With a health care worker shortage so dire that hospitals are being forced to close beds, delay transferring patients, and divert ambulances elsewhere, Michigan’s leading health care associations announced Thursday they are teaming up to offer a solution: asking the state Legislature for $650 million to “recruit and retain health care workers.”
What that money would be for, exactly, is intentionally being left open-ended, said Michigan Health and Hospital Association spokesperson John Karasinski. But it would include a scholarship program, as well as some kind of direct payments to health care workers.
“How the $650 million would be split between the two proposed programs is up to the policymakers, as our goal is to work with the state to determine a fair and efficient distribution method,” he said via email. “The intention of the scholarships is that colleges and universities, community colleges and certificate programs would all be qualifying institutions. We do not have specifics yet on what form health care worker payments would take, outside of being focused on increasing recruitment and retention."
The newly-formed Healthcare Workforce Sustainability Alliance includes the major state trade and lobbying associations for hospitals (Michigan Health & Hospital Association, or MHA), long term care centers and skilled nursing facilities (Health Care Association of Michigan, or HCAM), EMS services (Michigan Association of Ambulance Services, or MAAS) and the Michigan Community College Association, as well as others.
A shared crisis as health care workers burn out, leave the field
Leaders were blunt in their descriptions of how bad the staffing shortages are right now. Since the start of the pandemic, the state’s nursing facilities have lost 17% of their workforce, or 11,000 employees, said Melissa Samuel, HCAM’s president and CEO. “And 85% of our facilities have had to limit or halt new admissions due to staffing shortages. Nearly half of our state's nursing facilities have closed units or beds due to staffing shortages.”
In hospitals, staffing shortages have led to “real concern” over “transfer[ring] patients from one facility to another in a timely fashion,” said Brian Peters, CEO of the MHA. “We understand that a growing number of our hospitals have unfortunately had to place their ambulance services on diversion, meaning our beds are fully staffed and fully occupied and we have to divert those those services to another facility. This is a real problem that we are dealing with today, and unfortunately there is no end in sight.”
And EMS workers are leaving the profession, said Angela Madden, executive director of the Michigan Association of Ambulance Services.
“Paramedics work a very tough job on the road, as do all of our counterparts in health care,” she said. “And it is becoming more and more difficult on their bodies. So what we used to see as a 10% turnover in our employment status year-by-year, that is now upwards of 25% and 30%. We just do not have the people coming in on the back side to help cover for some of those retirements and some of those exits. People are exiting EMS to not just to retirement, they are finding other employment and other health care fields which are a little bit easier on their body.”
Do the proposed solutions actually fix the problems?
In a press release, the group said the “Future Health Care Worker Scholarship Program” would offer up to two years of tuition costs to students “pursuing a degree in a clinical health care field.”
The scholarships are intended to attract more people into the field, said MCAA president Michael Hanson.
“What's really needed is an incentive to do that among students, and to reduce some of the barriers. And one of those barriers, of course, is tuition. And so to the extent that a tuition barrier exists, providing scholarships for these programs would allow for more enrollments.”
But at least in the nursing field, where staff shortages are especially critical, there already appears to be no shortage of interest among would-be students. Nationally, nursing school applications have risen dramatically during the pandemic. The University of Michigan received “1,800 applications for 150 freshman slots this fall, compared with about 1,200 in 2019,” according to USA Today. Michigan State University’s nursing program is also seeing a surge, WILX reported, and Lansing Community College is expecting a post-COVID bump in interest as well.
Rather, it’s a shortage of nursing faculty that’s a problem, according to the American Association of Colleges of Nursing.
“U.S. nursing schools turned away 80,407 qualified applications from baccalaureate and graduate nursing programs in 2019 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Most nursing schools responding to the survey pointed to faculty shortages as a top reason for not accepting all qualified applicants into their programs.”
But Hanson insisted most nursing schools in Michigan can take on more students.
“I think it's important to remember that almost all of the universities, and certainly all the 28 community colleges, have current nursing programs that are fully staffed,” he said. “I mean, finding qualified staff is always a challenge, but there is capacity to increase enrollments in many of these programs…
“The other thing I think to remember, is that one good way to increase the number of qualified faculty in these programs is to create a greater pipeline of students going into nursing, and then maybe going on for their Masters in nursing and Ph.D. in nursing. But you [have] got to get them in the pipeline first.”
As for retaining workers already in the field, the proposal would provide “direct payments to current health care workers,” said MHA spokesperson Ruthanne Sudderth. “Again, the details of who would be eligible and what the amounts would be are to be determined as we go forward in our work on advocating for this.”
But in contract negotiations around the state, nurses and health care workers have been clear that what’s pushing them out of the field isn’t a lack of quick, one-time opportunities to make money. Rather, workers are pushing for “safe staffing" ratios that would cap the number of patients each nurse can be responsible for at a time, increases in base pay, lower health care costs, and competitive wages to attract and retain the support staff needed for food and environmental services.
“The reality is, and the American Hospital Association data is very clear, that hospitals across the country including here in Michigan, have quite frankly been decimated financially by the pandemic,” said Brian Peters, CEO of the MHA. “And so our ability to simply do some of these things in the short term, in terms of paying any employees a significant amount increase, that’s somewhat limited at this point. And that’s precisely why we’re here, talking about this help from a legislative initiative.”
Jamie Brown, RN and president of the Michigan Nurses Association, said they were awaiting details about the plan.
"We look forward to seeing the specifics because there's no doubt that Michigan's essential workers, including health care workers, deserve compensation for working on the frontlines throughout this pandemic," Brown said in a statement.
"It's imperative to make sure that any plan includes clear parameters requiring that the money actually go directly to the people doing the work. Many facilities have already received millions in CARES Act money that did not sufficiently go to frontline workers. It is also important to realize that it will take more than just money to fix what ails our broken health care system in order to retain frontline workers. That includes mandatory staffing ratios to make sure that nurses and health care professionals can always provide the highest quality of care possible and keep patients safe."
