ADDRESSING STAFFING SHORTAGES IN THE HEALTHCARE WORKFORCE

WHEREAS, nursing staff includes an entire care team comprising multiple disciplines and ancillary staff; and

WHEREAS, non-nurse disciplines, including physicians, physician assistants, pharmacists, physical therapists, respiratory therapists, and all other non-nurse specialties are crucial to delivery of high-quality care; and

WHEREAS, workers in transport, environmental services and other healthcare titles are crucial to ensuring safe, high-quality care for patients; and unprecedented vacancies in these positions have been created due to safety concerns, inequitable compensation, and other poor working conditions, which are felt at the bedside; and

WHEREAS, working conditions in clinical settings have deteriorated to the point where experienced professionals are leaving the bedside, new professionals are taking jobs outside of healthcare, and vacancies in ancillary jobs are critically unfilled; and

WHEREAS, this situation is not only placing unconscionable strain on healthcare workers, it also has created a crisis that threatens the safety of patients and the overall stability of the American healthcare system; and

WHEREAS, nurses, professional associations, and unions have been advocating for safe staffing laws for decades. The lack of consensus among nursing groups and employers has stalled the discussion for too long, resulting in continued application of dangerous staffing approaches; and

WHEREAS, mandatory overtime, misuse of on-call for staffing, overreliance on travelers and contract nurses, and unmanageable patient care assignments have become normalized. Staffing committees and other venues for nurses to vocalize staffing needs, while valuable, have not produced positive movement toward a standard that is safe; and

WHEREAS, being responsible for unreasonable patient loads; relying on inexperienced and agency staff to supplement and care for these patients; and being expected to work more hours with fewer resources—putting their own health, the health of their patients and the health of their families at risk—have resulted in an adverse work environment wrought with ethical challenges that have left healthcare professionals feeling completely unsupported and morally injured, particularly during the pandemic;^[1] and

WHEREAS, two states have safe staffing limits (ratios) built into state law for all or some patient care units, with California having a comprehensive ratios law and Massachusetts mandating ratios in some patient-care areas. Research shows that minimum nurse-to-patient ratios improve patient outcomes, such as improvements in mortality, readmissions and length of stay;^[2] and

WHEREAS, while the lack of enforceable standards has rendered staffing untenable for decades, the current situation is creating an existential crisis for the nursing profession. The consequence of unsafe staffing has a cumulative severe impact on the physical, mental, emotional and spiritual health of the nursing workforce; and

WHEREAS, nurses and other health professionals are leaving the bedside because of unmanageable patient loads and the deplorable working conditions across the healthcare system. One survey reported that over one-third of nurses plan to leave their jobs by the end of 2022, and nearly a third plan to leave the profession altogether;^[3] and

WHEREAS, pandemic-related pressures on healthcare accelerated this trend—the rate of violence in hospitals increased by 25 percent in one year alone from 2019 to 2020.^[4] And the correlation between inadequate staffing and higher incidence of violence in healthcare was well known even before the pandemic; and

WHEREAS, violence against healthcare workers is a serious and growing problem exacerbated by inadequate staffing. Healthcare and social services workers experience 76 percent of all reported workplace violence injuries in the American labor force, and the number of actual incidents of workplace violence is likely to be much higher;^[5] and

WHEREAS, healthcare workers have endured unfathomable strain at work during the pandemic, including inadequate personal protective equipment; ever changing care protocols; and administrators who were unprepared, not supportive and, often, not present; and

WHEREAS, our healthcare workforce has increasingly experienced moral distress caused by ethically challenging situations, such as the perception of not always being able to provide the normal standard of care and emotional support to patients and their families;^[6] and

WHEREAS, the compounding impact of experiences of moral distress, burnout, and impossible working conditions is exacerbated by environments with inadequate organizational support by employers and government;^[7] and

WHEREAS, the fatigue and overwork (resulting from poor staffing and other failures of employers to prioritize a positive work environment for those delivering patient care) serve to deteriorate the resilience and ability to cope with stress across our healthcare workforce, impacting workers’ health, personal relationships and families; and

