associates. The survey showed that many
16560_C1_4,P01_20 1/27/03 11:51 PM Page 2
nurses who currently are not working in the profession would
consider returning to direct patient care if certain conditions
were met. Almost two out of three who had left said they would
consider returning if there was better pay (23 percent), better staffing levels (21 percent) and better, more flexible, schedules (21 percent).
The survey results also showed that without these types of
changes, one in five current direct-care nurses plans to leave
the profession within the next two years, exacerbating an
already dire shortage of nurses in our nation’s hospitals.
2
E M P T Y H A L LWAY S
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SURVEYING HEALTHCARE PROFESSIONALS
B
UILDING ON THE FINDINGS OF THE 2001 SURVEY, AFT HEALTHcare commissioned Peter D. Hart Research Associates to conduct parallel surveys among three groups
of health professionals: respiratory therapists, radiology technologists and certified nursing assistants (CNAs) in spring
2002. The survey sought to determine if these health professionals were experiencing the same types of workplace problems as nurses and if recruitment and retention were problems of concern. Interviews were conducted with 308 respiratory
therapists, 302 radiology technicians and 302 certified nursing assistants in states that require CNAs to be registered.
While each group of professionals had a distinct perspective, what united them was their perception of a serious staffing
crisis in their field. Here are the surveys’ key findings:
4

All three groups of professionals express low satisfaction
with current conditions for health professionals, and point
to inadequate staffing as the number-one problem they
face.

Professionals report that staffing shortages are compromising the quality of healthcare provided, and even putting patients at risk.

Beyond the staffing problems in their own facilities, respondents perceive a broader shortage of qualified professionals in their fields that is caused by unsatisfactory working conditions. Indeed, inadequate staffing has itself
become a cause of recruitment and retention problems.
E M P T Y H A L LWAY S
16560_C1_4,P01_20 1/27/03 11:52 PM Page 5

