Matthew Bucala, MPH, is a biostatistician with the University of Chicago.

Matthew Bucala, MPH

Editor’s note: This article is about IPs; however, it very much transcends to other positions and disciplines. Even if you aren’t an IP or in health care, I recommend reading. As always, we welcome your input.

The infection preventionist (IP) workforce comprises a core group of highly specialized experts whose primary mandate is to rigorously control and proactively prevent infectious disease transmission. Their work is the bedrock of patient and community safety. Far exceeding a standard quality function, this indispensable field simultaneously drives operational excellence, ensures fiscal solvency for health care organizations, and maintains required public health compliance.

Yet there is a profound disconnect between how IPs experience their essential role and leadership's level of understanding of that role. The IP community is navigating a changing public health landscape, with shifting priorities that directly affect program funding. This push and pull has created a central conflict: The necessity of a successful infection prevention program is being fundamentally undermined by the resources and organizational support needed to sustain it. Challenges are overwhelmingly uniform: IPs are crushed by an increasing scope of responsibilities while battling staff shortages and budget constraints. Overarching all is the number 1 reported challenge: lack of organizational support.

From July to August 2025, we distributed a short survey across LinkedIn seeking input from infection prevention professionals to glean a direct, unfiltered snapshot of their current workplace reality, challenges, and what IPs need to feel better supported. Seventy-eight participants' voices were included to create the snapshot below.

Our first article focused on the quantitative results, while this article will focus on the qualitative responses to 3 key questions. The resulting data reveal a story in which the core issue, a lack of support, is explored through 3 distinct layers of conflict: the operational reality, the structural solution, and the strategic failure. To prevent future health care crises and prepare for the next global threat, hospital leadership must first address this internal strain.

Layer 1: The Operational Reality: What Are the Challenges?

We asked participants to choose their top 3 challenges. The challenges fall into themes representing a systemic strain: resource scarcity, role expansion, and structural conflict. The primary challenge is the lack of organizational support, which underpins nearly every other struggle. This resource scarcity manifests clearly as severe staff shortages, constant staff turnover, and debilitating budget constraints. The result is a cycle of “never enough,” with IPs trying to do more with less while more keeps being added to their plates. This can create a sense of drowning, which inevitably leads to exhaustion.

The department's effectiveness is undermined by internal friction. IPs are handicapped by technology limitations and a fundamental lack of data and surveillance tools. When IPs attempt changes, they often face resistance from clinical staff. The narrative is not about a lack of expertise, but a failure of the system to resource and empower that expertise. IPs are fatigued, under-equipped, and constantly forced to prioritize reactive containment over the vital, proactive work of prevention 

Layer 2: The Structural Solution: What Must Change in 2 to 3 Years?

Next, we asked what the most important trend or change needed in infection prevention over the next 2 to 3 years would be, which coalesced into 4 primary, highly impactful themes. This layer transitions the discussion from problem to prescription, detailing the nonnegotiable investments and structural shifts required to achieve sustainability

The structural solution (the “how” to fix it)

IPs are demanding an immediate overhaul of compensation and staffing models, recognizing that current demands are unsustainable. The burden is characterized by impossible math: "We need better staffing ratios instead of having 1 IP for a 150-200 bed acute care hospital," one respondent said. To boost retention, another wrote, "Increase compensation; better training and pay; increase pay; Hire and pay [masters in public health (MPH)] and value them as much as nursing." They lament that "The field needs competitive pay and must broaden its recognized professional backgrounds beyond nursing."

For flexibility, one respondent advocates: "An important shift is adopting flexible work schedules, including hybrid workflows; allow remote work." Finally, to attract and retain talent in a competitive market, another IP sees "modernizing work structure as a crucial strategy for retention and recruitment.

Leadership, authority, and structural support (the strategic silo)

IPs need structural and political change so their authority can finally match their massive responsibility. The narrative is one of deep frustration: IPs feel siloed and stripped of agency within the current organizational chart, unable to effectively enforce the critical safety measures they are tasked with leading. As one participant responded, the job needs "recognition as leaders. I have managerial-level duties... yet am not a 'manager'.” The current lack of official status means the role's scope and accountability are misaligned with its power to enforce change.

The key to fixing this lies in the reporting structure itself. IPs are united in their demand for independence, insisting the role "needs to be leadership support and a separate chain of command for IP, not under Nursing and Quality." IPs need a strategic voice within the organizational hierarchy to advocate for resources and enforce protocols without undue influence.

