Provider burnout and staffing shortages among U.S. healthcare workers

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Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, in discussion with PwC Principal Katie Burg Plaza, on how health organizations can combat and prevent provider burnout and staffing shortages, including:

  • Implications of provider burnout on the healthcare industry prior to COVID-19
  • Downstream impacts of provider burnout on staffing, patient care and operations
  • Short and long-term considerations for employee retention across care continuum

Topics: provider burnout, staffing shortages, hospital, healthcare, COVID-19, patient care, employee retention

Episode transcript

Find episode transcript below.

Trine Tsouderos (00:04):
Welcome to HRI's Next in Health podcast. I'm Trine Tsouderos and I lead PwC's Health Research Institute. I'm also a management consultant at PwC working with pharmaceutical companies on vaccines, mRNA, mAbs and other drug products. Today I'm thrilled to be here with Katie Burg Plaza. Who's a principal in our healthcare provider transformation practice. Katie works with our healthcare provider clients and also leads our clinical hub prior to PwC Katie worked as a nurse practitioner at an academic medical center in Philadelphia. We're hear to talk about provider burnout and staffing shortages. And these are burning questions right now for a lot of healthcare providers and their clinician and staff, especially with the pandemic continuing on. I think we're all tired of the pandemic, but I think nobody can say that more than the folks working in our hospitals and health systems. So welcome Katie.

Katie Burg Plaza (00:58):
Thanks. So great to be here.

Trine Tsouderos (01:00):
So Katie, one of the things that we did in preparation for this podcast is we looked at what evidence there was out there of provider burnout and staffing shortages. And there was no shortage of that. We found a 2020 report from Medscape that surveyed 2000 physicians1. It found that 79% of physicians reported their feelings of burnout began before the pandemic. So this is a huge number of folks coming into the pandemic already feeling burned out. In 2020, there was a survey of a thousand healthcare workers from mental health America indicating that they're stressed and stretched too thin. 93% reported experiencing stress. 86% said they were experiencing anxiety, 77% reporting frustration, 76% reporting exhaustion and burnout. And 75% said they were overwhelmed. So this is September, 2020, we're already into the pandemic.People almost universally working in healthcare reporting that they are feeling anxiety and stress. And then going back just before the pandemic, you see, again, an analysis in the annals of internal medicine, finding that physician burnout costs Americans about 4.6 billion a year in poor clinical outcomes.

Trine Tsouderos (02:16):
So it's not just a problem for the providers, for the clinicians, but also for us patients. If we look at all of this, the message I got is that we went into the pandemic in a bad place. We are in the pandemic and we're in even a worse place. And I imagine Katie that you're hearing from providers, this message loud and clear. So I wonder if you could talk a little bit about what you are hearing from provider organizations, from executives, from clinicians and what are those conversations like?

Katie Burg Plaza (02:47):
Yes, you're spot on. It is a predominant challenge throughout the country. Some of the issues stem from pure staffing numbers and a lot of our clients are nursing shortages and other healthcare providers shortages with travel agencies and the other options in that format. However, that in itself is creating challenges due to discrepancy in payment rates, a full-time employee versus a traveling nurse as an example. So there are a lot of efforts to try to fill the gaps, but the main thing we're hearing are real issues with nursing retention. And of course we know it's been exacerbated significantly by COVID and the excessive stress and burnout that the nursing teams and others have faced. But like you alluded to, this is not a new problem. It's been in the making. One of the biggest issues coming into the last couple of years was the mass Exodus and retirement of the baby boomer generation, which were a lot of senior experienced nurses. And that was happening prior to COVID. So it's sort of compounding this issue and challenge that our clients are facing, but I am hearing it from both the executive level, as well as staff level and nursing management levels of teams, just a lot of frustration and stress. And there is no quick and easy fix, unfortunately. So I do see folks starting to get a lot more creative in how to handle the situation that we're in.

