Increased workforce turnover and pressures straining provider operations

Private sector hospital leaders are tackling ways to address challenges and boost the US healthcare workforce.

As patient volumes return and begin to exceed 2019 levels in the United States, and COVID-19 hospitalizations continue to be a factor, hospital leaders are taking a number of steps to meet increased demand and ensure access to care, according to a new McKinsey survey. These actions have included expanded clinic hours and increased physician productivity expectations, optimized operating room scheduling, and expanded operating room hours. 1 A critical challenge hospitals cite in continuing to meet this need is the capacity and well-being of the US healthcare workforce. Healthcare systems are managing short-term, pandemic-era workforce challenges while sowing seeds for longer-term changes that enhance workforce and patient experience. Employers are examining a wide range of ideas and models to achieve the latter.

Nursing workforce coverage is a continuing challenge

When asked about key challenges still faced, 84 percent of survey respondents reported continued challenges with nursing workforce coverage. Sixty percent reported challenges with broader clinical support staff coverage. In addition, respondents reported nursing turnover and vacancy rates have increased, on average, 4 to 5 percentage points in the past 12 months. This may only be the start of greater challenges, as 22 percent of the nursing workforce reported in our Spring 2021 Future of Work in Nursing survey that they may leave their role providing direct patient care in the next year.
COVID-19 challenges respondents still face

How operations have been impacted due to workforce constraints

These workforce challenges have already begun impacting operations, with 60 percent of respondents reporting having to change their care model, 48 percent reporting having to reduce inpatient capacity, and approximately 40 percent reporting reductions in operating room and ambulatory clinic capacity, increased emergency department diversion, and increased length of stay.
Impact to operations of workforce constraints

Hospitals are responding by increasing wages and amplifying recruitment efforts

Hospitals are responding to this challenge and implementing a variety of tactics to maintain a strong nursing workforce. Wage increases and amplified recruiting efforts are the most commonly reported strategies.
Top tactics hospitals have deployed over last three months to maintain a strong nursing workforce

Moving forward, continued multi-stakeholder efforts to support and retain the current US healthcare workforce and recruit and develop additional talent will be critical.

Research methodology


From July 16 to 24, 2021, McKinsey surveyed strategic and operational leaders from 100 large private-sector hospitals in the United States to see how COVID-19 had impacted hospital volumes, and to understand what expectations and implications were for the upcoming year(s). A similar survey was also conducted in May 2021, February 2021, and July 2020, with approximately 30 large health-system respondents.

All of the 100 respondents represented hospitals with more than 200 hospital beds. These 100 hospitals represented hospitals from all regions of the United States (Northeast, Midwest, South, and West), and collectively represent approximately 10 percent of all hospital beds in the United States.

All survey questions were based on the experiences of an individual facility, rather than the system overall. Responses were aggregated and weighted equally for analyses.

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