Finally, the profession must tear down internal barriers to expertise. Many feel constrained by an outdated focus on clinical background, noting there's "too much bias in the field if you aren't an [registered nurse (RN)]...it is hindering our role, even after obtaining the job." IPs argue that this bias is a structural barrier preventing the field from bringing in critical epidemiological and public health expertise. Ultimately, IPs are campaigning to be seen and supported as the independent, high-level strategists they already are.

Technology, data, and proactive focus (the need for modernization)

IPs who answered the survey see technological modernization as the only way to fundamentally change how they work. They are trapped in a manual, reactive surveillance cycle, demanding a "Larger focus on proactive efforts vs reactive; Being more proactive, not reactive." IPs need automation to shift their focus from manual surveillance to high-value proactive work.

They view technology as the key to escaping the cycle of containment and surveillance. AI is viewed as a strategic, transformative tool: "We need our AI moment both to support us and also healthcare workers, and also leadership." As another respondent wrote, this technology must be practical: "IP technologies need to be more human- and hospital-need-centered. Technology reliability and transparency on adherence can make a big difference.” This technology must be practical: "IP technologies need to be more human and hospital-need centered. Technology reliability and transparency on compliance can make a big difference."

To be successful, there must be clarity and consistency

The final necessary transformation is a fundamental shift in hospital culture and accountability. IPs need infection prevention to move beyond being a periodic "box-ticking exercise" and become ingrained habits and expectations for everyone. This requires buy-in from the ground up, as one professional noted: "More nursing and front-line staff buy into IP as an everyday thing." The goal is to stop viewing IP as a checklist and start seeing it as a mandatory practice, summarized by the call for "staff accountability; shifting the mindset of considering [infection prevention and control] IPC practices as another task-based job to a habit."

For this cultural shift to take hold, one respondent said there must also be clarity and consistency across the board: "I think we need more standardization in guidelines and communication about basic types of policy." This is a clear call for both external and internal clarity to reduce confusion and ensure consistency of practice, allowing staff to fully integrate IP into their daily routines.

Layer 3: The Strategic Failure: What Leadership Still Doesn’t Understand

The final open-ended question we asked the participants was: “What is the one thing you wish hospital/organizational leadership better understood about the current state of Infection Prevention?” This final layer serves as the moral climax. IPs wish leadership understood the vast difference between their perceived and actual strategic value. They are tired of being viewed as a liability, forcefully stating, "The importance of the role... We are not quality, we are operations."

The strategic value and scope of ip (not just quality)

IPs feel that leadership sees them as "health care-associated infection trackers" rather than as essential, comprehensive experts. As one respondent wrote, IPs are tired of being viewed as a cost center or a liability, and forcefully state that their function is fundamentally financial and operational: "the importance of the role...We are not quality; we are operations." IPs emphasize that their work extends far beyond basic HAI tracking, asserting that it affects everything "downhill" and "touches every department in the hospital." They must manage everything from regulatory compliance to global health preparedness. The role is not a low-level quality check; it is "a highly specialized and demanding field that requires deep expertise and constant adaptability." By failing to recognize this deep level of expertise, leadership continues to under-resource and undermine its most vital strategic defense line.

The crisis of resources and sustainability (IPs are drowning)

IPs are clear that the workload has increased while resources have decreased. They stress that this is not just about being busy, but about a fundamental lack of support for the immense responsibility: "The amount of time involved. The workload has increased while resources have decreased. Just because there isn't a ratio doesn't mean that we should dump it all on 1 IP." The lack of staff forces IPs to be in the office to manage mandatory surveillance and regulatory checks, preventing them from doing their most impactful work. The result is urgent: "IPs are drowning, and burnout is real," wrote one respondent. Another warns that failure to invest is a critical management mistake: "If executive leadership does not prioritize resources for the IP department, including adequate staffing, this presents a challenge in successfully executing organizational IP-related goals." Leadership must commit to recruitment and retention by investing in the future, as "IP winging it only gets you so far in life."

Authority, accountability, and culture (the enforcement gap)

The deepest source of frustration is the profound gap between their accountability and their authority. IPs are tired of being the scapegoats for a lack of shared accountability across the organization. They are clear that their role is investigative and advisory, not disciplinary, yet they feel forced into the latter role. This feeling is captured perfectly by the one IP’s statement: "IPs are held responsible for staff noncompliance but [have] no ability to enforce. We can't make anyone do the right thing."

