Hello, and welcome to episode 28 of The Nurse Trauma Healing Podcast. I’m Dr. Lorre Laws, your host, and today we’ll be discussing the healthcare workforce crisis. We’ll discuss a recent report from the New England Journal of Medicine who conducted an Optum report survey of 150 health care executives across various settings – 52% from the provider segment, 35% from payer (insurance and others) organizations, and 13% form state or federal government agencies. I’ll discuss what the c-suite executives are seeing, including the roadblocks ahead. Let’s take a peek behind the corporate curtain to see what’s really going on. And, in full disclosure, I was invited to attend a panel of experts session regarding these important topics in several weeks. I’ll be sure to report the findings from that session in an upcoming podcast. For now, let’s take a deep dive into the healthcare workforce crisis, including the challenges and possible solutions before us.
The biggest challenge, surprising no one is . . .
Sixty-six percent of the health executives surveyed state that skyrocketing labor costs are their biggest challenge.
The second biggest challenge highlights the significance of avoidable nurse and healthcare professional trauma exposure . . .
Medical errors are the second biggest concern. Sure, from the perspective of a spreadsheet, a profit-and-loss statement, and an operating budget the cost of medical-related errors are significant expenses. They are also taking a toll on nurses and healthcare professionals who carry the burden of guilt and shame that are associated with near misses, adverse events, sentinel events . . .burdens that are not theirs to carry, but rather due to (in most cases) organizational shortcomings or system failures.
Then there’s the “workforce disruptions and their impact on performance”. . .
From the C-suite professionals surveyed, 47% of leaders cited training costs as the leading disruption. And 33% identified lack of skilled talent as a top disruption. The cost to retain, attract and train the workforce is an overwhelming pain point for all health organizations.
Now, let’s look at these reported workforce disruptions through the lens of avoidable nurse- and healthcare professional-specific trauma in these specific categories: workplace safety, bias in the workplace, mental health, and worker exhaustion made the top 10 workforce disruptions list.
Is it just me, or is anyone else seeing that IF c-suite executives and their teams addressed workplace safety, violence, and bias issues that contribute to mental health challenges and worker exhaustion AKA burnout and occupational traumatization . . .that this would actually decrease their training costs, help with recruiting and retaining skilled professionals and paying them a competitive wage or salary? Wouldn’t all of this help offset the impact of worker caregiving responsibilities and early attrition to resignation and retirement?
Be assured I will be speaking to that perspective with clarity and urgency when I attend the NJEM panel soon.
It’s clear that the old ways aren’t cutting it anymore . . .
Fifty-five percent of executives report that even when leadership is clear on the problem, it is difficult to arrive at a solution due to money, leadership, and varied approaches to decision-making. That’s why it’s easier to address the small, incremental problems than the seemingly insurmountable ones that desperately need addressing.
Strategies that leaders are exploring include staff scheduling and flexibility. Many organizations are allowing their employees to self-schedule their shifts and the length of them while 72% of leaders are turning to strategic partnerships such as AI, virtual health, etc. that are needed to fill the gaps . . .but they often do not have the in-house expertise that is needed.
Here’s the reality check – 61% are prioritizing automation while realizing that this technology has to make the work more human, not just efficient. It’s a nuanced play at the human-technology interface. And health care isn’t the only sector facing these types of challenges.
It’s a wake up call. We need to rethink how we work. How we train. And how we use technology to empower people – not replace them.
We need new approaches to how we work, how we train, and how we use technology to support us, not create endless boxes to tick, fields in which to type, or alerts and alarms that continually fatigue us. Technology needs to empower people, not replace them.
Currently, many health care leaders – 65% of those surveyed – are making calls without a playbook in today’s broken system health care context. It’s hard to get everyone on board to make cohesive decisions, highlighting the degree to which health care systems and delivery are fragmented.
When asked about the lack of skilled health care professionals, 65% again said finding the right people with the right skill set is among their top challenges to address.
Which begs the question, if finding and retaining a skilled workforce is so important, why aren’t health care leaders examining how their systems and policies are inflicting avoidable occupational-related trauma exposure on their employees?
Leaders state that they not only need employees who are skilled, but who are heart-centered, passionate, compassionate, and can thrive in their roles. They keep looking at the characteristics of the employees through the outdated lens of burnout instead of creating safe practice conditions where employees are regulated in their nervous systems. Then, and only then, from the employee’s Window of Tolerance in ventral vagal tone, is thriving, passionate employment possible. Here’s a refresher for those of you who are new to this podcast, of Dr. Stephen Porges’ Polyvagal Theory which illustrates the physiological importance of creating a safe and adequately staffed and resourced setting in which health care professionals do their work.
It. Is. Possible.
