The Trustees’ Role in Addressing the Workforce Shortage


By Amy Eskew

Maintaining appropriate levels of workforce and staffing continues to be a significant challenge for hospitals. Before the COVID-19 pandemic, Texas faced a significant physician and nursing shortage, particularly in rural communities. A 2019 report from the Texas Center for Nursing Workforce Studies projected that the demand for nurses between 2018 and 2032 would increase by nearly 40%, while supply was projected to grow by only 30.5%. This shortage has been further accelerated and exacerbated by a now two-year pandemic, which has caused nursing staff to leave the industry or shift around like never seen before. The American Hospital Association’s 2022 Environmental Scan reports that the annual rate of turnover in emergency, ICU and nursing departments has increased from 18% pre-pandemic to 30% in 2021.

As a board member, you may feel like your efforts to address the issue are sidelined. Understandably so, as staffing is a management function, falling within the purview of the CEO or hospital administrator. There are, however, things you can do as a hospital board member to support your leadership and organization to help address staffing levels. The following is a list of actions you can take as a board member and important discussion questions to help address this ongoing challenge.

Look at the Data

Understand how staffing and demographics were already changing in your community and if they continue to do so during the pandemic. Prior to 2020, many communities saw an influx of growth or outward migration. Texas was particularly impacted by substantial population growth over the past several years. This is a key factor in staffing has a key role in staffing in not only understanding the availability of labor in your area, but also what resulting population changes may mean for the amount and type of staff your organization needs. It’s important to have these conversations as a board as you look to the future staffing sustainability of your organization.

Discussion questions may include:

  • How did our population look prior to the pandemic and what significant changes have we seen?
  • What labor/workforce changes did we see before the pandemic compared to now?
  • What if certain staff don’t return to the community?
  • Are there new service lines or staffing models we need to explore to meet the needs of our community?
  • Are we beginning to see changes in care delivery or in alternative care settings?
  • What does our employee satisfaction data indicate about the workplace? What are the trends in employee morale?

Resource Allocation

Staffing costs and salaries are a central component of COVID-19-related staffing shortages. According to the AHA 2022 Environmental Scan, nationally, hospitals and health systems are paying $24 billion more per year for qualified clinical labor than pre-pandemic.

The board’s primary responsibility is to ensure that resources are allocated appropriately to meet the organization’s needs. The board may need to re-evaluate the current workforce budget to allow the CEO to adjust as needed to properly staff the hospital or enhance current retention programs. This may lead to difficult conversations in determining where financial resources are best spent.

Discussion questions may include:

  • Does the hospital currently have hiring incentives or staff retention initiatives in place?
  • What financial adjustments might need to be made to those initiatives in the one, three or five years?
  • What non-financial benefits have we explored or offered?
  • What programs do we provide to support the emotional well-being of the staff?
  • What has resulted from any adjustments made, are we seeing progress in hiring or retention?

Community Partnerships

Another important aspect of attracting and retaining staff is making sure the community can meet their needs. This may be addressed through affordable housing, economic opportunities and development. Serving on a hospital board means you are a link between the organization and the community; this is particularly true for elected board members. In this important role, trustees can help facilitate introductions and establish relationships with key community leaders to ensure the community can support and welcome new staff and residents.

Discussion questions may include:

  • What is appealing to residents about our community?
  • What are the challenges of bringing new talent into this community?
  • What agencies, organizations or non-profit groups could help address these challenges?

Be Supportive

Governing and managing are separate but complementary functions. Governance looks forward, sets expectations and provides responsible oversight. Management works to meet expectations, achieve performance goals and manage the hospital’s daily activities. Be supportive of the management and CEO during these particularly challenging times and help keep an eye forward toward the future. As was often discussed last year, there’s no going back to a pre-pandemic time, we are headed to a “new normal” or “next normal.” The bottom line is that health care will look significantly different as we enter the endemic and though some of the same challenges like staffing may linger, they may not have the same solutions as originally envisioned.

Amy Eskew is the President/CEO of Texas Healthcare Trustees.