This situation leads directly to a punitive culture, which IPs call the "Don't Punish the IP" Rule. One IP explains that "leadership sees infection prevention gaps as infection prevention owned." They feel they are blamed for HAIs caused by noncompliant staff, viewing the IP as the problem, not the investigator. To address this gap, IPs are seeking permanent structural elevation, the need for C-Suite reporting: "We should have a voice directly to C-Suite instead of reporting to Quality or other teams."

The current model for infection prevention professionals is unsustainable and actively risks patient safety and financial solvency. Leadership must recognize that this is not a minor operational issue but a crisis in which IPs are forced to focus on the immediate rather than the strategic. One participant articulated this reality most powerfully, capturing the financial and moral consequences of inaction: "That without investment, they will only see the consequences when the patient impacts are already significant, and the costs are high. Investing now prevents worsened consequences." 

This quote is a stark reminder that the cost of sustained under-resourcing far outweighs the cost of prevention. The IP community is pleading with leadership to understand that cutting IP programs saves little now but will guarantee massive costs later, both in financial terms and in preventable patient harm. The time for leadership to act is before the next crisis hits, by moving beyond the punitive culture and investing in the strategic workforce that keeps the entire health care system safe.

Articles

 A national survey of infection preventionists reveals deep concerns about staffing shortages, lack of leadership support, limited authority, and outdated surveillance systems. IP professionals warn that without structural investment, modernization, and executive recognition of their operational value, patient safety, regulatory compliance, and hospital financial stability remain at risk.

IP Voices From the Trenches: What Leadership Fails to Grasp About Your Job

Infection prevention (IP) professionals are the silent guardians and indispensable subject matter experts responsible for identifying, monitoring, and passionately preventing the spread of infectious diseases. As the crucial defense that helps keep patients, residents, and communities safe, IP professionals are not just the "quiet engine of safety and quality,” but also safeguard the financial health of entire health care systems and ensure the regulatory integrity of public health operations.

Yet, this vital workforce is approaching a breaking point. The IP community is navigating a critical resource deficit that poses significant risk to every facility, health system, and public health agency. The central conflict, known as the IP Paradox, is clear: Highly specialized professionals are held responsible for near-zero harm across complex populations, operating without sustained support. This chronic underresourcing leads to widespread burnout and forces a necessary but ultimately limiting focus on reactive containment tasks rather than proactive prevention efforts. 

A recent survey of 78 IP professionals (IPPs) provides a collective voice from the trenches, illustrating the escalating strain on resources. From July to August 2025, we distributed a short survey on LinkedIn to gather direct, unfiltered insights into IPPs’ current workplace realities, challenges, and what they need to feel better supported. 

In total, we received 87 responses, and after excluding responses submitted by participants who identified their role as noninfection prevention (eg, case worker, consultant/contractor) and not working in a health care or public health setting (ie, medical device company or vendor), we had 78 participants whose responses were included in the snapshot below.

Methodological Considerations and Limitations

While the survey provides invaluable insight directly from the IP workforce, the findings should be viewed within the context of the study’s limitations. The sample size of 78 is relatively small for national generalization, and the recruitment method (via LinkedIn) may introduce self-selection bias, potentially over-representing those IPP who are either highly engaged or experiencing acute dissatisfaction.

Furthermore, the data on burnout, understaffing, and workload are self-reported and lack external validation against objective operational metrics or standardized ratios. Finally, the survey did not collect organizational context (eg, hospital size, academic affiliation, or location), which could affect resource allocation and staffing needs. Despite these limitations, the key findings align with other current research on these topics.

The Unsustainable Reality of Infection Prevention

The current scope of responsibility assigned to IPPs is reported to exceed the operational capacity provided by supporting resources. This imbalance forces IP professionals to constantly prioritize duties, a strain that is a major factor contributing to workforce instability and high-risk environments within organizations. The survey results paint a clear picture of the resource challenges impacting retention and efficiency across the field. A significant 67% of surveyed IPPs report being understaffed, which results in individuals being tasked with handling overwhelming workloads with inadequate support. This persistent operational stress directly contributes to a moderate-to-severe burnout rate of 41%, posing a substantial risk of permanently losing specialized and experienced talent.

