The Health Resources and Services Administration–Bureau of Health Workforce Response to the COVID-19 Pandemic

As associate administrator of the Bureau of Health Workforce (BHW) within the Health Resources and Services Administration (HRSA), US Department of Health and Human Services (HHS), I welcome you to this supplemental issue, “Expanding the Health Workforce Capacity and Responding to Public Health Emergencies.” The COVID-19 pandemic, one of the most important public health emergencies of recent times, demonstrated the importance of a well-trained, competent, and responsive public health workforce for safeguarding the health of the nation. The nursing, medical, behavioral health care, and public health professions serve as the backbone of the nation’s disaster response. However, the COVID-19 pandemic, along with other challenges such as the opioid epidemic, has placed public health services under substantial stress.

The mission of BHW is to improve the health of medically underserved (hereinafter referred to as underserved) populations by strengthening the health workforce and connecting skilled professionals to communities in need. The COVID-19 pandemic highlighted the need to support nurses and other health care professionals in maintaining the health care system’s ability to function. For example, early in the pandemic response, stresses on the nursing profession affected patient care and highlighted preexisting workforce shortages. ¹ When vaccines became available, lack of support for nurses impaired vaccine access and distribution and contributed to increased vaccine hesitancy. ²

The pandemic also highlighted health disparities and brought health equity to the forefront of national discourse. By many measures, racial and ethnic minority populations and medically disadvantaged groups have lower access to health care and worse health outcomes than majority groups. ³ The pandemic only deepened these disparities. Efforts are needed to address the full spectrum of factors that affect the health and well-being of individuals and communities, known as the social determinants of health (SDOH). Bridging this health divide to advance health equity depends on how nurses, physicians, behavioral health providers, and public health professionals understand the complex relationships among SDOH, the health care system, and health outcomes, which become especially tenuous during public health emergencies. ⁴

Federal Efforts

Even before the COVID-19 pandemic, Congress passed the 21st Century Cures Act in 2016 to study and bolster the nation’s workforce to address mental health issues and substance use disorders, with a focus on the opioid epidemic. ⁵ When the pandemic arrived in 2020, it affected the mental and behavioral health of health care providers and patients. As a result, the US health system responded by continuing to evolve to better address multiple behavioral health challenges. The federal government has implemented initiatives and programs to promote mental health parity with other health care services, encourage integrated and team-based care for mental health and substance use treatment, and break down barriers to providing mental and behavioral health care. These programs include the following:

• Behavioral Health Workforce Education and Training: Developing community-based experiential training to increase the supply of students preparing to become peer support specialists and other behavioral health–related professionals and paraprofessionals.

• Promoting Resilience and Mental Health Among Health Professional Workforce: Supporting health care organizations in promoting resilience, mental health, and wellness among health care providers.

• Advanced Nursing Education Nurse Practitioner Residency Integration Program: Preparing new nurse practitioners in primary care or behavioral health practice in integrated, community-based settings. ⁶

Future supply and demand for behavioral health practitioners will be affected by several factors, including the growth and diversity of the nation’s population, the aging of the population, overall economic conditions, expansion of health insurance coverage, changes in health care reimbursement, and forces affecting the health workforce.

The 2020 Coronavirus Aid, Relief, and Economic Security Act provided additional resources and flexibility in federally funded programs and the ability for programs to channel resources to help health centers across the country in their pandemic response, while maintaining or increasing staffing levels to address public health needs.^7,8 The 2021 American Rescue Plan provided additional funds to allow nursing students and professionals, as well as other health care providers, to receive support for self-care and to reduce burnout, with grants targeted toward developing wellness and resiliency strategies and programs.^9,10

