Ethical Issues Related to Staff Shortages

March 2002
November 2007 (revised)
November 2012 (revised)

Statement of the Issue

The effects of staff shortages are felt acutely by hospitals and other healthcare organizations. While healthcare executives have struggled with how to reduce their organization’s staff responsibly, today they face an equally daunting challenge. They must fulfill their responsibility to provide high-quality, affordable patient care in the face of workforce shortages that may leave them with vacancies in many positions throughout their organization.

Alleviating workforce shortages or adapting to them is a complex problem for which there are few easy solutions. Nevertheless, healthcare executives have an ethical responsibility to address any shortages that exist within their organizations in such a way that patient care is not compromised, existing staff are not unduly burdened and financial costs do not become excessive.

Policy Position

The American College of Healthcare Executives (ACHE) recommends that healthcare executives develop responsible action plans for delivering patient care in the face of staff shortages. To this end, ACHE recommends that such plans address the following:

  • Attracting and retaining qualified staff by addressing issues important to today’s workforce, including strengthening the patient/clinician/executive partnership, treating each other with respect, promoting continuous quality improvement, and providing fair compensation, flexible scheduling and professional development;
  • Maintaining workloads and expectations that strive to alleviate and prevent burnout;
  • Examining work stream processes to ensure staff is being deployed in an effective manner to meet patient needs;
  • Creating systems for job assignments and backup coverage that ensure responsibilities are appropriately matched with qualifications;
  • Being sensitive to the financial and nonfinancial consequences of utilizing temporary personnel to fill vacancies;
  • Responding to potential disasters that would significantly impact staff availability over sustained periods, requiring multilevel backup capacity;
  • Conducting employee opinion surveys and exit interviews, using results to identify steps to improve job satisfaction;
  • Identifying ways to engage employees to help define and address issues adversely affecting recruitment and retention objectives;
  • Maintaining a diverse and culturally competent work force;
  • Analyzing departments or units with high turnover rates to determine whether management shortcomings, working conditions, and/or other factors may be contributing to staff morale problems;
  • Exploring, evaluating and implementing best practices from similar organizations that could be helpful in avoiding staff shortages; and
  • Closing units or diverting patients if staff shortages become severe, to ensure that patient care is not compromised and high-quality care is maintained.

Healthcare executives may find it beneficial to join forces with others in their service areas to address the problem of staff shortages. Collaboration to recruit qualified staff will prove to be a more effective long-term strategy than competition for the same resources. ACHE encourages healthcare executives to collaborate on the development of creative, sustainable strategies that will benefit their respective organizations as well as help ensure that high-quality, affordable healthcare remains available in their communities.

In addition, ACHE encourages healthcare executives to work to ensure the future supply of healthcare workers. Healthcare executives should collaborate with others to expose students to careers in healthcare, including both clinical and managerial careers.

Approved by the Board of Governors of the American College of Healthcare Executives on November 12, 2012.