Compounding this staffing deficit is the finding that 73% of IPPs surveyed reported their organizations are not actively hiring for open IP positions. This trend suggests a systemic lack of investment in departmental expansion and in developing future talent. While IPPs demonstrate strong professional commitment with the majority of responses, 82%, intend to stay in the field for at least 2 years. Loyalty is being tested by the reported unsustainable working conditions.

This scarcity of resources forces IPPs into an unwinnable trade-off that defines the current state of the field: they are placed in the position to postpone or limit high-value work, such as proactive outbreak investigation, system-wide education, and onsite consultative support, in favor of the bureaucratic, time-consuming demands of mandatory surveillance and complex data aggregation. Overwhelmingly, the latter is winning, leaving IPPs "drowning," stuck managing reports and bureaucratic demands instead of in the field or at the bedside enacting real-time change, as one respondent lamented. This reactive, data-driven operational model, imposed by lack of support and chronic understaffing, is inherently incompatible with a commitment to zero harm.

The Mandate for Change: Ranking the Investments

The high job satisfaction (69% satisfied) confirms that IPPs are deeply committed to the core purpose of their profession. They value the specialized work of protecting patients and preventing outbreaks. This is an intrinsic commitment, passion for work, is a massive asset for any organization. This dedication is evident with 82% of IPPs reporting they are still likely to be working in IP in 2 years. The high likelihood of staying in the field further confirms this professional loyalty and dedication to the mission of zero harm. 

This loyalty, however, is being exhausted by unsustainable conditions. The high job satisfaction coexisting with high rates of burnout and demands for better work-life balance signifies a profound disconnect: It is not a people problem; it is a system problem.

The survey provides a clear mandate for change, revealing a workforce that feels undervalued, unrecognized, and unsupported by leadership. Investing in the IP team is not an expense; it is a strategic investment in patient safety, financial stability, and long-term organizational viability.

The top demands from IPPs are not just for more resources, but for a fundamental correction in their perceived professional standing. This category addresses the most significant indicators of organizational respect and value. 

The single most important action organizations can take is to provide higher compensation, as reported by 59% of IPPs. This demand is crucial because competitive pay is seen as the most tangible measure of respect and valuation for their high-stakes, specialized expertise, and a failure to provide it sends a clear message that the IP role is undervalued.

Second in urgency is the demand for additional training and education opportunities, which was rated as "Most Important" by 41% of respondents. This priority illustrates the IPP’s commitment and passion for their role, as they are actively seeking organizational investment to build on their current knowledge base.

Finally, the demand for greater recognition and respect from clinical staff garnered the highest total support, with 90% of respondents ranking it as important. This issue highlights a serious cultural friction, where IPPs often operate without top-down organizational buy-in, forcing them to battle for compliance and respect on the front lines despite their expertise.

Personal capacity and workload protection

The need for strategic support underscores the IPP's struggle to move from a reactive, administrative role back to a proactive line of support to front-line staff. The absence of this support signals that leadership views the IP function as a cost center to be managed, rather than a critical asset to be empowered.

The most critical factor overall, with a near-universal 95% total support, is better work-life balance/flexible schedule. While 22% ranked this as "Most Important," the overwhelming consensus underscores the severity of the current workload strain and the unsustainable working conditions that are testing IPPs' loyalty. 

Next, 85% of respondents rated more supportive leadership as important. This is a vital call for strategic authority, as IPPs need leadership support to gain the necessary leverage to drive organizational change. Without it, their function is often relegated to a bureaucratic box-checking exercise.

The need for more administrative support was also ranked as important by 83%. This may be in part due to the role IPPs feel administration plays in the current work environment, along with the perception of the value administration provides to IP and the role it serves.

Finally, increased staffing remains a major concern, ranked as important by 73% of IPPs. However, the IPPs from this study indicate that they prioritize strategic support and professional validation—fixing the system—over simply adding more people without addressing the underlying structural issues.

Operational efficiency and role definition

IPPs’ desire for better tools and clearer roles reflects a commitment to finding more efficient ways to address administrative tasks and to define their boundaries. These operational improvements are essential for empowering them to shift from being reactive administrators to proactive subject matter experts.

A critical need for operational improvement is better technology and tools, with 80% of IPPs ranking it as important. Investing in informatics tools to automate data collection and surveillance reports is an effective way to give IPPs back time, freeing them to return to the floors for high-impact work like rounding and education.

