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

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. (Figure 1)

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. (Figure 2)

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.(Figure 3) (Figure 4)

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. (Table 1)

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. (Table 2)

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.

Foundational value and recognition

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. (Table 3)

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. (Figure 5)

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.

Conclusion: The Cost of Undervaluation

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

• Beyond metrics: 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.
• The accountability dilemma: 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. (Table 2)
• The future of risk: The IP role is rapidly being complicated by technology and global preparedness. A stark warning emerged from the survey: "We are not ready for the next pandemic" 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:

1. Stop undervaluing our expertise: 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.
2. Give us authority to drive change: 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.
3. Free our time for patients: 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.