State of Work in America survey reveals stressors on healthcare employees
The constant influx of new patients would seem to be a strong factor in making working in the healthcare sector a fairly stable industry in which to work. Healthcare workers certainly have more of an immunity to economic shocks than the general population, However, there are plenty of stressors and factors that make working in that space challenging and difficult. The COVID-19 pandemic, one of the most important recent job stressors, while finally ceasing to dominate the industry’s concerns, hasn’t altered that fact. Learning what those stressors are, along with learning what factors keep healthcare employees at their jobs, can be a way that healthcare companies attract and retain talent that better puts their organizations in a competitive advantage.
So, what is stressing out healthcare workers at their jobs? What retains them, and what causes them to leave? How do they feel about their work environment, about their benefits and about their management? Is there a single factor, above all others, that if addressed could improve healthcare workers attitudes toward their job and their profession?
This spring, Grant Thornton LLP conducted a State of Work in America survey where we surveyed 5,000 U.S. employees on a wide range of aspects of their job to find those answers. Ten percent of those respondents, around 500 employees, were from the healthcare sector, so it was possible to examine our data to learn not only what factors influenced these workers’ attitudes towards work, but how those attitudes differed from the general population.
While we found that healthcare employees attitudes aligned with those of U.S. workers overall, healthcare workers concerns, motivators and stressors were different in key ways. Among our many findings, what stood out among our State of Work survey results for healthcare included:
- Healthcare workers’ overall well-being is viewed significantly less favorably than workers overall. More employees say their mental, financial and physical well-being has become worse in the past year than better.
- Base pay is the top motivator keeping employees at their company, compared to U.S. employees overall who rank benefits as their top reason to stay. Related to that, significantly fewer healthcare workers feel their pay is linked to their performance compared to all employees.
- Healthcare workers repeatedly indicate they are not feeling valued at their organization. It’s the top reason they would leave their job, and job environment qualities such as “My company understands my needs” and “The organization cares about me” are all rated significantly lower by healthcare workers than workers overall.
- Employee shortages is ranked highly as a stress factor for all U.S. employees, but they dominate responses from healthcare workers as a factor causing stress at work.
- Healthcare employees are significantly less likely to feel valued at work and consistently rank positive statements about work less highly than workers overall
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Perceptions of well-being
Our survey asked how employees viewed their well-being and broke this down into six factors. While our overall survey discovered that U.S. employees felt most negatively about their financial and mental well-being, those findings were more pronounced in the healthcare sector. Only 27% of healthcare workers indicated their mental well-being was better or somewhat better, 10 percentage points lower than workers in general and three points less than healthcare workers who thought their mental well-being was worse or somewhat worse.
“There is not any emphasis being put on helping healthcare workers balance work and life.”
Similar to the overall workforce, the survey also tallied high number of healthcare employees who thought their financial well-being and their physical well-being were somewhat or much worse, again at a higher level than the overall (30% versus 26% for financial well-being, 27% versus 21% for physical well-being). And in each of these, those whose well-being traits were ranked worse or somewhat worse outnumbered those who felt it was better. Clearly, there is a need for healthcare organizations to focus on caring for their own employees.
Angela Nalwa, Managing Director and Practice Leader for People & Organization at Grant Thornton said what happens too frequently in healthcare is a sort of “quiet promotion” where more responsibility is added to someone else’s workload due to shortages. “Allowing for time and programs that support employees in their emotional, mental, financial and physical well-being is critical right now,” Nalwa said.
When asked what was causing burnout and stress at work, the answer was clear. The shortage of workers was cited by more than half of healthcare employees as a cause of burnout, 10 percentage points higher than employees overall (51% versus 41%). And while more employees overall said staff shortages were the most stressful part of working at an organization (14%), that percentage jumped to 22% for healthcare workers and was almost three times higher than any other factor.
Today’s worker shortages in healthcare had been accurately predicted for some time, but even with that foresight, healthcare companies generally did not prepare adequately for it, said David Tyler, National Managing Principal for Healthcare at Grant Thornton. The pressure is bidirectional, in which the stresses of front-line workers immediately affects other clinicians and administrators. The pressure of relying on contract nursing to fill gaps, for instance, is putting financial pressure on organizations paid through federal programs like Medicare and Medicaid and even commercial insurance that aren’t providing funds to match these increasing costs, Tyler said. “It's not an uplifting environment at times,” Nalwa said, “and there is not any emphasis being put on helping healthcare workers balance work and life.”
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Factors impacting attraction and retention
When asked why people stay where they are, U.S. employees ranked benefits as the top reason, but not healthcare workers, who cited pay as the top answer. Almost four out of 10 healthcare employees named it as the top reason to stay in a job.
“A lot of emphasis on pay comes from third-party nursing. It's a recipe for disaster, as it puts a premium focus on dollars and cents among staff, as opposed to qualities full-time employees may not see, such as benefits.”
“A lot of emphasis on pay comes from third-party nursing,” Tyler said. The demand for them is so high, it has doubled in recent years, while costs have gone up by 60%. “It’s a recipe for disaster, as it puts a premium focus on dollars and cents among staff, as opposed to qualities full-time employees may not see, such as benefits.” One factor that could inform why base pay is ranked so highly is that only 41% of healthcare employees thought they were paid fairly for the contributions they make to the success of the organization, compared to 52% of all employees. The source of that lower percentage becomes more clear when we examine the gender differences. Fifty percent of male healthcare employees said they were paid fairly – while only 39% of women said the same. That gender gap appears in the overall results as well, so healthcare organizations have the double challenge of ensuring better pay overall and specifically addressing the gender gap in pay.
