Healthcare Staffing Shortages Lingering, Putting Care at Risk

Federal and state lawmakers are scrambling to find solutions.

It’s no surprise that the COVID-19 pandemic has continued to impact the healthcare industry generally, but the specific area in which it is being felt the most is in healthcare workforce numbers. And this continuing struggle creates a dangerous situation; take, for example, a recently uncovered conspiracy seemingly pulled straight out of the plot of the film “Catch Me If You Can.”  

The U.S. Attorney’s Office for the Southern District of Florida recently charged more than two dozen defendants for their participation in a nursing credentialing-related wire fraud scheme, as part of an investigation titled Operation Nightingale. The Office stated that the defendants sold 7,600 fraudulent nursing degree diplomas and transcripts from actual Florida-based nursing schools. These fake documents were used to qualify would-be nurses to sit for the national nursing board exam, and then go on to obtain nursing licenses and jobs around the country. 

While the purchasers of these fake documents did have to pass their board exams, investigators found that they did not take any real courses or complete required clinical training hours; they simply paid up to $15,000 to what was described as a “cash mill.” The nursing schools involved are now closed, but this means that there are potentially 7,600 nurses with fraudulent credentials across the country. And while investigators said they had not discovered any evidence of patient harm stemming from this scheme, as the U.S. Attorney for the District pointed out, “when we talk about a nurse’s education and credentials, shortcut is not a word we want to use.” 

One of the reasons this scheme is so devastating is that it comes on the heels of an overall workforce and access-of-care shortage in the healthcare industry, as well as serious burnout reported by medical professionals. A recently released study found that employment in healthcare is below expected levels, given pre-pandemic trends in the industry, while some specialties are still seeing basic staffing levels struggle to return to numbers seen before March 2020. Both Congress and state legislatures are proposing various solutions to combat these issues.

The Centers for Medicare & Medicaid Services (CMS) recently awarded the first 200 of a promised 1,000 Medicare-funded physician residency slots designed to supplement the healthcare workforce and fund additional hospital positions, particularly in rural and underserved communities. Created as part of the Consolidated Appropriations Act of 2021, the positions are spread out over 30 states, and focus on primary care and mental health.

In addition to expanding COVID-era telehealth provisions, some states have begun looking at healthcare worker staffing and worker-to-patient ratio laws. Washington and Massachusetts have introduced bills that, if passed, would create nurse-to-patient ratios in hospitals, and the Washington bill’s language also places a cap on on-call hours. Oregon lawmakers introduced a bill developing staffing committees that would establish staffing and workforce standards. This type of legislation already exists in California, New York, and Colorado, but New York’s law was at issue earlier this month when more than 7,000 nurses went on strike over workforce levels; a deal that centered around staffing ratios and the addition of new nursing positions brought the strike to a close within three short days.

As legislative committees begin to meet again for 2023, lawmakers have to examine how best to support the healthcare workforce through this time, particularly when discussing what a post-public health emergency (PHE) world will look like.

While there are proponents and opponents for almost every option we’ll see debated, everyone can agree that this will be a top priority for the year ahead.