States Explore Array of Proposals to Bolster Healthcare Workforces

Healthcare, generally, is considered a growing industry in the United States. Yet headlines constantly scream about a healthcare workforce crisis—not enough nurses, doctors or home-health workers to meet the nation’s demands.

How can that be? America faces a shortage of healthcare workers for a number of reasons, not the least of which is tough working conditions that lead to burnout or outright discourage people from entering the sector to begin with.

The problem was laid bare during the COVID-19 pandemic and, since then, state legislators have been trying various tactics to shore up shortages. They’re still looking for the right mix of policies to attract workers and keep them in the sector.

Handful of States Target Violence against Healthcare Workers

One tactic state lawmakers are exploring in 2023 is trying to improve working conditions for healthcare workers. Receiving particular attention of late has been rising incidents of violence or threats of violence against healthcare workers.

Three state legislatures already have passed bills this year to combat this troubling trend.

• The Georgia legislature approved HB 383, the Safer Hospitals Act, which allows all Peach State hospitals to establish campus police departments with Peace Officer’s Standards and Training (P.O.S.T.) certified officers.

• The Montana Legislature approved HB 590, which requires employers of healthcare workers to report an act of violence against one of their employees within 24 hours. The hope is that by collecting better data, the state of Montana can then develop solutions to address the problem. 

• The Vermont legislature approved SB 36, which allows police to arrest a person without a warrant if officers have probable cause to believe the person assaulted or threatened a healthcare worker at a healthcare facility.

“The Bureau of Labor Statistics reports that the rate of injuries from violent attacks against medical professionals grew by 63% from 2011 to 2018, and hospital safety directors say that aggression against staff escalated as the COVID-19 pandemic intensified in 2020,” the Association of American Medical Colleges reported in August 2022.

In fact, the AAMC said federal data revealed that healthcare workers are five times more likely to experience workplace violence than employees in all other industries—making healthcare, an industry known for burnout, all the less attractive to current workers or potential new ones.

Massachusetts Considering Multitude of Proposals

The Massachusetts Legislature also is considering several proposals to help improve workplace conditions for healthcare workers. In fact, according to the LexisNexis® State Net® legislative tracking system, the Massachusetts legislature has the most pending bills related to the healthcare workforce, with topics ranging from workplace safety to staffing to retirement benefits.

Among the pending proposals are:

• SB 1538, which requires the state to develop statewide standards for evaluating and addressing known security risks at Massachusetts healthcare facilities. HB 2381 would do the same thing.

• SB 1472, which requires employers of home healthcare workers to develop programs to minimize the danger of workplace violence against their workers. HB 2128 would do the same thing.

• HB 1838, which would outlaw mandatory overtime for workers at healthcare facilities, except in emergency situations.

• HB 1166, which would regulate the overuse of temporary nursing service agencies at state skilled nursing facilities. SB 780 would do the same thing.

• HB 2192, which would require all hospitals and freestanding surgical facilities to adopt policies to protect healthcare workers and patients from surgical smoke, which can be a byproduct of using lasers or conducting electrosurgery.

• SB 1619, which creates a retirement credit bonus for all state and municipal first responders and front-line healthcare workers who worked during the COVID-19 pandemic.

• HB 1220, which would establish a healthcare industry recruitment and education advisory council within the state Executive Office of Health and Human Services. The council’s mission would be to assist the Massachusetts Secretary of Education, Secretary of Health and Human Services, Secretary of Labor and Workforce Development and Secretary of Housing and Economic Development with increasing student interest in healthcare. The bill would also create the Healthcare Industry Recruitment and Education Fund, or HIRE Fund, to pay for healthcare education.

Speaking at a National Conference of State Legislatures® panel in December 2022, Massachusetts Senate President Karen E. Spilka (D) said there’s a dire need for more workers in all sectors, particularly healthcare, and building out the state’s workforce would be a key focus for her in 2023.

“So many people, particularly women, were sandwiched in between the care for their children and their parents and dropped out of the workforce,” she said at the time, referring to the pandemic.

Nursing Ratios of Particular Concern to State Lawmakers

One issue in particular receiving a lot of attention in state legislatures is nurse staffing ratios. For years, nurses have asserted the need for lower nurse-to-patient ratios, frequently raising the issue in protests or during contract negotiations.

