Staffing shortages wreak havoc on hospital workforces, raising patient safety concerns and harming employee well-being. At this point, the problem is well-known — but the solutions remain unclear.
From December 2022 to April 2023, researchers with the University of Pittsburgh School of Social Work conducted focus groups with 45 current and former Pittsburgh hospital workers to gain insight into workforce challenges and hear their proposed solutions. Seventy-three percent of participants who left their hospital jobs identified short-staffing as the primary reason, while 87 percent reported high levels of burnout.
One persistent issue is that those on the ground perceive a disconnect between themselves and upper management, according to the report. This leads to frustration with leadership's proposed solutions, which are often out of touch with workers' lived experiences. When hospital employees feel unheard and unsupported, they are more likely to depart, exacerbating staffing shortages and continuing the cycle.
Here are 16 quotes from the report, given by anonymous hospital workers, that illustrate the dilemma in their own words:
On management and workplace culture:
- "I want an executive to follow me in my day, get to report on these crazy, acute, insane, patient situations. I need them to watch me. I want them to come down from their office and come and see how we all have to work together, we all dig deep, do these things, don't get lunch, just do my job."
- "My biggest thing is expectation versus reality. A lot of the administrators who exercise their expectations for specific job functions, they do not actually tend to know what's going on in that job function to be able to appropriately guide workers."
- "The job is already pretty emotionally difficult. You see a lot of the worst things and are often there on the worst day of people's lives, and then to have that feeling of not, not only not being supported by your managers but also, professionally concerns about our professional ethics and concerns about maintaining our own integrity. So there was a lot [of] emotional and mental exhaustion, and also this question of are we violating our own code of ethics?"
- "You have people who are supervising you, who you're supposed to call if you come up with and run into issues, who have no idea what the environment is like, or how to address it, and a complete refusal on their end to provide any sort of help."
- "I deserve my voice to be heard too. I deserve a seat at the table when decisions are being made that I have to carry out."
- "We can all talk about the pandemic. Yeah, the pandemic created some scarcities, but this was gonna happen even without the pandemic."
On recruitment and retention:
- "It's like that circular thinking. They don't think people are going to stay. They're not going to pay them enough to stay. They're not going to train them or support them long enough to stay, and then they're not surprised when they don't stay. But they just created this cycle."
- "A lot of the people are quitting jobs because they don't have adequate child care. I have a son. I should have more flexibility in my schedule. Sometimes I'll be threatening to quit my job because of this, you know, because of the scheduling situation, you know, or the child care situation, or even the transportation. We should have free parking at night. Why do we have to pay for parking and literally no one's there?"
- "The reason why people are leaving is because they're not getting paid enough money. The cost of health insurance is a lot, you know. If they would treat us like they treat the travelers [traveling nurses], they'd have plenty of staff."
- "Nurses are still at the bedside. We're still suffering from burnout. I can tell you that if I came into nursing now, I don't know if I'd survive. I don't think I would."
On mental health effects and subpar solutions:
- "The things that they do have for our mental health are almost laughable. It's kind of insulting, and I think that also lends to really not feeling appreciated, feeling almost like you're being chastised whenever you do try to say 'we're having a hard time."
- "I realized I was skipping lunches. It was just not good and I expressed to my supervisor like, 'Hey, I realize this is not good for me. At most, my sessions, I can go about five or six sessions a day, but I need to be eating something, maybe even seven. But I can't do 10. I can't do nine.' I was told, 'Well, if you can't handle that, then you're probably not cut out for the job, or to be a therapist,' I think that's where it hit me, like, wow! My job does not care about me at all. I remember feeling like a robot. Like it was just see people, see people, bill, bill, bill. I just didn't understand, personally, how an employee can be treated this way and still be able to give to their clients."
On patient safety concerns:
- "The public needs to understand, needs to truly know what happens if the patient is in an unsafe assignment, is in an over ratio assignment, their family deserves to know. I deserve to know that my loved one isn't in a safe environment."
- "Patient placement told us they do not stop placing patients on our floor until we're double over ratio. So the other night, it meant that we all had seven patients — ICU-level patients. It gets morally exhausting, because you aren't able to care for people like you would want to and like you should be."
- "People don't know out there how bad it really is, and they don't know when they come to the hospital how dangerous it could possibly be, because of staffing levels. I definitely think that the higher ups lean on the fact that we all care so much about the patients, and we, many of us did choose this type of career, because, you know, we are altruistic. So I think that they take us for granted."
- "I know of patients who shouldn't have died that have died because we have been understaffed. So we need to do something about it and change it now."
Read the full report from Pittsburgh Wage Study here.