Research Projects Identify Issues Facing Frontline Health Care Workers

Dates of Project: December 2004 to April 2006

Field of Work: Workforce development for frontline health care workers

Problem Synopsis: Despite their importance, frontline workers—home health aides, nurse aides, psychiatric technicians, social workers, and human service assistants who often are the first point of contact for patients—are poorly paid, do not receive benefits and have little opportunity for advancement.

Synopsis of the Work: From December 2004 to April 2006, researchers in Baltimore, Boston, New York City,  North Carolina, and Washington DC, designed five diverse projects that explored issues impacting the frontline workforce. Their activities included conducting focus groups and interviews with workers, employers, and funders; administering a national survey; and reviewing the literature on existing and past workforce development initiatives.

"Frontline health care workers are expected to perform tasks once performed by professional staff. For example, home health care workers report having to understand the complex interactions of the medications their patients take. In a hospital and community health center, certified nursing assistants now do what registered nurses used to do—watch patient monitors, take patients' vital signs and assist physicians with exams such as pap smears."

Key Findings

Key findings from the five projects include:

  • Feeling respected by and belonging to the medical team is highly important to frontline workers, yet they feel ambivalent about their role and standing as team members.
  • Frontline health care workers are caring, committed and compassionate people dedicated to their profession, and they report a general desire to help people.
  • Some 40 percent of licensed social workers identify behavioral health care as their practice focus, making this group the largest single group of active licensed social workers.
  • National, state and local funders support a range of strategies related to frontline health care workforce issues, but they showed limited interest in supporting a "Caregiving Collaborative" that spans the child-care and long-term-care sectors.
  • As priorities for workforce development, frontline workers in the addiction field urged addiction treatment agencies to adopt a uniform orientation policy and commit to providing excellent clinical supervision. They also wanted stronger networking and mentoring opportunities.

An examination of 10 education and training initiatives for frontline health care workers found "a common set of challenges that prevents the expansion of existing programs or the creation of new ones to alleviate workers shortages and deliver consistent high quality care." To meet these challenges, employers must provide training programs that "make it easier, make it work, and make it pay" for frontline workers.

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The growth rate of the frontline health care workforce (32.6%) is more than double all other U.S. occupations—Bur. of Labor Statistics, 2003