Trine Tsouderos (04:09):
Katie, what happens when you have a shortage of nurses and you're bringing in maybe agency nurses, what does this look like for hospitals, for patients for the staff? Are people working longer shifts? Are they burned out in their quitting? What does it look like on the ground?

Katie Burg Plaza (04:27):
Yeah, there's a few different dimensions to that. For sure. Nurses are working longer hours. Hospitals are offering bonus pay for additional effort and time. So there is that in place. However, there's so much burnout. The staff are less interested in working additional hours, despite the financial incentives. You certainly see, as we've seen again, this round, a decrease in elective procedures and surgeries in many areas of the country. And when that happens, nurses shift to different types of units.

Katie Burg Plaza (04:57):
So there are rotations through COVID units as an example, and some hospitals trying to give nurses a break. So they're not always in the COVID units. There's a shuffling of staff from administrative positions into direct clinical care again for nurses or other clinicians that had already made a career move out of direct patient care. They've been brought back to help with the shortages. There's been a lot of focus on boomerang staff, bringing nurses and others back to the frontline. If you will, who had already either left the hospital or retired just for the need to fill the gaps. And you know, that's one of those double edged sword situations where it's great to get them back, but often they're coming back with big bonuses to return and it's hurting some of the staff that have been loyal and haven't left who haven't had a financial incentive for staying. So along those lines, there have been retention bonuses and those types of structures. We're seeing that more often. So to summarize all of what I just said, a lot of shuffling of people, a change in some of the procedures that are available to the patients and then a variety of financial incentives and rewards to try to keep folks at the bedside.

Trine Tsouderos (06:06):
I imagine one of the outcomes of this is that labor costs are going up a lot. What you're describing is a lot of money being spent to address the shortage.

Katie Burg Plaza (06:15):

Trine Tsouderos (06:16):
One thing that comes to mind is what you were talking about is that there was a issues before the pandemic. And then we had the pandemic, we had this initial scramble where hospitals were canceling non-emergent procedures and services. And now here we are, you know, quite a while in, have you seen a change in the situation staffing wise over the period of the pandemic or has it remained kind of constant all the way through? Is it different now than it was say a year ago or 18 months ago?

Katie Burg Plaza (06:45):
I do think the difference now is true burnout. I think when the initial crisis happened, I don't want to generalize, but nurses are there for their patients. You know, they were in it as a team to get through this crisis, but this has gone on for a long time. And you can imagine being in crisis mode for all this time and especially right now where there's the added dilemma of knowing that a vaccine exists, it has changed the tone a bit and some of the ability for people to power through, you know, and just layman's terms. So yes, I think the stress and burnout as compounded at this point in time, and that is why the issue of retention has become that much more important and a real focal point for the providers that you work with and that we see around the country.

Trine Tsouderos (07:31):
So Katie, what are we telling these folks that are calling you? What's our advice? How do we help them address this really difficult puzzle? And one that I think we don't see an immediate end in sight. It's not like this is going to end by the end of this year. Presumably we're going to be in this situation for some time. But what are you telling clients?

Katie Burg Plaza (07:51):
There are a lot of short-term things that we have been talking about and putting our heads together across our own clinical team to figure out retention strategies. We're really putting retention first, even before recruiting, although they happen simultaneously and concurrently, they really need to focus on retaining their talent that they have across the Institute, not just acute care, but ambulatory home health, et cetera, it spans the entire continuum of care. And so with that, we've been helping clients think about what is your current state?

Katie Burg Plaza (08:20):
So we do benchmarking, we look at their numbers, we look at their overtime spend. We look at all those sort of typical levers that we would study when we look at any hospital pre pandemic or during pandemic. And then we're trying to really think creatively about different types of care models, how to help everyone nurses, CNAs, advanced practice providers work at their top of license. So are there ways to leverage non-nursing activities that may be performed by a nurse to others as an example, different ways to staff units thinking about, can it rotate out, do some virtual care, do administrative work for, you know, a day a week, as an example, we've seen some of that working with middle management, just to give them a break from the constant pressure of direct patient care, the list goes on, but I would say a lot of it is about creativity with the daily work.

