---
title: "COVID-19 Impact on Hospital Workforce Staffing and Safety Perceptions"
id: "pubmed-42841276"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42841276"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42841276/"
doi: "10.1097/QMH.0000000000000588"
published_at: "2026-10-07T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# COVID-19 Impact on Hospital Workforce Staffing and Safety Perceptions
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42841276
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42841276/)
- **DOI:** [10.1097/QMH.0000000000000588](https://doi.org/10.1097%2FQMH.0000000000000588)
- **Published At:** 2026-10-07T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The COVID-19 pandemic significantly stressed US hospitals, leading to concerns about staffing and safety. - A study analyzed national trends in hospital workers' perceptions of staffing adequacy and work pace from April 2020 to July 2022. - Findings indicated a steady decline in perceptions, with an average decrease of 3.5 percentage points annually. - Increased mortality rates during the Delta and Omicron surges were correlated with worsening perceptions of staffing and work pace safety. - ICU staff reported a sharper decline in safety perceptions compared to non-ICU counterparts. - A doubling in mortality rates was linked to a 38% increase in negative perceptions for all settings and a 40% increase for ICU settings. - The study underscores the need for healthcare leaders to monitor workforce perceptions to enhance support and resilience.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Hospital Workforce Staffing and Work-Pace Safety Perceptions During the COVID-19 Pandemic: A Cross-Sectional Analysis [Lauren Edelstein](https://pubmed.ncbi.nlm.nih.gov/?term=Edelstein+L&cauthor_id=42841276)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841276/#full-view-affiliation-1 "Author Affiliations: Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, Maryland \(Dr Edelstein\); Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington \(Dr Sehgal\); Management and Organization Department, Robert H. Smith School of Business \(Dr Shapiro\), and Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland \(Drs Gourevitch, Fouladi, and Franzini\)."), [Neil Sehgal](https://pubmed.ncbi.nlm.nih.gov/?term=Sehgal+N&cauthor_id=42841276), [Debra Shapiro](https://pubmed.ncbi.nlm.nih.gov/?term=Shapiro+D&cauthor_id=42841276), [Rebecca Gourevitch](https://pubmed.ncbi.nlm.nih.gov/?term=Gourevitch+R&cauthor_id=42841276), [Negin Fouladi](https://pubmed.ncbi.nlm.nih.gov/?term=Fouladi+N&cauthor_id=42841276), [Luisa Franzini](https://pubmed.ncbi.nlm.nih.gov/?term=Franzini+L&cauthor_id=42841276) Affiliations Expand ### Affiliation * 1 Author Affiliations: Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, Maryland (Dr Edelstein); Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington (Dr Sehgal); Management and Organization Department, Robert H. Smith School of Business (Dr Shapiro), and Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland (Drs Gourevitch, Fouladi, and Franzini). * PMID: **42841276** * DOI: [ 10.1097/QMH.0000000000000588 ](https://doi.org/10.1097/qmh.0000000000000588) Item in Clipboard # Hospital Workforce Staffing and Work-Pace Safety Perceptions During the COVID-19 Pandemic: A Cross-Sectional Analysis Lauren Edelstein et al. Qual Manag Health Care. 2026. Show details Display options Display options Format Abstract PubMed PMID Qual Manag Health Care Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Qual+Manag+Health+Care%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Qual+Manag+Health+Care%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42841276/) . 2026 Oct 7. doi: 10.1097/QMH.0000000000000588. Online ahead of print. ### Authors [Lauren Edelstein](https://pubmed.ncbi.nlm.nih.gov/?term=Edelstein+L&cauthor_id=42841276)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841276/#short-view-affiliation-1 "Author Affiliations: Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, Maryland \(Dr Edelstein\); Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington \(Dr Sehgal\); Management and Organization Department, Robert H. Smith School of Business \(Dr Shapiro\), and Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland \(Drs Gourevitch, Fouladi, and Franzini\)."), [Neil Sehgal](https://pubmed.ncbi.nlm.nih.gov/?term=Sehgal+N&cauthor_id=42841276), [Debra Shapiro](https://pubmed.ncbi.nlm.nih.gov/?term=Shapiro+D&cauthor_id=42841276), [Rebecca Gourevitch](https://pubmed.ncbi.nlm.nih.gov/?term=Gourevitch+R&cauthor_id=42841276), [Negin Fouladi](https://pubmed.ncbi.nlm.nih.gov/?term=Fouladi+N&cauthor_id=42841276), [Luisa Franzini](https://pubmed.ncbi.nlm.nih.gov/?term=Franzini+L&cauthor_id=42841276) ### Affiliation * 1 Author Affiliations: Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, Maryland (Dr Edelstein); Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington (Dr Sehgal); Management and Organization Department, Robert H. Smith School of Business (Dr Shapiro), and Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland (Drs Gourevitch, Fouladi, and Franzini). * PMID: **42841276** * DOI: [ 10.1097/QMH.0000000000000588 ](https://doi.org/10.1097/qmh.0000000000000588) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background and objectives:** The COVID-19 pandemic placed unprecedented strain on US hospitals, creating conditions of high patient acuity, elevated mortality, and staffing shortages. These pressures threatened care quality and shaped how workers perceived their ability to provide safe care. This study examined national trends in hospital workers' staffing and work-pace safety perceptions (SWSP) during the pandemic and evaluated whether changes in hospital mortality rates were associated with worsening perceptions. We further assessed whether intensive care unit (ICU) staff experienced sharper declines in SWSP compared with non-ICU counterparts. **Methods:** We conducted a quantitative analysis using de-identified responses from the Hospital Survey on Patient Safety Culture, linked with mortality data from the Healthcare Cost and Utilization Project State Inpatient Databases. A total of 258 987 responses from more than 400 hospitals were included from the pandemic period (April 2020-July 2022). Staffing and work-pace safety perception was measured using a composite of 2 Hospital Survey on Patient Safety Culture items on staffing adequacy and work pace, dichotomized into negative/neutral versus positive perceptions. Logistic regression models assessed associations between monthly mortality rates and SWSP, adjusting for individual- and hospital-level covariates. Stratified analyses compared ICU and non-ICU settings. **Results:** Nationwide, SWSP declined steadily, decreasing by an average of 3.5 percentage points per year. Periods of heightened mortality, including the Delta and Omicron waves, coincided with sharper deterioration. A doubling of overall mortality was associated with a 38% increase in odds of negative/neutral SWSP (odds ratio [OR] = 1.38, standard error [SE] = 0.02, P - [DOI](https://doi.org/10.1377/forefront.20250516.299379) 5. 1. Rosen A, Cahill JM, Dugdale LS. Moral injury in health care: identification and repair in the COVID-19 era. J Gen Intern Med. 2022;37(14):3739-3743. doi: 10.1007/s11606-022-07761-5 - [DOI](https://doi.org/10.1007/s11606-022-07761-5) Show all 41 references [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42841276/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42841276%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42841276/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42841276%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42841276%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42841276/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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