Recommendations to expand and sustain health care workforce during pandemic
An article written by health workforce leaders and published today in the New England Journal of Medicine calls for health care delivery organizations, educators and government leaders to "cut through bureaucratic barriers and adapt regulations to rapidly expand the U.S. health care workforce and sustain it" for the duration of the COVID-19 pandemic.
The article was written by eight leaders of public and private research centers who interact with and study the U.S. health workforce, including Peter Buerhaus, director of the Montana State University Center for Interdisciplinary Health Workforce Studies and professor in the MSU College of Nursing. Additional authors are Erin P. Fraher, Patricia Pittman, Bianca K. Frogner, Joanne Spetz, Jean Moore, Angela J. Beck and David Armstrong.
"Current efforts to fight the COVID-19 pandemic aim to slow viral spread and increase testing, protect health care workers from infection, and obtain ventilators and other equipment to prepare for a surge of critically ill patients. But additional actions are needed to rapidly increase health workforce capacity and to replenish it when personnel are quarantined or need time off to rest or care for sick family members," Buerhaus and the other authors wrote in "Ensuring and Sustaining a Pandemic Workforce."
The authors of the article, which was published in the Perspective section of the journal, recommended a number of measures that could expand and sustain the health care workforce. Among their suggestions:
- Having governors remove barriers to expand capacity by enacting emergency orders that modify or temporarily rescind medical malpractice policies that inhibit health professionals' ability to expand their scope of practice.
- Changing internal policies such as workflows, task-delegation protocols or union agreements in hospitals and nursing homes to allow health workers to fully use their knowledge and skills.
- Expanding the types of services that can be covered by insurance, broadening the number and types of providers eligible for insurance payments and allowing services to be provided in a wider range of settings.
- Allowing hospitals to provide benefits to support staff, such as multiple daily meals, laundry service for personal clothing or child care services.
- Sending respiratory therapists to hospitals most in need and developing programs to quickly train workers who can operate ventilators competently.
- Allowing medical students in their third and fourth years who are no longer in clinical rotations to perform various medical tasks to free up clinicians for COVID-19 care.
- Identifying health care professionals who have either retired or temporarily left the workforce and encouraging them to return to work.
- Training dentists, optometrists, chiropractors and other health professionals whose practices have temporarily closed because of COVID-19 to conduct screenings, take vital signs, provide telephone follow-up, collect epidemiologic data and provide community education.
- Planning for the needs of millions of people in the U.S. who require treatment for mental health disorders.
- Allowing health care workers to offer telehealth services across state lines, even if they're not part of interstate licensing compacts.
- Examining regulations to determine whether health professionals' scope of practice is being unnecessarily restricted.
"How well the country handles the COVID-19 crisis depends largely on how effectively our health workforce is used," the authors wrote. "Much can be done to ensure that the workforce is prepared to defeat the pandemic."
A second article by Buerhaus and colleagues David I. Auerbach and Douglas O. Staiger, "Older Clinicians and the Surge in Novel Coronavirus Disease 2019 (COVID-19)," was published March 30 in the Journal of the American Medical Association. Among other points, the authors noted that hospitals and other care delivery organizations should carefully consider how best to protect and preserve their workforce, with careful consideration involving older physicians and nurses.
The older nurses and physicians caring for patients today are "an essential and vitally important component of many organizations," Buerhaus and his colleagues wrote, especially because many older nurses and physicians have experience with disasters, triaging, decision making, and managing staff and resources under times of great stress.
"While hospitals and other organizations ramp up their preparations, this is the time to determine whether there may be different roles for older clinicians that ensure they are able to contribute over the long-term course of the pandemic," the authors wrote in the article, which appeared in the journal's Viewpoint section. "This is not to suggest that these older nurses and physicians should necessarily be precluded from providing clinical care or should be isolated, but rather to consider if their direct clinical duties can be shifted to emphasize roles with less risk of exposure."
More information: Erin P. Fraher et al. Ensuring and Sustaining a Pandemic Workforce, New England Journal of Medicine (2020). DOI: 10.1056/NEJMp2006376
Peter I. Buerhaus et al. Older Clinicians and the Surge in Novel Coronavirus Disease 2019 (COVID-19), JAMA (2020). DOI: 10.1001/jama.2020.4978