Katie Burg Plaza (09:07):
And then second to that, working very closely with HR and nursing leadership on benefit options and thinking differently about benefits and where can they really reward tenure consistently across the house? Are there even small perks around paying for parking and other things that would benefit the teams that are working so hard? So I would say benefits are the other big bucket where we're trying to help them think creatively. So we're really trying to help them think about this from all those different dimensions.

Trine Tsouderos (09:36):
So it sounds like we've got a lot of tools to help the situation in this short-term emergency scenario that we're all living through. How about long-term? So we know that this has been a long-term problem. It's just made worse by the pandemic. Eventually we will be out of this crisis, what should be done long term to address this. So that going into the next pandemic, we don't end up in the same situation and that folks who are burned out now are able to not continue to live in that state going forward. What's the long-term solution.

Katie Burg Plaza (10:09):
Yeah, I think there are a few dimensions there as well. One is around the recruiting and the pipeline, if you will, for nursing within these health systems, many have affiliations with nursing schools really tightening that up. Also thinking about more formal structure for the nursing assistant role and levels within that. So there's career progression opportunities and having a more robust, constant interaction and engagement from a pipeline perspective. I would also say the good news now in that area is nursing enrollment is still strong, so that's good. We haven't lost interest in the profession. Hopefully we'll gain more interest in the profession. But then the next piece is like I alluded to really thinking about nursing care models, helping nurses work at top of license, giving them a career pathway that's rewarding and meets their needs. One of the things that we find interesting about nursing as a career is that there are many different personas within the nursing profession.

Katie Burg Plaza (11:06):
Some have ambition to move around the health system, but then there also are many who are very content working the way their ships are designed. So they have time with their family and other needs. So there are a lot of different personas or dimensions of nursing professionals. And we think it's very important for our clients to think about that and design benefits, packages, and career direction and options accordingly. So those are a few of the longer term areas of focus, but I think this would have to continue to evolve. The other piece is technology. And what kinds of tools exist for nurses from scheduling to increasing efficiencies within documentation in the electronic record? What kinds of tools can we help our clinicians have at their fingertips just to make the job easier, where we can, knowing that there's always the stress of the patient care and other factors throughout their day. So I think there's a lot of different angles to work at. And it's an opportunity for all of us to really think outside the box, knowing that we really need a stable, solid nursing workforce, forevermore, despite the pandemic and everything else everyone's been through.

Trine Tsouderos (12:15):
Katie do you feel like this could be something of an inflection point for nursing where out of this crisis, the longer term changes that you're talking about, that they could really improve the profession and then sort of reflect the value that nurses bring to our healthcare system. Do you think that's sort of in our future potentially?

Katie Burg Plaza (12:34):
I would hope so. And I think it's imperative that there is a focus on nurses first and as a priority within a health system. One of the challenges that COVID brought was a lack of trust between the providers and the health systems for a variety of reasons. PPE is one. And I think it's time to really rebuild that trust. And I think having health systems and leaders in nursing really think creatively focus on retention, having the nursing profession feel that value and that essential value that they bring would be a wonderful inflection point from all of this and would serve all of us moving forward.

Trine Tsouderos (13:13):
I think everybody benefits from those kinds of changes. Every single one of us. Thank you so much, Katie, for joining us, it's been a real pleasure talking about the nursing shortage and things that can be done to address it.

Katie Burg Plaza (13:25):
Thanks for having me. It's been great to have the opportunity.

Trine Tsouderos (13:27):
Great well for more on these topics and other health industry insights, driven by policy innovation and care delivery changes. Please visit our website at Until next time, this has been Next in Health.

Announcer (13:47):
This podcast is brought to you by PwC. All rights reserved PwC refers to the U.S. member firm or one of its subsidiaries or affiliates, and may sometimes refer to the PwC network. Each member firm is a separate legal entity. Please see for further details. This podcast is for general information purposes only and should not be used as a substitute for consultation with professional advisors.


1 Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide

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