WHEREAS, increased incidence of depression, anxiety and suicide among healthcare workers signify an immediate need to act;^[8] and

WHEREAS, a survey of emergency health workers reinforces our members’ experience and found a strong association between a perceived adverse working environment and poor mental health, particularly when organizational support was deemed inadequate; and

WHEREAS, unfair and inadequate pay practices exist, such as the refusal to increase wages for experienced nurses, low starting wages for hard-to-fill positions, and failure to pay ancillary staff a living wage; these are contributing factors to both new and experienced health professionals leaving their jobs—a dynamic that is exacerbating shortages; and

WHEREAS, the use of travel agencies to fill staffing holes has skyrocketed, forcing stark and unjust disparities in pay among clinicians; this is a development that exposes a deeply broken labor market in the healthcare industry; and

WHEREAS, consolidation in the healthcare industry has resulted in a reduced number of corporations competing for workers, which has resulted in practices like wage suppression, normalization of diminished working conditions, increased healthcare costs, and few resources spent to ensure health professionals have the tools needed to deliver safe, high-quality care; and

WHEREAS, elimination of services by hospitals not only deprives communities of care in rural and underserved areas, it also leaves specially qualified healthcare professionals unemployed, a dynamic that creates economic harm to families and those communities; and

WHEREAS, moving work out of acute care settings, outsourcing through contract work and telemedicine, and the use of artificial intelligence are strategies driven by cost savings, not patient needs; and

WHEREAS, employers and industry stakeholder groups are actively working to maximize profits—by cheapening care delivery through efforts to deskill our professions and seeking out cheaper labor forces—which complicates delivery of care, erodes scope of practice for a multitude of health disciplines, and threatens our jobs; and

WHEREAS, the COVID-19 pandemic has exacerbated pre-existing pressures and strain on the healthcare system and its workforce to a critical breaking point; and

WHEREAS, healthcare is a high-stakes environment with highly complex systems on the clinical and the business sides, and where factors like the evolution of different models of nursing care, reimbursement-driven documentation systems, and advances in research and treatment mean incessant change for direct care clinicians; and

WHEREAS, too often, nurses and other health professionals are scapegoated for lapses in systems and structures. Threats to just culture and other frameworks that ensure a culture of safety and accountability in healthcare have corroded to the point that health professionals are no longer willing to assume a disproportionate level of responsibility for this situation or heightened level of personal risk and liability; and

WHEREAS, the healthcare industry is in the midst of a workforce crisis, with unprecedented numbers of people leaving the bedside and many more preparing to leave the professions altogether; and the AFT is in a unique position to provide crucial input on strategies for addressing this situation because we represent clinicians, career and technical education teachers, faculty for nursing and other professional programs; and

WHEREAS, equity in the healthcare workforce is a requirement for broader health equity and the time for authentic, meaningful efforts at addressing racism, diversity, equity and inclusion in our healthcare workforce; and

WHEREAS, it is well settled that outcomes improve when the healthcare workforce reflects the population it serves. However, minority healthcare workers are currently underrepresented, and as the complexity of the positions and the salaries increase, the diversity of the workforce decreases; and

WHEREAS, the role of nurses is not only crucial to the stability of today’s patient care environment but is also critical to teaching the next generation of nurses. At the same time, nursing education programs do not have the funding, facilities or faculty needed to address the workforce shortage. And in nursing programs, where the problem is particularly acute, low salaries for faculty make choosing teaching unaffordable for many nurses:

RESOLVED, that the American Federation of Teachers will develop and implement a strategy with its national and state leaders for obtaining state law that mandates staffing ratios, or safe patient limits, in at least five states by 2025; and

RESOLVED, at the federal level, that the AFT will continue its work to secure staffing ratios in federal law by advocating for the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act and through all available regulatory means; and

RESOLVED, that the AFT will continue its efforts at securing legislation banning mandatory overtime by advocating for legislation at the federal level and through support of affiliates advocating for mandatory overtime prohibitions in state law; and

RESOLVED, that the AFT will support affiliate efforts to secure staffing ratios in collective bargaining agreements through supporting campaigns, developing model contract language, and providing training and resources; and

