PCORI Biweekly COVID-19 Scan: Addressing Nursing Shortages, Decreased Routine Vaccination (February 17-March 2, 2022)

ECRI Horizon Scanning has selected the topics below as those with potential for impact relative to COVID-19 in the United States within the next 12 months. All views presented are preliminary and based on readily available information at the time of writing.

Because these topics are rapidly developing, we cannot guarantee the accuracy of this information after the date listed on this publication. In addition, all views expressed in the commentary section are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders. Topics are listed in alphabetical order.

Description

Travel nurses are RNs who work in temporary roles to help fill gaps where nursing shortages exist. Travel nurses are typically employed by independent staffing agencies. While ​travel nursing dates back decades, recent reports suggest that agencies have been increasingly hiring travel nurses over the past two years. 

Nursing shortages have worsened during the COVID-19 pandemic, alongside increased rates of burnout. A survey of 6000 acute and critical care nurses indicated that 66% have considered leaving nursing because of their work experiences during the previous 18 months of the pandemic. Many have considered switching to contract travel nursing for higher pay and better benefits. A hospital system in West Virginia reported that about 40% of their acute care nurses are currently on temporary contracts (compared with none in 2019).

Since the COVID-19 pandemic began, reliance on travel nursing has grown to address the health care needs of high volumes of patients across health care settings. For example, AMN Healthcare, a travel nurse agency, reported that more than 15 000 nurses and other traveling staff were on assignment in the fourth quarter of 2021, a rate 50% higher than in 2020. With staffing costs soaring, some states are considering legislation to cap nurse wages.

Commentary

Increased reliance on travel nurses might increase the ability of health care staff to meet the medical needs of patients, especially during surges of patients with COVID-19.  

Early feedback from ECRI internal stakeholders suggested that reliance on travel nursing agencies is practical in the short run. However, the high hourly rates, housing stipends, and staffing agencies’ profit margins increase the financial burden on already strained health care systems. Increased travel nursing might worsen health disparities for patients being treated in medical settings that cannot afford to hire travel nurses to mitigate staffing shortages.

Stakeholders also thought that reliance on travel nurses is unlikely to decrease until employment issues (eg, staffing levels, fair pay, and psychological needs) are prioritized and addressed. Education and training strategies might help alleviate burnout, prevent further staffing shortages, and improve patient outcomes. Salary increases and retention efforts for staff nurses might provide a more long-term solution.

• Categories: Systems and management
• Areas of potential impact: Patient outcomes, population health outcomes, health care costs, health care disparities

Description

Stay-at-home orders, social distancing, concerns about SARS-CoV-2 exposure, misinformation, and vaccine fatigue have contributed to a decrease in routine vaccination nationwide during the COVID-19 pandemic. Encouraging adherence to routine vaccinations is an important public health measure to protect individuals and communities against contracting and spreading dangerous or deadly communicable diseases, such as influenza, hepatitis B, and measles. The COVID-19 pandemic has negatively affected routine immunization rates, with substantial decreases observed in vulnerable populations such as children, people who are immunocompromised, and older adults.  

Measures are being taken to spread awareness of the importance of routine vaccination and to increase patient access to vaccination while the COVID-19 pandemic is ongoing. In response to the COVID-19 public health emergency, the US Department of Health and Human Services expanded vaccination administration regulations to allow pharmacists to administer immunizations to children 3 years of age and older, to help alleviate strain for pediatric offices and provide additional vaccination site options. Local and state health departments have increased community outreach and created initiatives to help individuals know when and how to come in (or to bring their children in) to receive routine vaccinations.

Some clinics have attempted to limit the number of patients in the clinic at one time, thus reducing risk of exposure to SARS-CoV-2 for both patients and staff, by using online patient portals to schedule appointments (decreasing walk-ins), verify patient information, and disseminate patient education materials. Vaccination clinics in schools and mobile health clinics are helping to increase patient access to timely vaccination and administer missed doses. The CDC recently approved an updated recommended immunization schedule for adults that incorporates recommendations for the use of COVID-19 vaccines, which could help efforts to better integrate the administration of routine vaccines with COVID-19 vaccination.

Commentary

Decreased routine vaccination during the COVID-19 pandemic might result in negative patient and population health outcomes, particularly in populations at increased risk for contracting communicable diseases and experiencing worse outcomes. Initiatives are needed to help restore timely and routine vaccination.

Early feedback from internal ECRI stakeholders suggested that efforts to increase adherence to recommended vaccine schedules might improve health outcomes, especially for individuals with reduced access to health care providers due to the COVID-19 pandemic. Mobile clinics, increased pharmacist involvement, and school programs make vaccines quicker and easier to access. Increasing consistent, long-term, and scalable access to routine vaccination might work to decrease health disparities for vulnerable populations. Educational interventions might help address vaccine hesitancy and enable individuals to make more informed decisions about their health.

The addition of COVID-19 vaccination to the recommended immunization schedule might reduce infection rates and lessen the risk of long-term complications from breakthrough SARS-CoV-2 infections. The outcomes of these outreach efforts might help inform preparation for future outbreaks of coronavirus variants or new pathogens.

• Categories: Systems and management
• Areas of potential impact: Patient outcomes, population health outcomes, health care disparities

Horizon scanning is a systematic process that serves as an early warning system to inform decision makers about possible future opportunities and threats. Health care horizon scanning identifies technologies, innovations, and trends with potential to cause future shifts or disruptions—positive or negative—in areas such as access to care, care delivery processes, care setting, costs of care, current treatment models or paradigms, health disparities, health care infrastructure, public health, and patient health outcomes.

The PCORI Health Care Horizon Scanning System (HCHSS) conducts horizon scanning to better inform its patient-centered outcomes research investments. Initially, PCORI defined the HCHSS project scope to focus on interventions with high potential for disruption in the United States in 5 priority areas: Alzheimer’s disease and other dementias, cancer, cardiovascular diseases, mental and behavioral health conditions, and rare diseases. In addition, the system captures high-level disruptive trends across all clinical areas, which may lead PCORI to expand the project scope to include other priority areas in the future.

In early 2020, the COVID-19 pandemic created a fast-moving, widespread public health crisis. In May 2020, PCORI expanded its HCHSS to elucidate the landscape of potentially impactful applications for COVID-19. The HCHSS COVID-19 supplement scans for, identifies, monitors, and reports on emerging and available COVID-19-related treatments, diagnostics, preventive measures, management strategies, and systems changes with potential for high impact to patient outcomes—for individuals and populations—in the United States in the next 12 months.

The HCHSS COVID-19 supplement produces 3 main outputs:

• Biweekly COVID-19 Scans (eg, this document) provide ECRI Horizon Scanning with a vehicle to inform PCORI and the public in a timely manner of important topics of interest identified during ongoing scanning and topic identification or through the ECRI stakeholder survey process.
• Status Reports (quarterly) briefly list and describe all COVID-19-related topics identified, monitored, and recently archived.
• High Impact Reports (every 4 months) highlight those topics that ECRI internal stakeholders (eg, physicians, nurses, allied health professionals, public health professionals, first responders, health systems experts, clinical engineers, researchers, business and finance professionals, and information technology professionals) have identified as having potential for high impact relative to COVID-19 in the United States.