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How are U.S. health care providers managing COVID-19’s impact on staffing, compensation?

The second of our ongoing series of flash surveys provides insights into this changing situation.

Compensation Strategy & Design|Health and Benefits|Talent|Bienestar integral
COVID 19 Coronavirus

April 14, 2020

While organizations continue to report that staffing overall is not an issue, those reporting difficulties in getting nurses to come into work relative to other positions has increased from our first survey.

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About our COVID-19 coverage

In our ongoing coverage of the COVID-19 outbreak, experts from across Willis Towers Watson share insight into what you need to know to manage your business and employees and reduce your risk.

As several municipalities work to manage the patient load from COVID-19, our nation’s health care providers are now partnering with federal, state and local governments – and each other – to an unprecedented degree, aligning staff, supplies and patients to balance capacity constraints. Health care providers are also trying to support health care workers under sustained pressure from working multiple shifts, lack of personal protective equipment and fears of transmitting the virus to their families when they return home.

Below, we share the high-level findings from Willis Towers Watson’s second flash survey to see if compensation and staffing practices have changed from the beginning of the pandemic to now; this survey summarizes responses from the 147 participating organizations (twice as many as responded to our first survey) ranging from single facilities to multi-state, multibillion-dollar systems nationwide.

Premium pay

Where provided, premium pay usually takes the form of overtime pay rates for all hours worked, an additional hourly kicker or a bonus shift differential.

Consistent with findings from our first survey, most organizations have not and do not plan to provide premium pay to staff, as many believe it is part of the job. While findings from our first survey suggested that premium pay was more likely to be provided in states with a large number of active cases, we do not observe any patterns regarding premium pay based on location or organization size in this second survey. The driving rationale behind premium pay reported by those organizations that provide it are staffing shortages.

Nurses, techs and clinical support roles are the most likely to receive premium pay – and it is typically only provided if the individual is working directly with COVID-19 patients. This premium pay provided to nurses and techs is generally $10 to $11 per hour (median/mean for 13 organizations) or 20% to 50% of the current pay rate (median/mean for six organizations) and less for support roles ($6 to $7.65 per hour at median/mean). Most organizations are using current programs already in place to incentivize staff to take on extra shifts, as needed, and those in non-clinical roles continue to be significantly less likely to receive premium pay.


The premium pay provided to nurses appears to be in response to the increased staffing challenges organizations face for this position. While organizations continue to report that staffing overall is not an issue, the prevalence of organizations reporting difficulties in getting nurses to come into work relative to other positions has increased from our first survey. This is not surprising since nurses are the most likely to experience the sustained pressures of caregiving.

That sustained pressure replaces absenteeism due to childcare, which no longer appears to be a significant driver of staffing challenges. Where respondents are facing challenges with staffing, it is due to COVID-19 exposure, pregnancy or being in a high-risk category. 

To meet any staffing challenges, organizations continue to redeploy clinical roles (90% of respondents) as well as administrative roles (70% of respondents). Organizations may have maxed out their ability to do this or they have shifted their staffing attention to rehiring retirees (50% of responding organizations, significantly up from 9%). 

Support services

Organizations may have gotten out ahead of staffing shortages through the additional support they are providing to staff. Employee assistance programs and onsite counseling increased from 50% to 68%. More notably, 30% of organizations are reporting that they are providing temporary housing to support clinicians who do not want to return home and risk infecting families. The remaining support services reported in the prior survey (food and parking) continue to be employed, as well.

Cost containment

On the flip side of providing additional support to employees, paid time off (PTO) remains less generous among health care providers than in other industries (as reported in our first survey) and, based on the results of our second survey, practices have tightened further. Now over 50% of responding organizations are requiring hourly employees who cannot work from home to draw down PTO. Larger organizations are more likely to let PTO banks go negative and/or extend PTO/sick bank maximums, potentially demonstrating their better financial position and validating the aggregation of health care systems over the last decade. 

Three-quarters of responding organizations have also cut discretionary travel and expenses in an attempt to manage the growing costs of responding to COVID-19. About a quarter of organizations have already furloughed some employees and another 40% are considering or planning to do so. Merit increases are being delayed by 10% to 15% of responding organizations, with a third of organizations considering it – generally for a period of six months. Salary cuts and layoffs are also being considered, but few organizations have actually implemented them.

Despite being on the front lines of COVID-19, respondents are also considering some actions that we have seen reported in Willis Towers Watson’s other surveys: freezing hiring, cutting capital expenditures, modifying incentives, reducing retirement plan contributions, deferring vendor payments or reducing work hours.

More information

Results from our first survey can be found in our previous blog post, How are U.S. health care providers managing compensation amid COVID-19?

More information about COVID-19 and how health care providers and other employers are responding to this rapidly changing landscape can be found on our COVID-19 page. You can also forward questions to WTW.TR.US.Health.Care.Providers.Industry.

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