ASCA Survey Shows Extent of Staffing Issues

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ASCA Survey Shows Extent of Staffing Issues

Surgery centers are experiencing nursing shortages

In March 2021, ASCA introduced a bimonthly survey series named 60-Second Survey. As the name suggests, each survey takes approximately a minute to complete and asks fewer than 10 questions on a current topic. The topic changes survey to survey, but each aims to take the pulse of the ASC community and help ASCA better serve its members and the ASC industry at large. The fifth survey, conducted in December 2021, asked questions regarding nursing and other staff shortages. The survey received 338 total responses.


After almost two years of the COVID-19 pandemic and the recent wave of infections driven by the Omicron variant, the American healthcare system is strained. According to a November 2021 survey of rural hospitals performed by The Chartis Group, 98.5 percent of respondents indicated they were experiencing a staffing shortage, with 96.2 percent identifying nursing roles as being difficult to fill. An October 2021 Labor Brief from the nonprofit Altarum Institute showed that overall healthcare employment was down 524,000 jobs compared to pre-pandemic levels. That number has likely increased significantly by now as the Omicron variant has caused case counts and hospitalizations to reach new pandemic peaks in January 2022. The reasons for nursing/staff shortages are understandable and myriad. Many health workers are burned out after almost two years of continuous high-volume work, with no real end in sight, and have either retired or taken other employment. Some staff might have been laid off after many healthcare organizations implemented vaccination mandates in late 2021. In a unique twist, the shortage of nurses has created a booming and lucrative travel nursing market. Many nurses can achieve multiple times their current salary by traveling and filling in shortages at high-paying temporary roles in other facilities. ASCA had heard anecdotally about shortages from several members but wanted to conduct a survey to get a better sense of the state of nurses/staffing in ASCs specifically.

Survey Results

Overall, 77 percent of respondents (249/322) said they are experiencing nursing or other staff shortages. There is no significant difference between responses from single-specialty (76 percent experiencing shortages) and multispecialty facilities. Of the 249 respondents that said they are experiencing shortages, 88 percent (220/249) said that the shortages are affecting nurses (RNs, LPNs) in particular. Twenty-four percent (60/249) of respondents said shortages are affecting other licensed practitioners and 29 percent (72/249) responded that nonclinical facility staff is being affected (respondents could select more than one category of staff affected).

60-Second Survey

When asked about reasons behind the shortages, 76 percent (189/249) attributed the shortages to higher pay elsewhere, possibly the aforementioned salaries being offered to traveling nurses. This was by far the highest rationale given, although 33 percent (81/249) of survey respondents attributed shortages to general staff burnout and 21 percent (53/249) said some staff left or were let go previously during the pandemic and never returned. Notably, just 6 percent of respondents (16/249) cited a vaccination mandate, whether governmental or corporate, as the reason behind shortages.

In an encouraging sign, almost 40 percent (99/249) of respondents said that issues related to staffing has had no effect on their ASC’s ability to provide a normal volume of procedures. The same number of respondents (40 percent, 99/249) said that issues related to staffing are causing a slight decrease (less than 5 percent reduction) to procedure volumes. Just 12 percent of respondents (30/249) said that staffing issues are causing a significant (greater than 5 percent) decrease to procedure volumes. Overall, 32 percent of survey respondents experiencing shortages (79/249) said that the shortages are affecting their ability to provide service to Medicare patients.

ASCA continues to provide up-to-date resources and advocacy to give ASCs maximum flexibility to operate during the ongoing COVID-19 pandemic. This includes the COVID-19 Resource Center with updated state guidance on elective surgeries, an issue that is resurfacing in the current wave of Omicron variant infections. Please write Alex Taira for questions about this survey or to propose topics for future surveys.