The solutions to these shortages identified by professionals
include mandatory maximum professional-to-patient
ratios, higher pay, improved health coverage, more support staff, opportunities for continuing education and a
stronger voice on the job.
The staffing problem within these three professions mirrors that of nursing. The complex circle begins with inadequate staffing, which serves as an impetus for workers to leave
the profession, resulting in an even worse staffing situation.
With proper staffing levels, workers tend to be more satisfied
and less likely to leave. This is evidenced in the Australian
province of Victoria where mandatory nurse-to-patient ratios
recently were negotiated. Not only have more than 3,300 nurses
who left the profession returned, but the use of agency nurses
has almost ceased, and morale among Victoria’s working
nurses has improved exponentially.
NO DEBATE: THERE ARE SHORTAGES
Health professionals experience the staffing crisis directly
and personally. Every day, it reduces the quality of their work
lives and constrains their ability to deliver quality healthcare.
Yet given these results, it is clearly not a problem limited to
certain facilities, professions or regions. There is a shortage
of qualified professionals in all of these fields, and those working in the field clearly recognize it.
Seventy-four percent of respiratory therapists report that
there is a shortage of therapists in the area in which they live,
including 33 percent who say the shortage is severe. Among
CNAs, 79 percent report a shortage in their area, with 27 percent describing it as severe. The worst shortage appears to be
in radiology, with 82 percent perceiving a shortage and fully
43 percent a severe shortage. Clearly, the healthcare system
faces a widespread crisis in terms of hiring an adequate number of professionals to meet the needs of patients.
E M P T Y H A L LWAY S
5
16560_C1_4,P_01_20 2/14/03 12:32 AM Page 6
WHO ARE THESE WORKERS?
RESPIRATORY THERAPISTS
There are about 100,000 respiratory therapists in the United States. They work
with patients of all ages and in many different care settings. Respiratory therapists are members of the healthcare team that provides respiratory care for patients
with heart and lung disorders.
Most respiratory therapists work in hospitals where they perform intensive
care, critical care and neonatal procedures. They typically are also a vital part of
the hospital’s lifesaving response team that handles patient emergencies. Of the
more than 7,000 hospitals in this country, about 5,700 have respiratory care
departments.
RADIOLOGY TECHNICIANS
Radiology techs are the medical personnel who perform diagnostic imaging
examinations and deliver radiation therapy treatments. They may specialize in
a specific area of radiological technology – such as mammography, magnetic resonance, nuclear medicine, sonography, cardiovascular- interventional technology, radiation therapy or diagnostic radiography.
Although the majority of radiological technologists practice within a hospital setting, many now work in private clinics or mobile facilities. There are more
than 220,000 registered radiology techs practicing in the United States today.
CERTIFIED NURSING ASSISTANTS
There are more than a million certified nursing assistants (CNAs) working in
hospitals and nursing homes around the country under the direction of nursing
and medical staff. They perform essential routine tasks such as serving meals,
making beds and helping patients eat, dress and bathe. CNAs may also take temperatures, pulse, respiration and blood pressure. They often help patients who
need assistance walking, and they observe patients’ physical, mental and emotional conditions, reporting changes to nursing or medical staff.
In nursing homes, CNAs are often the primary caregivers, having far more
contact with the residents than any other members of the staff. Some nursing
home residents may stay in one facility for months or even years and develop
ongoing positive relationships with the CNAs who care for them.
6
E M P T Y H A L LWAY S
EMPTY HALLWAYS
1/28/03
3:25 AM
Page 7
Shortage of Health Professionals
Is there a shortage of [people in your profession] where you live?
82%
79%
74%
Yes, minor shortage
Yes, moderate shortage
Yes, severe shortage
Respiratory Radiology
therapists technologists
CNAs
FIG. 1
A shortage can reflect problems in both recruitment and
retention. It appears that both factors are at work in all three
fields, but with notable differences. Radiology techs report
that retaining qualified techs is a problem (44 percent categorize it as being major or moderate), but consider recruitment to be the greater problem (64 percent). Similarly, respiratory therapists perceive a greater recruitment challenge (66
percent) than retention problem (44 percent). The situation
is reversed for CNAs: Forty-six percent report a problem recruiting qualified CNAs, but 59 percent see a problem in retaining
them. The fact that fully 29 percent of the CNAs have been
working in the field for four years or fewer – compared to 6
percent of the respiratory therapists and less than 1 percent
