Strengthening the Health Care Workforce in a Time of Crisis

As the COVID-19 pandemic reshapes the health care landscape in the US and across the world, it's also exposing the numerous barriers and inequities that stand in the way of meeting America's emergency and long-term health care workforce needs.

Health care professions in the United States are both hard to get into and hard to advance through. Moving up the ladder from a support role to better-paid jobs in nursing and respiratory therapy, which require higher credentials, can be prohibitively costly and time-consuming for working learners. And even with mass layoffs and unemployment looming, the United States struggles to train enough workers for the critical support roles performed by nursing assistants, community health workers, and a wide array of medical technicians.

As the country grapples with the present pandemic, there are steps we can take to increase critically needed healthcare system capacity today, while promoting equitable access to health care occupations in the future:

• Utilize skilled veterans to meet emerging health care needs. The US military trains thousands of Americans to serve in a variety of emergency and clinical health care roles. However, our health care workforce development practices and state licensing makes it hard for veterans with valuable health care experience to translate their existing skills into credit toward a needed degree, certification, or license. Governors should create a health care worker corps to bring these skilled men and women back to civilian hospitals to help combat the crisis.
• Base requirements to practice on skills and competencies. Some states, like Maryland, have already taken steps to allow health care professionals to take on tasks beyond their scope of licensure, as long as their supervisors believe they are capable of completing those tasks well. This step allows practitioners to leverage the full range of their skills to address patient needs, even if what is required of them stretches beyond what their license would normally permit. States should follow Maryland’s lead in expanding scope of practice.
• Facilitate licensure of immigrants with health care credentials from outside the United States. Many immigrants and refugees who come to the US have valuable experience and certifications in health care. Their expertise is urgently needed to meet health care needs, but transitioning to an American license for the same occupation can be an insurmountable challenge. States should smooth the path for new Americans to put their health care skills to work to fight the virus. With support from the state of Maryland, the Baltimore Alliance for Careers in Healthcare (BACH) sponsors a competency-based apprenticeship program to help immigrants who worked as health care professionals in their home counties find comparable employment in the US.
• Leverage retired health care professionals as clinicians and trainers. Many states, like Illinois, are working to reintegrate retired doctors and nurses to ensure emergency health care needs are met. While this is a smart move, these mostly older practitioners may be more susceptible to coronavirus and thus should not be treating COVID-19 patients. Instead, these health care professionals should be hired to address other health care needs or to fill faculty gaps in health care education and training programs. Federal and state resources should be used to ensure colleges, universities, and labor management organizations that operate health care training programs have the resources to hire as many faculty as needed to expediently train new professionals. The wisdom of retired doctors and nurses is needed desperately, whether in the hospital or in the classroom.
• Provide provisional licenses to medical and nursing students able to take on patient care roles. Across Europe, advanced medical students are being fast-tracked into roles as doctors. But currently, in states like California, nursing students who have almost completed their programs are being sidelined because of a lack of clinical hours. Instead of stopping students in the final years of their programs in their tracks, states should follow Europe’s lead and instead enlist final year students to treat patients. As with Maryland’s expanded standards for practice, as long as these emerging professionals have the skills and competencies to complete needed tasks, nothing should stand in the way of them serving their community in this time of crisis.

COVID-19 is stretching our health care system in ways that require creative workforce solutions. The recommendations above represent a series of actions that federal, state, and local leaders can take to get all hands on deck for the sake of our country’s health. We don’t have a moment to spare.

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