Reflecting this, when asked what factor would cause a healthcare employee to leave her or his job, healthcare workers ranked “Wages not keeping up with inflation” higher than U.S. workers overall. This feeling of not being valued at work is a consistent theme in other questions related to attitudes and opinions of work environment.
When asked about factors that would influence whether deciding to seek another job, healthcare employees were slightly more worried that wages would not keep up with inflation than U.S. workers in general. Not surprisingly, given the industry’s chronic staffing shortages, two-thirds of healthcare respondents said they were not worried about losing their job in the coming year, compared to 44% of all U.S. employees. Yet these respondents also ranked job security highly as a reason to stay in a job, so why the worry with so many jobs unfilled?
Nalwa said it’s difficult to separate what is going on in the outside economy from one’s own work, as Tyson Foods, 3M, Disney, Walmart, Bed Bath & Beyond and McDonalds have all announced layoffs this spring. Lack of opportunity can play into security concerns as well, Nalwa said, as there are only so many hospitals in a regional area, which is a factor when hybrid working is not practical as it is in many other fields.
Healthcare employment tends to be a lagging indicator in the economy, which means that layoffs will typically happen elsewhere before they happen in that industry. But healthcare is not immune to layoffs, Tyler said, and there have been a few in the industry lately. But the job security concern also speaks to the type of people who are in healthcare—typically more empathetic and thus more receptive to what others are experiencing. If other people are worried about layoffs, healthcare workers can’t help but be concerned as well.
Appreciating and valuing employees
Our survey asked respondents to respond to an array of positive statements about their employer and in some respects, healthcare respondents closely matched assessments from other fields. Statements such as whether benefits were understood and benefitted their families, whether their company inspires them to perform well and whether they see themselves working there a year later all were consistently rated as “Completely Agree or Agree” by the majority of respondents. Healthcare company employees agreed that they had opportunities and learning support at levels just below U.S. workers overall.
But as previous mentioned, when healthcare workers were asked questions reflective of how their company values them, their responses were consistently below average compared to overall results. Examples include:
- I am paid fairly for the contributions I make to my organization’s success (52% overall, 41% healthcare)
- I feel all employees are paid equally for equal work regardless of gender (58% overall, 48% healthcare,
- My organization understands my needs as an employee (52% overall, 44% healthcare)
- My organization is a safe place for employees to speak out (53% overall, 46% healthcare)
- I feel like my organization cares about me as a person and a professional (51% overall, 43% healthcare)
- I feel like my voice is heard at work (48% overall, 39% healthcare)
Nalwa said these results are not surprising, partially due to the nature of healthcare work but also because of the complexities of the workload, concern for physical safety and sometimes the need for long hours. One particularly startling finding, Nalwa said, was how many healthcare employees thought poor performers where appropriately managed—only 28% agreed or completely agreed, compared to 40% overall. Difficulty addressing worker issues leaves other people doing their work, which would naturally leave employees feeling their own work wasn’t valued.
One such way to address these concerns about lack of value could involve more timely performance feedback from supervisors. When asked about the frequency of performance assessments, our study showed that 28% of U.S. workers received feedback at least weekly, while only 15% of healthcare workers did. Healthcare workers, by a significant margin, had performance feedback only yearly—34% compared to 21% for all U.S. workers. Feeling valued at an organization could be helped by having managers hold weekly reviews of work, not to increase criticism but to build a connection to their managers that is a tangible demonstration of value.
However, Tyler said what counts as feedback may not be perceived as such. With patient care decisions, often feedback on decisions and care is instantaneous given the seriousness of the issues involved. Additionally, the regulatory oversight in healthcare regularly provides feedback/oversight. For more formal performance reviews, it’s important to keep in mind that given the 24/7 nature of the industry, managers may not work the same shift as employees who report to them, so formal feedback reviews may not happen as easily.
Conclusion
Our survey uncovered some clear shortfalls that seem to permeate worker environment and employee attitudes in healthcare. Employees in this sector have issues with maintaining well-being, and even if those issues aren’t arising from work-related responsibilities, they nonetheless are a concern for employers as, increasingly, employees are expecting their companies to offer ways to address them.
When it comes to being paid fairly, healthcare workers say it is both a top motivator to stay in a company and a top reason to leave if it’s not satisfactory. Despite rampant staffing shortages, healthcare employees are very worried about layoffs and strongly value job security, so reassurances in this area, when possible, can have a positive effect.
Closely tied to well-being concerns, healthcare companies would be advised to devote attention to factors that make employees feel valued and appreciated at work, factors that go beyond more money. Healthcare workers say they are not appreciated for covering for staff shortages and don’t feel, on average, that their opinions are being heard or that they matter. Management training, focused on more frequent performance feedback requests, could go a long way toward resolving this issue.
Many of these issues should be addressed not just by a human resources department but with the engagement of company leadership. Often a third-party advisor experienced in addressing the kinds of organizational challenges these survey results reveal can provide the guidance to make proposed changes effective across a healthcare organization.
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