'Extreme stress': How the COVID-19 pandemic affected hospitals

Hospitals and health systems have faced extraordinary pressure during the COVID-19 pandemic, and a new federal report offers more insight into those challenges.

In treating waves of coronavirus patients for more than two years, hospitals have battled staff shortages, burnout and mental health issues, and thousands of workers have been infected. Health systems have also endured financial woes as well.

The new report from the U.S. Department of Health and Human Services, published May 3, outlines some of the struggles. The pandemic has placed “extreme stress” on the nation’s healthcare workforce.

“The challenges of treating COVID-19 patients as the pandemic has continued caused acute staffing shortages in many hospitals,” the report states.

At the peak of COVID-19 hospitalizations in January 2022, roughly 1 in 5 hospitals reported critical staffing shortages. 

During the wave of patients with the fast-spreading Omicron variant, the 7-day average of hospitals reporting critical staffing shortages hit a pandemic high of 22%, the report stated.

However, even this figure may not capture the accurate number. It’s possible some smaller hospitals were so overwhelmed they simply didn’t have the resources to report they were dealing with critical staffing shortages, the report stated. It’s also possible some hospitals that weren’t battling severe staffing shortages felt less urgency to report.

As COVID-19 cases and hospitalizations have dropped in recent months, some of the staffing challenges have eased to a degree. In mid-March, 9% of hospitals were reporting critical staffing shortages.

Some hospitals are lacking staff, including infectious disease specialists and respiratory therapists, to care for complex COVID-19 patients, the HHS report stated.

“Shortages of specialists has long been an issue, and hospitals worried that the prevalence of COVID-19 patients experiencing long COVID, in addition to an increase in the number of patients with behavioral health needs, would make this situation worse,” the report stated.

While the staffing crunch has generally abated at a nationwide level from January to March, some states, including Minnesota, Nevada and Rhode Island, had a higher percentage of hospitals reporting critical shortages in March. On the flip side, New Mexico, West Virginia and Wyoming had some of the biggest declines in hospitals reporting critical staffing shortages.

Rural hospitals in particular dealt with staffing shortages and financial challenges in the pandemic, another worrisome sign for health providers already facing difficulties, the report said. Between 1990 and 2020, more than 300 rural hospitals closed around the country.

As many as 40% of America’s rural hospitals are in danger of closing due to financial issues, the Center for Healthcare Quality and Payment Reform estimates.

Since the pandemic began, nearly 1 in 5 healthcare workers (18%) have quit a job, according to a survey by Morning Consult.

Shortages could get worse

The staffing shortages had an impact on patient care, the report noted.

Officials with the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services have expressed increased concern about the pandemic’s impact on patient care in recent months. In an analysis published in the New England Journal of Medicine in February, CDC and CMS officials pointed to an erosion of patient safety during the pandemic, citing increases in hospital-acquired infections.

The healthcare industry was already projecting shortages of doctors and nurses before the arrival of the coronavirus, but the COVID-19 pandemic has only exacerbated those concerns. By 2025, 37 states are projected to have a shortage of physicians, the report noted, citing projections from the Health Resources and Services Administration.

Doctors and nurses have said the stress they endure during the pandemic has them thinking about leaving the profession. As many as 40% of nurses have said they plan to walk away in two years, while roughly 1 in 5 doctors also said they planned to leave in that time.

The report notes another factor adding to shortages: America’s doctors and nurses are getting older. Nearly half of all registered nurses are over 50, while nearly half (44%) of all doctors in 2019 were 55 years old or older.

With the shortage of nurses, some hospitals have said they’ve had to turn to travel nurses, and their labor costs have risen sharply.

Before the pandemic, hospital staff nurses earned about $1,400 per week, the HHS report stated. During the pandemic, travel nurses can earn between $5,000 and $20,000 per week, according to the report.

Hospitals have bemoaned the costs associated with travel nurses and have pressed federal lawmakers and regulators to investigate the possibility of price gouging. Small hospitals and rural providers said they are having an especially hard time paying for staff.

For their part, nurses have said health systems haven’t offered sufficient pay, fair scheduling or adequate support at the workplace.

Physical and mental toll

Hospital and health system staff have faced no shortage of risks to their physical health during the pandemic. Through April 2021, 3,607 healthcare workers in the U.S. have died due to COVID-19, according to the report.

Roughly one-third (31%) of healthcare workers said their physical health has worsened in the pandemic, according to a Morning Consult poll released in Oct. 2021.

Support staff and nurses have been more likely to die than physicians, and nearly two-thirds of the healthcare workers who have died have been non-white or Hispanic, the report states. About one third of those workers were born outside the country. Nationwide, about 1 million Americans have lost their lives to COVID-19.

Many health workers have said their mental health has suffered during the pandemic, numerous studies and reports have found.

Even worse, some aren’t getting help, either for fear or letting fellow workers down or due to the stigma of mental illness. A recent survey found a majority of nurses said their work was affecting their mental health, but few were getting counseling.

The Lorna Breen Act, a new federal law inspired by an emergency doctor who died by suicide early in the pandemic, offers funding to help health systems address mental health issues.

Going forward

Policymakers need to address the looming shortages of healthcare workers and develop a stronger pipeline of new physicians and nurses, the report states.

Workforce development efforts also must address the need for more diversity in the nation’s pool of doctors and nurses, which will help address staffing needs and ultimately lead to better care for patients of minority populations.

The American Hospital Association has implored Congress and the White House to approve more Medicare-funded physician residencies and to offer more support for nursing schools. The association is also advocating for more funding for hospitals to address staffing and mental health needs.

The HHS report also said it’s time to pay more attention to community health workers, direct care assistants and other paraprofessionals who are at higher risk of COVID-19 infection.

In addition, there’s a demonstrated need for a more reliable pipeline of personal protective equipment and other necessary supplies.