In fact, in March 2022, nurses nationwide called on The Joint Commission, a nonprofit that accredits healthcare organizations and programs, to require safe staffing ratios as a condition of accrediting healthcare facilities.

Hospital associations counter that policies limiting nurse staffing ratios would limit health access, exacerbate the nursing shortage and drive-up hospital operating costs.

Still the topic is a popular one among state lawmakers. Measures dealing with nurse staffing ratios have been considered in at least 21 states this year, according to the State Net® legislative tracking database. And two states, Washington (SB 5236) and West Virginia (HB 2436), have enacted such legislation.

Sydne Enlund, state outreach manager at NCSL, wrote in a June 2022 white paper that nursing has been one of the healthcare professions hardest hit by shortages, particularly since the COVID-19 pandemic.

“A recent survey found that nearly one-third of nurses have thought about leaving their jobs by the end of 2022, mostly due to exhaustion and burnout,” Enlund wrote. “The demand for health care services is predicted to increase in the coming years due to an aging population and workforce as well as higher rates of chronic disease. However, the supply of providers is not expected to keep pace with the demand.”

In other words, there’s a reason lawmakers are paying particular attention to nursing shortages: it’s a serious, persistent problem.

Many State Lawmakers Focusing on Nurse Staffing Ratios

Lawmakers in at least 21 states have considered legislation this year dealing with nurse staffing ratios, according to the State Net legislative tracking system. Two states, Washington (SB 5236) and West Virginia (HB 2436), have enacted such measures.

Incentives to Enter the Industry Take on Different Shapes

Unsurprisingly, several states are considering various proposals to explicitly encourage workers to enter the healthcare field. In fact, the legislatures in two southern states already have approved such proposals.

The Kentucky legislature approved HB 200, which creates the Kentucky Healthcare Workforce Investment Fund, designed to boost healthcare training programs in the state. The Mississippi legislature approved SB 2731, which establishes the Accelerate Mississippi Nursing/Allied Health Grant Program to increase enrollment in state nursing and healthcare training programs.

The New York Legislature is considering a proposal to create a healthcare workforce fund, SB 1637. Vermont HB 484 is a large workforce development proposal with a major healthcare component. In the Connecticut legislature, SB 1228 seeks to address the state's healthcare worker shortage by asking various officials to look into ways to expand the workforce, including establishing an interdistrict magnet school. And Illinois HB 4073 would task the State Healthcare workforce Council with coordinating education and training to meet the state's healthcare workforce needs.

Meanwhile, the Georgia legislature is considering two proposals—SB 137 and HB 228—that would expand the availability of tuition equalization grants to better pay for healthcare workers’ education.

The Hawaii Legislature is considering legislation (SB 439 and HB 1450/SB 1215 to expand the definition of healthcare preceptors, which are experienced healthcare workers who provide supervision during clinical practice.

Also pending in the Hawaii Legislature is HB 1062/SB 1360, which would continue funding the state’s Hospital Sustainability Program to help keep the state’s network of hospitals afloat.

Finally, a bill (HB 3527) pending in Oregon would require the state Housing and Community Services Department to “study healthcare workforce housing” and submit a report to the state legislature in September 2024.

State lawmakers are throwing everything and the kitchen sink at this issue because healthcare worker “shortages remain one of the primary obstacles to ensuring access to long-term services and supports for older adults and individuals living with disabilities,” as NCSL wrote in a March 2023 white paper on “Strengthening the Direct Care Workforce.”

“High turnover rates (estimated between 40% and 60%) and increased demand for direct care services due to an aging population continue to exacerbate the shortage of direct care workers. The COVID-19 pandemic also worsened shortages across the country as an estimated 420,000 nursing home workers left the workforce since 2020. Two-thirds of states reported the permanent closure of at least one Medicaid home-and community-based (HCBS) provider during the public health emergency, and cited workforce shortages as the primary challenge for certain types of HCBS providers.”

The healthcare workforce problem is serious, pressing—and only growing.

—By SNCJ Correspondent BRIAN JOSEPH

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