Each year, the research institute ECRI publishes a report on the "Top 10 Patient Safety Concerns" of those using health care organizations. Drawing on data gathered from scientific literature, reported patient safety events, and other sources, ECRI's 2022 list includes concerns about bias and racism, supply chain disruptions, and vaccination gaps, among others. Topping the list are staffing shortages and the effects of COVID-19 on health care workers' mental health.

Health care facilities have suffered from inadequate staffing of both clinical and nonclinical positions for many years. The ECRI report enumerates some immediate reasons for shortages in nurse staffing, including high turnover (18.7%), an aging workforce (nearly 20% of RNs are 65 or older), and inadequate capacity in nursing schools (80,407 qualified applicants were turned away in 2019). The U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs for expansion and replacement of retirees. The ECRI report also notes shortfalls in the number of laboratory technicians, physicians, and executives.

To alleviate staffing shortages and their impact on patients, ECRI recommends adjusting organizational systems "to respond to staff needs," and developing an "inclusive, culturally competent workforce." The report also contains suggestions for data gathering, and calls for focused evaluation of staff/patient ratios on "incidents and outcomes."

With regard to health care workers' mental well-being, ECRI concludes that COVID-19 amplified the impact of stress already present in the health care workforce prior to the pandemic, including exhaustion, burnout, and depression. The report cites a February 2021 survey of nurses that found poor sleep quality in 35% of respondents, heightened anxiety during unexpected events in 28%, and "unintended negative memories" in 25%. One-quarter of the nurses working in ICUs and on dedicated COVID-19 units reported high levels of emotional exhaustion. On the positive side, 39% reported so-called posttraumatic growth or positive psychological change following stressful circumstances.

Recommendations to combat stress and burnout include providing institutional support for interpersonal understanding as well as an array of "wellness" treatments for workers needing assistance. The ECRI report can be accessed at http://www.ecri.org.-Frank Brodhead