A stressed nurse

The healthcare sector is experiencing increased worker turnover in the wake of the COVID-19 pandemic even as employment rates have steadied in many areas of the industry, according to a new JAMA Network study. 

These results have especially worrying implications for the long-term care sector, according to lead author Karen Shen, PhD, assistant professor at Johns Hopkins University.

Quarterly staff exit rates across healthcare were 7.7% by the end of 2021 — a full 30% higher than the baseline 2018 rate. While entry rates nearly exactly matched the exit rates, the increased worker churn still has costs, especially for skilled nursing where employment trends have not reached that fairly steady baseline.

“Long-term care is one of the sectors that has actually experienced a net employment decrease since the pandemic, and a lot of evidence suggests that it is one of the industries that has been affected most by the pandemic,” Shen told McKnight’s Long-Term Care News Friday. “I would expect that any staffing issues seen in the broader healthcare sector would be exacerbated in the long-term care industry.”

The findings suggest that even if care providers are able to match the higher exit rates with better recruiting strategies, there are still additional costs created by staff churn. 

“Turnover can potentially have negative effects on morale, quality and consistency of care and the cost of onboarding more workers,” Shen said. “Many healthcare firms cite frequent staff turnover as one of their greatest challenges, and our research suggests that has increased post-pandemic.”

The study was co-written by Julia Eddelbuettel, a PhD candidate at Harvard University, and Matthew Eisenberg, PhD of Johns Hopkins University.

A shrinking labor pool

A greater share of workers exiting healthcare post-pandemic are totally leaving for other industries. This contrasts with mid-pandemic exits that were usually simply to unemployment. 

“This increase in people exiting to other sectors may be a cause for concern for health care organizations and policymakers,” the researchers wrote. “It may suggest a declining overall competitiveness of health care jobs in the broader labor market.”

Long-term care has lost more than 200,000 workers since the start of the pandemic. Burnout and a lack of competitive wages have been consistent complaints of care workers, while providers have struggled to address those concerns due to rising care costs.

Another concerning trend is the disproportionate share of women and Black care workers who left following the pandemic. These demographics, often relied upon by long-term care providers, are also not entering the sector at the same pace, according to Shen.

“Our results point to a post-pandemic decrease in the share of people entering healthcare who are people of color,” she said, “suggesting that this pool of workers that healthcare has traditionally relied on to fill lower-wage jobs may be less likely to enter healthcare in the post-pandemic world”

Addressing this shrinking labor pool will require addressing workers’ wage, professional development and burnout needs, Shen suggested. Some recruitment programs around the country are already taking these factors into account, but the researchers noted that public policy efforts to attract workers to healthcare also are warranted given the severity of the workforce trends.