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

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 (Table).

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."

What Leadership Needs to Grasp

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.