Equally important (80% total support) is the demand for clearer role definitions. There is a need for IPPs to be provided with a clear scope of work they are responsible for, to protect against “mission creep.” (Mission creep refers to the slow, often unnoticed expansion of an initiative beyond its original purpose, scope, or intended objectives.) This creates a clear understanding between IPPs, partners, and stakeholders of what is under the IP purview and reduces IPPs from being pulled into unnecessary directions.

The final request is for a reduced scope or rebalanced duties, which 69% of respondents ranked as important. This request is distinct from clearer definitions and specifically targets the overall volume of work assigned to address the unsustainable scope of responsibility. This allows IPPs to focus on the work that is valued and supports them in prioritizing their workload as they are no longer chasing a moving target.

This mix of factors creates an environment of at-risk retention. IPPs are currently working in challenging work conditions 

 they like the work, but there is a breaking point. IPPs may not leave because they found a better career, but they will leave because they cannot physically or mentally continue to perform their current job duties without systemic changes.

This snapshot into how IPPs are experiencing their work environment serves as a clear warning to leadership: Your most dedicated and high-value employees are at risk of turnover, not because of the nature of the job, but because of the operational model you have imposed on them.

The priorities of the IP workforce send an unmistakable message to health care leadership: The current operational model is not just inefficient; it is professionally demoralizing. The need for higher compensation and respect, even above staffing levels, indicates that IPPs prioritize the quality of the organizational relationship over the sheer quantity of hands.

The current state of working in IP is defined by a real and pervasive sense of undervaluation, in which highly trained professionals are asked to continue performing at their best without the competitive pay, organizational authority, or administrative support needed to succeed. This systemic failure to value IPPs contributes to their burnout and is the greatest threat to long-term talent attrition and, ultimately, to patient safety.

The Strategic Disconnect: A Leadership Wake-up Call

The most critical message for organizational leadership is the need to reevaluate what an IPP is—and what they are not.

 The prevailing complaint is that leadership sees the IPP as merely a "quality metric collector." In reality, IPPs are an "all-encompassing operational function that saves and generates money." Cutting IP programs is a deferred cost, guaranteed to result in eventual surges in high-cost health care-associated infections and regulatory penalties. IPPs must be empowered as the trusted authority figure to drive critical safety changes.

 IPPs find it most frustrating that they are "held responsible for staff noncompliance but [have] no ability to enforce." They are investigators, not the disciplinary body. Adherence must be a shared organizational commitment. Leadership must step up to hold managers and frontline staff accountable for following IP protocols. 

 The IP role is rapidly being complicated by technology and global preparedness. A stark warning emerged from the survey: 

due to current resource depletion. Depleting the IP workforce today is akin to dismantling your hospital's fire suppression system. 

The Path to Sustainability: A Strategic Investment

The crisis is not theoretical; it is a life-or-death challenge articulated directly by the experts on the front lines. To effectively resolve the IP Paradox and secure the future of patient safety, hospital leadership must act on the top 3 structural mandates identified by Infection Preventionists:

Invest in compensation and career paths. The demand for higher compensation is not merely about money; it’s the clearest way to show respect for a high-stakes, specialized role. Leadership must immediately implement competitive pay and define a clear career track for IP leadership to retain and reward this critical talent.

Elevate our reporting structure. IPPs need strategic power, not just responsibility. Establish a direct reporting line for IP leadership to the C-suite to grant the necessary authority to enforce protocols and prevent the IP function from being siloed and ignored.

Adopt automation tools. The biggest drain on IPP time is surveillance and data collection. Leadership must commit to adopting technology and other tools to automate these functions, immediately freeing IPs to return to high-value, proactive work, such as rounding and education, which prevent infections before they start.

By prioritizing these investments based on the urgent needs expressed by the IPPs themselves, health care leadership can ensure a future of true patient safety and regulatory resilience.

Slideshows

Infection prevention professionals are facing a critical breaking point. New survey data reveal widespread understaffing, rising burnout, and systemic undervaluation that threaten patient safety, outbreak readiness, and health system resilience.

Matthew Bucala, MPH

Articles

IP Voices From the Trenches: What Leadership Fails to Grasp About Your Job

What Is the IP Paradox? Numbers Tell the Story of Underresourced Experts in a High-Stakes Environment