Education will be key in addressing Tennessee’s unprecedented healthcare workforce crisis, according to the THA


Shane Ersland


The Tennessee Hospital Association (THA) has identified several factors contributing to an unprecedented healthcare workforce staffing crisis, and is working to address them.

The THA worked with its subsidiary, the Tennessee Center for Health Workforce Development, to conduct a study on healthcare staffing projections through 2035. The study, which was released in October 2022, projects an expected shortfall of more than 15,000 positions by 2035. That includes a gap of 8,500 registered nurses, 5,590 medical lab technicians and technologists, and 1,080 respiratory therapists.


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Kelly Insana, vice president of marketing and communications at the THA, told State of Reform that the state’s healthcare workforce challenges were greatly exacerbated by the COVID-19 pandemic.

“One thing that is an overarching thing you’ve seen nationwide is pandemic stress,” Insana said. “Some people said, ‘This is my time to step away, retire, or try something different.’ We’ve seen some shifting. Respiratory therapists were under extreme strain during the pandemic.”

Another thing causing stress in the healthcare workforce is increased workplace violence, Insana said. A new survey from Premier found that 40 percent of healthcare workers have experienced at least one incident of workplace violence within the past two years, which occurred most frequently against nurses.

“This is, unfortunately, something we have seen and continue to see,” Insana said. “That can cause people to reconsider their career path.”

The THA report recommends the establishment of a statewide workplace violence prevention consortium to provide training and support for workers, and recommend policy changes.

Focusing on educational efforts will be key in supplementing the healthcare workforce pipeline, Insana said. 

“A lot of what we’re looking at is how education is working. We need to make sure to engage with students early to get them interested in healthcare. One thing we’ve ramped up is engagement with middle/high school students. How do we introduce them to healthcare careers even earlier?”

— Insana

The THA launched the It Happens in a Hospital campaign last year, which introduces youths to a plethora of hospital jobs that they might not initially consider being associated with a hospital. It informs them of hospital jobs that relate to food services, transport and registration, cleaning, administrative services, and marketing, among others.

“When you think of healthcare careers, you think of a doctor or a nurse,” Insana said. “But you can also be a graphic designer, an emergency medical technician, or a chef. Maybe instead of working at Taco Bell, you could work in the cafeteria at a hospital. And there’s job security there.”

The THA worked with several different partners to identify ways to support the healthcare workforce following the study, Insana said.

“All year long, different departments were working on different things to address the workforce shortage. What tools do we need to support clinicians during stressful times and to mitigate burnout? We have to meet people where they are. Are there ways to leverage technology? 

So we had data with this study and needed to put it together. We talked about bridging the gap, but what we really need to do is mend the gap. How do we attract more people into the pipeline? And we need to make sure the pipeline can handle an influx of students.”


The report called for the creation of a statewide awareness campaign to highlight the variety of hospital careers available, and resources to assist in training and education for those careers. It also recommended the creation or augmentation of existing programs that provide stipends or financial incentives (tuition assistance, paid internships, loan forgiveness, child care assistance) to pursue careers in high-demand healthcare fields.

While the THA focused on workforce priorities in 2022, hospital finances became its priority in 2023. The KaufmanHall report released last winter showed that the financial impact of the pandemic was staggering. Hospitals incurred approximately $500 million in losses in 2022, according to the report.

“It showed that the majority of hospitals experienced negative margins,” Insana said. “They were on an unsustainable trajectory. And the cost of the workforce was a contributing factor. So that was the immediate need in 2023; how to keep them open.”

Rural hospitals are disproportionately affected by workforce challenges, and Gov. Bill Lee established the Tennessee Rural Health Care Task Force in 2019 to improve health access and outcomes for rural Tennesseeans. The task force recently released a report that includes several recommendations, which center on workforce development, access to care, and social drivers of health.

The THA hopes lawmakers consider recommendations in the THA report, as well as the rural task force’s report when making decisions during the upcoming legislative session, Insana said.