Health care workforce shortage persists as states seek solutions

DENVER — State lawmakers may consider several options to address the staffing problems plaguing health care systems.

Adjusting licensing rules, funding training, raising Medicaid provider rates, and helping the industry improve workplace safety are all on the table for lawmakers this year.

For many states, efforts to bolster the health care workforce will build on investments made since the COVID pandemic began.

“We focused a lot on the core this last year,” said Colorado Sen. Kyle Mullica (D), an emergency room nurse.

As a state representative, Mullica last year championed a $61 million investment in health care workforce training, recruitment and retention — funded with federal COVID relief dollars — as well as a law that increases state oversight of hospital nurse staffing.

“There’s still going to be stuff we can do around the edges to make sure we’re setting up the system overall to succeed,” he said.

Shortages of nurses and other critical staff are creating bottlenecks throughout the health care system. Some patients are waiting hours in emergency rooms, unable to move to a hospital bed. Or they are lingering in hospital beds, unable to move to a nursing home or outpatient facility. A recent surge of children sick with respiratory infections has strained pediatric services.

State leaders have stepped up efforts to support the health care workforce since the pandemic hit. They used federal aid to offer retention bonuses to nurses and other frontline workers. They increased funding for short-term training programs, such as medical assistant certificates, and long-term programs such as nursing degrees.

They changed licensing rules to let certain health workers practice with less oversight from doctors. They rushed to join compacts, or multi-state agreements, that make it easier for health care workers such as nurses to get jobs in other states.

“Licensure compacts have been the legislation du jour,” said Hannah Maxey, associate professor and director of the Bowen Center for Health Research & Policy at Indiana University School of Medicine. Thirty-nine states have joined a compact for nurses. States have also joined compacts for physical therapists, professional counselors and other key jobs.

Colorado is among the states where lawmakers have tried to address health care staffing problems from every angle. Recent laws fund short-term training for health care professionals such as emergency medical technicians; temporarily lift nurse licensing fees; and fund efforts to recruit workers with expired health care licenses back into the field, among other initiatives.

Colorado also now requires hospitals to form nurse-led committees empowered to draw up nurse staffing plans. Hospitals must submit the plans to state regulators. The new law aims to give nurses a voice and hold hospitals accountable for staffing decisions, Mullica said.

Loosening licensing rules will be on the agenda this session in some states. Pennsylvania lawmakers are re-upping a bill that would let nurse practitioners practice without physician oversight, for instance.

Nurse labor unions will continue pushing lawmakers to require hospitals to staff enough nurses per patient. Higher staffing ratios help retain nurses by making their jobs safer and less stressful, said Gerard Brogan, director of nursing practice at National Nurses United, a union and professional association of registered nurses.

“We’d like every state in the union to introduce nurse-to-patient ratios,” Brogan said. “But it’s a difficult task because the health care industry is absolutely opposed.”

A staffing ratio bill failed in Washington State last year, after hospitals said the proposed ratios were too strict and would require them to hire thousands of new nurses — potentially exacerbating the nurse shortage. Unions are trying again this year with a slightly different bill.

Both hospital groups and advocates for workers are calling for policies that could help protect health care workers from workplace violence.

The American Hospital Association wants Congress to make assaulting a hospital worker on the job a federal crime and to fund violence prevention grants. Some state-level groups, such as the Colorado Hospital Association, say policies that protect workers from violence also will be a priority for them.

State lawmakers also may step up investments in support workers, such as community health workers or peer recovery specialists, who help patients but don’t need years of training, said Hemi Tewarson, president and executive director of the National Academy for State Health Policy, a nonpartisan organization that advises state lawmakers on health policy.

Colorado’s Mullica has a new bill that would require the state to seek federal permission to pay community health workers with Medicaid funds.

State lawmakers also could pay more attention to supporting health care workers who assist with childbirth and postpartum care, Tewarson said. “We’ve seen a real renewed focus on doulas and midwives.”

Many state leaders want to know more about their state’s health care workforce needs, Maxey of Indiana University said. Her team collects and analyzes health care workforce data for the state of Indiana, and she said some lawmakers in other states want to create a similar resource

Utah lawmakers last year created a health care workforce advisory council and information center. Maxey said legislators in other states may advance similar bills this year.