Strategies to Mitigate Healthcare Personnel Staffing Shortages

Key Points

• Maintaining appropriate staffing in healthcare facilities is essential to providing a safe work environment for healthcare personnel (HCP) and safe patient care.
• CDC’s mitigation strategies offer a continuum of options for addressing staffing shortages. Contingency and then crisis capacity strategies augment conventional strategies and are meant to be considered and implemented sequentially (i.e., implementing contingency strategies before crisis strategies).

Introduction

This guidance is for healthcare facilities that may be experiencing staffing shortages due to COVID-19.

Maintaining appropriate staffing in healthcare facilities is essential to providing a safe work environment for healthcare personnel (HCP) and safe patient care. As the COVID-19 pandemic progresses, staffing shortages will likely occur due to HCP exposures, illness, or need to care for family members at home. Healthcare facilities must be prepared for potential staffing shortages and have plans and processes in place to mitigate these, including communicating with HCP about actions the facility is taking to address shortages and maintain patient and HCP safety and providing resources to assist HCP with anxiety and stress.

CDC’s mitigation strategies offer a continuum of options for addressing staffing shortages.  Contingency and then crisis capacity strategies augment conventional strategies and are meant to be considered and implemented sequentially (i.e., implementing contingency strategies before crisis strategies). For example, if, despite efforts to mitigate, HCP staffing shortages occur, healthcare systems, facilities, and the appropriate state, local, territorial, and/or tribal health authorities might determine that HCP with suspected or confirmed COVID-19 could return to work before the full Return to Work Criteria have been met.

At baseline, healthcare facilities must:

• Understand their staffing needs and the minimum number of staff needed to provide a safe work environment and safe patient care.
• Be in communication with local healthcare coalitions, federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) to identify additional HCP (e.g., hiring additional HCP, recruiting retired HCP, using students or volunteers), when needed.

Contingency Capacity Strategies to Mitigate Staffing Shortages

When staffing shortages are anticipated, healthcare facilities and employers, in collaboration with human resources and occupational health services, should use contingency capacity strategies to plan and prepare for mitigating this problem.  These include:

Adjusting staff schedules, hiring additional HCP, and rotating HCP to positions that support patient care activities.

• Cancel all non-essential procedures and visits. Shift HCP who work in these areas to support other patient care activities in the facility. Facilities will need to ensure these HCP have received appropriate orientation and training to work in these areas that are new to them.
• Attempt to address social factors that might prevent HCP from reporting to work such as need for transportation or housing that allows for social distancing, particularly if HCP live with individuals with underlying medical conditions or older adults.
  • Consider that these social factors disproportionately affect persons from racial and ethnic groups also disproportionally affected by COVID-19 (e.g., African Americans, Hispanics and Latinos, and American Indians and Alaska Natives).
• Identify additional HCP to work in the facility. Be aware of state-specific emergency waivers or changes to licensure requirements or renewals for select categories of HCP.
• As appropriate, request that HCP postpone elective time off from work.  However, there should consideration for the mental health benefits of time off and that the burden of the disease and care-taking responsibilities may differ substantially among certain racial and ethnic groups.

Developing regional plans to identify designated healthcare facilities or alternate care sites with adequate staffing to care for patients with SARS-CoV-2 infection.

Allowing asymptomatic HCP who have had a higher-risk exposure to SARS-Cov-2 (the virus that causes COVID-19) but are not known to be infected to shorten their duration of work restriction as described in Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing.

• Healthcare facilities should understand that shortening the duration of work restriction might result in additional transmission risks. Healthcare facilities management that elect to implement approaches other than those described in the CDC scientific brief should understand that there might be additional transmission risks posed by their approach.
• These HCP should still report temperature and absence of symptoms each day before starting work.
• If HCP develop even mild symptoms consistent with COVID-19, they should either not report to work, or stop working and notify their supervisor or occupational health services prior to leaving work. These individuals should be prioritized for testing.
• If HCP are tested and found to be infected with SARS-CoV-2, they should be excluded from work until they meet all Return to Work Criteria. HCP with suspected SARS-CoV-2 infection should be prioritized for testing, as testing results will impact when they may return to work and for which patients they might be permitted to provide care.

Crisis Capacity Strategies to Mitigate Staffing Shortages

When staffing shortages are occurring, healthcare facilities and employers (in collaboration with human resources and occupational health services) may need to implement crisis capacity strategies to continue to provide patient care.  When there are no longer enough staff to provide safe patient care:

Implement regional plans to transfer patients with COVID-19 to designated healthcare facilities, or alternate care sites with adequate staffing

Allow asymptomatic HCP who are not fully vaccinated and have had a higher-risk exposure to SARS-CoV-2 but are not known to be infected to continue to work onsite throughout their 14-day post-exposure period.

• If permitted to work, these HCP should be monitored for symptoms as described above.

If shortages continue despite other mitigation strategies, as a last resort consider allowing HCP with suspected or confirmed SARS-CoV-2 infection who are well enough and willing to work but have not met all Return to Work Criteria to work.

• Considerations for determining which HCP could be allowed to work include:
  • The type of HCP shortages that need to be addressed.
  • Where individual HCP are in the course of their illness (e.g., viral shedding appears to be higher earlier in the course of illness).
  • The types of symptoms they are experiencing (e.g., persistent fever).
  • Their degree of interaction with patients and other HCP in the facility. For example, are they working in telemedicine services, providing direct patient care, or working in a satellite unit reprocessing medical equipment?
  • The type of patients they care for (e.g., immunocompromised patients or only patients with SARS-CoV-2 infection).
• Healthcare facilities (in collaboration with risk management) should inform patients and HCP when the facility is operating under crisis standards, the changes in practice that should be expected, and actions that will be taken to protect them from exposure to SARS-CoV-2 if HCP with suspected or confirmed SARS-CoV-2 infection are allowed to work.
• If HCP are allowed to work before meeting all criteria, they should be restricted from contact with severely immunocompromised patients (e.g., transplant, hematology-oncology) and facilities should consider prioritizing their duties in the following order:
  • If not already done, allow HCP with suspected or confirmed SARS-CoV-2 infection to perform job duties where they do not interact with others (e.g., patients or other HCP), such as in telemedicine services.
  • Allow HCP with confirmed SARS-CoV-2 infection to provide direct care only for patients with confirmed SARS-CoV-2 infection, preferably in a cohort setting.
  • Allow HCP with confirmed SARS-CoV-2 infection to provide direct care for patients with suspected SARS-CoV-2 infection.
  • As a last resort, allow HCP with confirmed SARS-CoV-2 infection to provide direct care for patients without suspected or confirmed SARS-CoV-2 infection. If this is being considered, this should be used only as a bridge to longer term strategies that do involve care of uninfected patients by potentially infectious HCP and strict adherence to all other recommended infection prevention and control measures (e.g., use of respirator or well-fitting facemask for source control) is essential.
• If HCP are permitted to return to work before meeting all Return to Work Criteria, they should still adhere to all Return to Work Practices and Work Restrictions recommendations described in that guidance.
  • Patients (if tolerated) should wear well-fitting source control while interacting with these HCP.
  • They should be reminded that in addition to potentially exposing patients, they could also expose their co-workers.
    • A respirator or well-fitting facemask should be worn even when they are in non-patient care areas such as breakrooms.
    • They should practice social distancing from coworkers at all times.
    • If they must remove their respirator or well-fitting facemask, for example, in order to eat or drink, they should separate themselves from others.
    • They should self-monitor for symptoms and seeking re-evaluation from occupational health if symptoms recur or worsen.