RESOLVED, that the AFT will continue its efforts to secure federal workplace violence protections through passage of the Workplace Violence Prevention for Health Care and Social Service Workers Act and Occupational Safety and Health Administration promulgation of the interim standard within one year; and

RESOLVED, that the AFT will support the work of its affiliates to address workplace violence in legislation, through collective bargaining, and other state and local work of healthcare affiliates; and

RESOLVED, that the AFT recommits to its advocacy to secure adequate pandemic preparedness protections in the law through means, like an OSHA infectious disease standard and updates to the Centers for Medicare & Medicaid Services emergency preparedness rule; and

RESOLVED, that the AFT will continue its work to educate and support affiliates and members about research, initiatives, and developments in pandemic preparedness at the employer and governmental levels; and

RESOLVED, that the AFT will prioritize its work to secure funding, programming, and other legal protections at the federal level to support health professionals in the areas of mental health, burnout and stress management, including addressing shortages in the mental health professions; and

RESOLVED, that the AFT will expand its work in partnering with other organizations and mental health experts devoting resources and work aimed at developing clear demands for improving healthcare workplaces, ensuring mental health needs of the workforce are addressed, and to development of resources and education programming that provide meaningful support to health professionals; and

RESOLVED, that the AFT will develop resources to support affiliate work addressing inadequate compensation in the healthcare industry through market and employer research, comparative analysis, and other needed means for use in collective bargaining and other affiliate efforts; and

RESOLVED, that the AFT will utilize opportunities to educate and advocate with government and other stakeholders on inadequate pay and compensation inequities; and

RESOLVED, that the AFT will deploy resources to secure more oversight of merger and acquisition practices in the healthcare industry through the Federal Trade Commission, Department of Justice, and the Centers for Medicare & Medicaid Services and to support affiliates pursuing state-level oversight; and

RESOLVED, that the AFT will work at the federal level to secure legal protections to protect scope of practice and our jobs with government and every other forum, and the AFT will support affiliates in similar state and local endeavors; and

RESOLVED, that the AFT will work to increase oversight for telehealth, hospitals at home, and other business practices so that our work, our jobs and our patients are protected; and

RESOLVED, that the AFT will make education, resources and direct support available to affiliates to address system problems that have been shifted too heavily on the backs of the healthcare workforce. This includes exploration of new member benefits to help shield health professionals from personal liability for systemic problems; and

RESOLVED, that the AFT will advocate for accountability in federal law and regulations that protects the licenses, jobs and livelihood of health professionals from unfair civil, administrative and criminal penalties that are the responsibility of an employer. The AFT will support affiliates in similar state and local efforts; and

RESOLVED, that the AFT will call on the federal government to develop a national healthcare workforce strategy, with participation and input by the AFT and its members, including those working in direct care, career and technical education program teachers, nursing programs and other healthcare professional program faculty; and

RESOLVED, that the AFT will work to advance efforts at meeting the needs of the healthcare workforce through CTE, apprenticeship programs, and residency and fellowship programs. We will also support affiliates in this work, as well as work to develop and expand language in collective bargaining agreements related to orientation, precepting, and other critical support for workers new to health professions; and

RESOLVED, that the AFT will continue promoting resources and support to healthcare affiliates and members for student loan forgiveness programs and also workforce development funding, particularly in communities of color and in rural and other underserved areas; and

RESOLVED, that the AFT will employ new strategies for affiliates to increase diversity in the local healthcare workforce, such as: addressing racism in healthcare workplaces; developing program models that help affiliates expand career outreach programs in communities of color to reach those who are underrepresented in healthcare jobs; and expanding targeted financial aid and loan repayment programs, including National Health Service Corps and the Nurse Faculty Loan Repayment program; and

RESOLVED, that the AFT’s healthcare and higher education program and policy councils will collaborate on development of a comprehensive strategy to address faculty shortages; and

RESOLVED, that the AFT adopts the report and recommendations made by its Healthcare Staffing Shortage Taskforce.

(July 16, 2022)