The Response of BHW

BHW is uniquely positioned to address these workforce challenges by supporting community-based training of a skilled health care workforce along with programs that incentivize clinicians to work in rural and underserved communities. In a recent study on workforce preparedness for disasters, many respondents, including those who directly or indirectly delivered patient care, reported that they felt unprepared to respond effectively to major disasters. ³ To support our mission of strengthening the health workforce and connecting skilled health professionals to communities in need, BHW administers more than 40 workforce programs that positively affect every aspect of a health professional’s career, from pipeline, education, and training; to service in the community; to continuing education. These programs include health professions training grant programs, which allow for innovative and flexible responses to the nation’s emerging health care challenges. ¹¹

In August 2021, BHW hosted a listening session focused on the nursing workforce during the COVID-19 pandemic and the postpandemic period. Attendees included federal staff from HHS and the White House, along with more than 200 representatives from nursing, health care, and other stakeholder groups and organizations. The session served to help health care leaders and policy makers understand some of the serious challenges facing the nursing profession that will require immediate and long-term solutions.

Within BHW, our Division of Nursing and Public Health has led HRSA’s mission to achieve health equity and address health workforce needs to mitigate public health emergencies. The Division of Nursing and Public Health has implemented targeted initiatives to promote access to behavioral health care, expand and ensure equitable distribution of the nursing and public health workforce, improve quality, and enhance the use of data and evidence to improve program outcomes and return on investment. ¹¹

Increasingly, BHW has emphasized workforce diversity across all program areas. As a bureau, we strive to prepare and deploy a health care workforce that reflects the communities it serves and ensure that health care providers are culturally competent to address local health challenges, reduce health disparities, and promote health equity. In particular, BHW maintains a strong focus on reducing disparities and expanding the nursing, behavioral, and public health workforce by integrating behavioral health into nurse-led primary care teams, providing primary residencies in rural and underserved areas for nurse practitioners, increasing diversity in the nursing workforce, and supporting wellness and resiliency programs for health care providers.^12,13

Furthermore, BHW has expanded its focus on behavioral and public health through such strategies as developing nurse-led clinics, supporting the professional and paraprofessional workforces, promoting cultural competency training, and prioritizing program applicants who demonstrate a commitment to serving underserved populations. BHW’s health professions training grant programs allow for innovative and flexible responses to the nation’s emerging health care challenges. Through its various workforce programs, BHW targets needs and gaps in the nursing, behavioral health, and public health workforce by providing grants to eligible health professions schools. The goals of the programs are 3-fold: (1) address the needs of the communities with a focus on increasing recruitment of health professionals from underrepresented/rural populations, (2) bolster underrepresented minority groups in the health care workforce, and (3) mitigate SDOH and reduce health inequities experienced by medically underserved communities.

In addressing the adverse impact of the pandemic on health care providers, BHW has responded with provider resiliency grants that aim to reduce burnout, suicide, mental health conditions, and substance use disorders and promote resiliency among health care students, residents, professionals, health support workers, trainees, public safety officers, and employers of such individuals, particularly in rural and medically underserved communities. ¹⁴ The Mobile Health Training Program provides the opportunity to deploy care (ie, behavioral, primary, maternity/child) from mobile clinics to communities in need. ¹⁵ In addition, new community health worker training programs and public health scholarships aim to bolster the workforce. ¹⁵ BHW is increasing access to health services in rural and underserved communities through collaborative models of health workforce training that are better able to meet identified community needs; integrate primary care, behavioral health, and oral health services; expand the professional and paraprofessional workforce; address health equity; and emphasize community-based training models.

Highlighting the Work of BHW Grantees

This supplemental issue of Public Health Reports highlights BHW grantee work of transformation, innovation, and expert commentary to paint the big picture of health equity through expanding the health workforce capacity and responding to public health emergencies. The efforts of BHW to reduce and eliminate health disparities and advance health equity require a multipronged approach by addressing the needs of communities. The key insights and themes contained in these articles are valuable for informing the evolution of HRSA’s programs and, more broadly, the development of the next generation of the health workforce. The articles in this supplement address behavioral and public health needs during the COVID-19 pandemic and help to pave the way for a health workforce that is fueled by a common goal: providing access to health services and improving the quality, distribution, and supply of the nursing, behavioral health, and public health workforce to communities in need.