of the radiology techs – also suggests that high turnover is a
problem in the CNA ranks.
The survey sheds some light on the underlying cause of
these retention and recruitment problems by exploring the
E M P T Y H A L LWAY S
7
16560_C1_4,_01_20 1/28/03 3:27 AM Page 8
job satisfaction of health professionals. All three groups express
low levels of satisfaction and report poor morale among their
professional peers. Clearly, these are not factors conducive
to successful recruitment or to retaining the services of qualified professionals.
There are certain aspects of professionals’ work situations
with which they express particularly strong dissatisfaction,
and which therefore are likely to be important factors in causing professional shortages. As Figure 2 reveals, these three
groups of professionals express low levels of satisfaction with
regard to a number of critical issues. Clearly, there are serious
compensation concerns: professionals are not satisfied with
salaries or – ironically enough – their own healthcare coverage and costs. A rather lukewarm endorsement of retirement
benefits is also offered by CNAs (42 percent satisfied), respiratory therapists (47 percent), and radiology techs (53 percent).
Low Satisfaction
With Key Conditions
I am very/fairly satisfied with this aspect of my job:
Respiratory Radiology
therapists
techs
Salaries
48%
47%
31%
Workload
46%
56%
42%
Health coverage/costs
41%
46%
38%
Job-related stress
39%
39%
46%
Staffing levels
36%
46%
42%
FIG. 2
8
CNAs
E M P T Y H A L LWAY S
16560_C1_4,P_01_20 2/14/03 2:12 AM Page 9
THE STAFFING CRISIS
Health professionals paint a rather gloomy picture in describing their current work environment. Only about half of respiratory therapists (53 percent), radiology techs (53 percent),
and CNAs (50 percent) are very or fairly satisfied with the conditions facing people in their profession today. Similarly, they
report low morale among their fellow professionals. Just 38
percent of respiratory therapists say morale is excellent or
good, while 62 percent say fair or poor (radiology techs: 49
percent fair/poor; CNAs: 45 percent fair/poor). These professionals are more likely to feel that conditions for healthcare workers are getting worse rather than better: respiratory
therapists (15 percent better, 56 percent worse), radiology
techs (24 percent better, 47 percent worse), CNAs (26 percent
better, 31 percent worse).
Respiratory therapists—Those in large hospitals (over 250
beds) are less satisfied with conditions and report lower morale
than those in smaller hospitals.
Radiology techs—Morale is disproportionately low for
those working in hospitals, and lower still for those in large
hospitals.
CNAs—Sixty-two percent of those who see 12 or fewer patients
per day report good or excellent morale, compared to 44 percent among those who see 13 or more patients per day.
Excellent
Poor
Good
Fair
FIG. 3
E M P T Y H A L LWAY S
9
16560_C1_4,P_01_20 2/14/03 3:53 AM Page 10
Getting
better
Staying about
the same
Getting
worse
FIG. 4
A number of factors contribute to this bleak outlook, including concerns about compensation, benefits and voice on the
job. However, the single most important problem facing health
professionals is inadequate staffing levels. As Figure 5 shows,
all three groups report that understaffing is the number-one
problem they face. Many also point to not having enough time
to spend with patients and job-related stress, both of which
are closely linked to the staffing problem.
Only a minority in all three groups report that they are very
or fairly satisfied with staffing levels at their facility, while a
Inadequate Staffing Is #1 Problem
What are the two biggest problems for [your profession] today?
Respiratory Therapists
Radiology Techs
CNAs
Staffing
49% Staffing
41% Staffing
46%
Time with patients
36% Pay, benefits
27% Pay, benefits
46%
Pay, benefits
Advancement
opportunities
Autonomy
22% Workload
45%
12% Job-related stress
24% Time with patients
22% Advancement
opportunities
22% Scheduling
Delegation of duties
8% Physical work
8%
Scheduling
7% Unsafe conditions
1%
Time for breaks
6%
14% Time with patients
Asked to perform
duties not trained for
Time for breaks
Autonomy
FIG. 5
10
E M P T Y H A L LWAY S
9%
6%
6%
5%
5%
16560_C1_4,P01_20 1/27/03 11:54 PM Page 11
majority of respiratory therapists (63 percent), CNAs (57 percent), and radiology techs (52 percent) say they are just somewhat or not satisfied. For respiratory therapists, this is the lowest level of satisfaction recorded among 15 different aspects
of their job.
Respiratory therapists—Seventy-four percent of those who
work in large hospitals, and 67 percent of those who see 13 or
more patients per day, express low satisfaction with staffing
levels.
Radiology techs—Just 38 percent of techs in hospitals are
satisfied with staffing levels.
The staffing crisis is a function of two powerful factors working together. First, professionals are simply being called upon
to serve more patients. Majorities of respiratory therapists
(72 percent) and of radiology techs (69 percent) report that
their patient load has increased in the last couple of years,
while among CNAs a significant 35 percent minority say their
