Peter J. Papadakos MD, FCCM, FCCP, FAARC, FNIV
It is seven in the morning and you are starting your day in the ICU. The sign-out you received was that you have several complex new admissions from overnight. You go into a patient room and do not recognize the nurse or respiratory therapist. The mid-level on service is from an agency. You are also informed that there is a backlog of MRIs that need to be done since the technicians have quit to join a staffing company and leave town. Furthermore, there is a shortage of pharmacists and ECHO technologists. Is this a nightmare? Or is it the new reality of the post-pandemic staffing model?
As critical care practitioners involved in the care of complex critically ill patients with neurologic or neurosurgical issues, we now have to deal with this dangerous situation. For a multitude of pandemic-related reasons—burnout, refusal to participate in vaccine mandates, or a new fear of working with patients—we now have a national healthcare staffing crisis. It affects all units and all types of hospitals, from internationally known university hospitals to smaller rural hospitals.
We are now forced to staff our units with individuals on short-term contracts from staffing agencies. This stopgap policy not only leads to adverse events in the care of critically ill patients but also contributes to even greater interpersonal issues which further fuel the fire and magnify staffing shortages. Your loyal long-term staff that has worked together as a team for many years and formed an ideal well-oiled machine realizes that the unfamiliar staff with the temporary IDs provided by agencies are making several multiples of their hourly wages, and in some cases also getting free housing and rental cars. We all can understand how this staffing model can make your own staff leave and join agencies themselves. In speaking to colleagues in large cities, they inform me that staff from hospital A are now working at hospitals B and C, then D, E, F and G as they rotate from place to place on lucrative six-week contracts.
This total dependency on locums staff affects all levels of healthcare workers from attending physicians to technologists. This “temporary” model has completely destroyed what in my mind was the greatest advance in critical care—the multidisciplinary team that provides high quality patient care and optimizes patient safety. We in neurocritical care have spent years working and training together, and our ICUs have developed protocols and guidelines on how we deal with specific problems. Our workplace is a model of this collective care plan where we all come together to address the needs of our patients. The current problem has led to a world where our training programs, mentorships, and social relationships have all decayed, with positions now being filled by temporary short-contract staff with no loyalty to the unit or the organization. I see a real danger in morale, professional satisfaction, and patient care as this new staffing model has taken hold. I predict that this issue will also affect quality of care in the longer term and lead to complications that will negatively impact patients. The massive cost of using locums staff will also affect the financial health and stability of our hospital systems and facilities. We can easily predict that hospitals may close due to this issue.
We must all unite and begin to address this problem. We need to work as a group to research and address the core issues at the heart of this situation. We need to work with local and national leaders to address their staffing issues. If we do not act, we will continue to see massive staff losses while the pool of new individuals joining the healthcare professions dries up. This trend, if it continues, will inevitably culminate in a decaying healthcare system that is unable to deliver adequate healthcare in the future.
As we see this problem affects all stakeholders from the patients, health professionals, hospital administration and government agencies. No one group can address this overriding issue. Our professional organizations, hospital leadership, educators and government agencies need to come to the table and evaluate the core issues and address them from many angles. Do we need to modulate salaries in better ways, can we address wellness and burn out, develop better pathways to recruit individuals and can we affect health regulations. First and foremost, we as critical care providers need to make our hospital and government leadership of the scope of this problem and how it affects patient care. We need to come together our I health care system will collapse.