But leaders are taking a non-trauma informed approach to addressing their challenges. Which reminds me of the famous quip, “if you continue to think like you’ve always thought, you’ll continue to get what you’ve always got”. I got my start in health care five decades ago. It’s been the same regurgitated burnout narrative for literally half-of-a-century. We’re long overdue for a paradigm shift.
What’s on the leader’s agenda to address the staffing crisis in healthcare?
It’s the same old narrative:
-expand the workforce – but we’ve been there, done that – that highly educated and trained people are refusing to work in unsafe, under-resourced conditions, fraught with dangerous patient-care provider ratios embedded in a culture of blaming the victim/employee.
–partner with universities, student loan assistance – but we’ve been there, done that – we’re losing 1 in 4 new graduate nurses to attrition during their first year of practice. The “churn and burn”, “hire to fire” employment model can’t keep pace. That’s why I, through my book and nonprofit, are offering 12-week programs to help employers take a trauma informed approach to nurse residency programs, new grad transition programs, and in-service training. Universities, such as the one in which I’m employed, do an amazing job educating and training the next generation of doctors, nurses, pharmacists, and allied health professionals. But most of them get burned out within the first six months of their practice. And by burned out, I mean traumatized. Avoidably and occupationally traumatized.
– rethinking the job requirements for some roles – again, just getting more warm bodies in a chair or on a unit doesn’t get at root cause. Health care organizations can and must examine and address the avoidable trauma exposures and provide resources and support, such as those I offer in my book and trauma prevention and recovery programs.
–change how they attract and retain employees – as you can imagine, I will be speaking at length to what changes are needed. I don’t want to sound like a broken record here. Suffice it to say they must stop avoidably traumatizing their employees to the point that their autonomic nervous system and mitochondria literally cannot produce enough energy over time to withstand the significant, chronic trauma exposures.
-invest in their existing employees – yes! And please do so in ways that help them to insulate their nervous system from harsh practice conditions so they CAN work from that regulated, heart-centered, open-minded, compassionate, and socially connected manner that ONLY comes when one feels safe in their environment. If you’re a health care leader out there – please message me. I’ve done the research. I have the programs through my nonprofit. You can help your employees AND receive a tax deduction for your donation! Shameless plug, over. Thank you for indulging me as I do everything in my power to be a part of the solution. Other strategies include up-skilling employees, opportunities for career expansion and upward mobility, role flexibility to promote autonomy and curiosity.
Quick, little changes are like bringing a bandaid to open heart surgery.
Leaders continue to look for “quick fixes” to systemic challenges, which is why we’re all on the hamster wheel. Running as fast as we can – in flight, fight, or fawning states – trying to get through the day. The quick fix, doing something is better than nothing approach is what keeps us mired in the health care staffing crisis.
Building trust, building work environments where employees feel safe because they are safe, building relationships, listening, collaborating to find mutually satisfactory solutions, prioritizing professional wellbeing, creating a culture where people feel safe to express themselves and make recommendations, self-service tools for scheduling shifts and training, giving employees more autonomy, control, and flexibility . . .These all take time.
And there’s this one. Offering mandatory training sessions during regular working hours. If we have a burned out, traumatized, and exhausted workforce who are leaving their roles in droves, why are we further burdening them with endless calls, texts, emails, training to be completed outside of working hours and often non-compensated? Same for professional development. Why is it that the employee is burdened with the time and cost developed to obtain additional training and often must do so by using their earned PTO instead of being compensated by the employer who is requiring that training.
Until part 2 of this podcast series, know that the point of empowerment is always in the present moment. Grab your chair, bring your table if you need to, and take your place at the policy and decision-making table. No one is going to save us. We are going to save ourselves. One nurse, one trauma avoidance, and one trauma healing at a time, one advocacy and change agent effort at a time. As we heal together as individual nurses, nursing teams and communities, we can work from our healing scars instead of our gaping wounds to usher in Nursing 2.0 – The Nurse Safety & Professional Wellbeing Edition.
If you’re curious about the solutions that I am bringing to the table, informed by five years of research, please preorder my book, Nursing Our Healer’s Heart – A Recovery Guide for Nurse Trauma and Burnout. During the pre-order promotion, you can email us at team@drlorrelaws.com to be entered into a raffle for a free and transferable scholarship to our Trauma Healing Academy for nurses, health professionals, and everyone else.
If you’re a healthcare leader and would like to see how our new graduate, nurse residency, or in-service programs can help you to attract, train, and retain employees that are professionally well and thriving in their roles while contributing to the financial wellness of your organization, please schedule a personal call with me. All donations to The Haelan Academy, a 501c3 nonprofit organization, are tax deductible. Nurses helping nurses and other health professionals. That’s what true heart-centered collaboration looks like!
Until next time, thank you for all that you are and do.
I see you.
I feel you.
I hear you.
And I am here for you.
From my healer’s heart to yours,
Dr. Lorre 💕