patient load has increased. Virtually no one reports patient
load having decreased over that time. Fully two-thirds of respiratory therapists say they see more than 12 patients per day,
and 57 percent of radiology techs see 20 or more patients.
Greatly magnifying the impact of this increasing ratio of
patients to professionals is the increasing acuity or sickness
of their patients. As a result of multiple changes in the healthcare industry, the average hospital patient today is much sicker,
and needs more care, than in the past. A majority of respiratory therapists (73 percent) and radiology techs (51 percent),
as well as a 47 percent plurality of CNAs working in hospitals,
say that the acuity of their patients has increased during the
past few years.
In addition to the shared experience of inadequate staffing,
these three groups are also united when it comes to what they
enjoy about their work as healthcare professionals. Over-
E M P T Y H A L LWAY S
11
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whelmingly, CNAs (81 percent), respiratory therapists (71 percent), and radiology techs (62 percent) point to “helping
patients and their families” as the aspect of their job that brings
them the greatest satisfaction. All three groups also cite challenging and interesting work and the opportunity to work
with colleagues they like as important benefits. However, their
primary motivation is clearly service to patients and families.
Unfortunately, the ability of these healthcare workers to
provide that service appears to be compromised by inadequate staffing levels. One immediate and important effect of
staffing shortages is that professionals have less time to spend
with patients. CNAs (60 percent) and respiratory therapists
(58 percent) both say this is a very or fairly serious problem
for them. (Direct patient contact is less relevant for radiology
techs.) Indeed, CNAs consider their inability to spend time
with patients to be as serious a problem as low pay or inadequate staffing, while respiratory therapists rank it second only
to staffing.
The Goal: Serving Patients/Families
What do you enjoy most about [your profession]?
Respiratory Radiology
techs
CNAs
therapists
Help patients and their families
71%
62%
81%
Challenging/interesting work
25%
27%
17%
Work closely with people I like
20%
25%
33%
Professional autonomy
17%
11%
2%
Continuously learning
8%
7%
19%
Good salary and benefits
7%
13%
5%
FIG. 6
E M P T Y H A L LWAY S
13
16560_C1_4,P_01_20 2/14/03 3:25 AM Page 14
QUALITY OF CARE SUFFERS, PATIENTS PLACED AT RISK
Of even greater concern, a majority of professionals in all
three fields say that as a result of poor staffing and increased
workloads, the quality of care patients receive has suffered.
Seventy-nine percent of respiratory therapists, 71 percent of
CNAs and 70 percent of radiology techs report a negative
impact on the quality of patient care. Moreover, substantial
proportions in all three professions report that patients may
have been placed at risk as a result of staffing shortfalls (58
percent of respiratory therapists, 46 percent of CNAs and 37
percent of radiology techs).
Respiratory therapists—In large hospitals, 86 percent report
an adverse impact on quality of care, and 67 percent say patients
have been placed at risk.
CNAs—Of those with 13 or more patients, 80 percent say
quality of care has been compromised, and 60 percent report
patients may have been placed at risk.
Radiology techs—About 72 percent of those in hospitals
say staffing has hurt quality of patient care.
The Consequence: Quality of Care
Suffers, Patients at Risk
As a result of increased workload/poor staffing [in my profession]:
Quality of care has suffered
Patients may have been placed at risk
79%
71%
70%
58%
46%
37%
Respiratory
therapists
FIG. 7
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E M P T Y H A L LWAY S
Radiology
technologists
CNAs
16560_C1_4,P01_20 1/27/03 11:55 PM Page 15
IMPROVING RECRUITMENT AND RETENTION
Despite professionals’ concerns about conditions in the
workplace, the survey results suggest that there are ways to
improve recruitment and retention. One step endorsed both
by respiratory therapists and by CNAs is establishing mandatory maximum patient-to-professional ratios. (This idea is
not particularly relevant for radiology techs who generally see
a wide variety of patients from various units and with varying degrees of acuity. Radiology techs supported increased
staffing levels and workload limits that would provide a minimum timeframe for various procedures.)
By an overwhelming margin, CNAs (88 percent to 7 percent) favor mandatory ratios. For CNAs in a hospital medical
or surgical unit, the median suggested ratio is about 6:1. Fully
71 percent suggest a mandatory ratio of no more than 8:1.
This stands in stark contrast to the current reality in hospitals, where fully 60 percent of CNAs say they currently care for
more than ei …
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Tags:
Southern New Hampshire University

health outcomes

HRM 630

Quality Of Healthcare

HRM

health staff

Staff Shortages

specific health professional

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