Katy students in the University of Houston College of Nursing train in simulation facilities, which offer hands-on clinical simulation training in a realistic environment. (Courtesy University of Houston College of Nursing)
Hospitals across the United States reported higher rates of turnover and staff burnout as nurses faced heavier workloads and treated critically ill COVID-19 patients for more than a year, according to a February study from the U.S. Office of Inspector General.
Texas hospitals, however, have faced nursing shortages since long before the pandemic. The Texas Department of State Health Services projects the Gulf Coast region will have a deficit of 21,400 registered nurses by 2032 as the growing demand continues to outweigh supply.
“Health care workforce shortages existed before the pandemic. We didn’t have enough doctors; we didn’t have enough nurses; and the pandemic has definitely exacerbated that problem,” American Medical Association President Susan Bailey said.
The median turnover rate for registered nurses in the Gulf Coast region was 17.5% in hospitals and 50% in long-term care facilities in 2019. Since the pandemic began, many nurses have considered leaving the profession due to the anxiety over bringing COVID-19 home to their families and the reality of losing at least 4,000 health care workers to the virus nationally, Bailey said.
On the other hand, health care workers have been dubbed pandemic heroes, and many have decided to enter the field as they learn more about what the role entails, said Dr. Renae Schumann, the former dean of Houston Baptist University’s School of Nursing and Allied Health, who now serves as District 9 president of the Texas Nurses Association.
“There’s the part of nursing where people are tired; they’re burned out; and they’re having a hard time staying in it. But there’s another part where people are looking at nursing and go, ‘I really want to be a part of that,’” Schumann said.
Local educators, including Kathryn Tart, dean of the University of Houston’s College of Nursing, said the nursing field does not come without its challenges. Still, she said, educators are searching for ways to encourage students to pursue the career path because of the incontestable need.
“It’s very meaningful work, but you have to find the right people to do that work who can overcome a lot of obstacles,” Tart said.
While the pandemic amplified Texas’ nursing shortage, experts said it has been a concern for years.
“There’s been a shortage of nurses for the past several decades—since long before I’ve been a nurse,” said Vicki Brownewell, vice president and chief nursing officer at Houston Methodist West Hospital. “Many people even date the shortage back to World War II.”
In the last decade, the region’s supply of registered nurses has grown by 45%, according to the DSHS, but it is not enough to keep up with the growing population, experts said.
According to the DSHS, about 24% of the region’s nursing workforce in 2019 was older than 55.
And as the nursing workforce ages, so does Texas’ general population, Tart said. New, younger nurses are needed to keep up with the “silver tsunami,” she said, referring to a metaphor used to describe the population aging since older residents require more care.
Nurses today can choose from a more diverse range of career paths than ever before, Brownewell said. Those different options often come without the demands of working in a hospital or clinical setting and offer more regular schedules, she said. For example, many nurses want to work in specialty areas of the hospital, and some have goals to move on to more advanced practices.
With facilities throughout the Houston area, including several Katy locations, Next Level Urgent Care representatives said their practice—which employs nurse practitioners instead of registered nurses—has not been affected by the shortage.
Nurse practitioners typically obtain a master’s or doctoral degree in nursing and often serve as primary health care providers, according to Texas Nurse Practitioners.
Houston Methodist works to retain nurses by giving them a voice in the processes and standards of practice, Brownewell said, as well as providing opportunities for nurses to grow and develop.
“We hire nurses who are going to be a good fit who can integrate well with us, do a good job and want to stay here for the long haul,” she said
Jennifer Mizell, who graduated from the UH College of Nursing in December, said she feels lucky working at a hospital now opposed to one year ago when the pandemic hit. But even when nurses are not grappling with a global health crisis, it is clear why they get burned out, Mizell said. ••“It’s constant stress. It’s hard to be on edge everyday, and as a nurse, you are,” she said.
Brownewell said the pandemic has caused some nurses to turn away from the profession over the risks and sacrifices, while others have found a renewed enthusiasm for the difference they can make.
“We have seen a bit of an increase in terms of turnover because of the pandemic but, thankfully, nowhere as high as some other hospitals in other parts of the country,” she said. “On the other hand, we’ve also seen more people who want to be nurses now after living through this.”
Schumann said COVID-19 has led to more registered nurses retiring earlier than usual. Others have transitioned to travel nursing or part-time work to alleviate stress, she said. ••“When you are in a full-time position, most of the hospitals will have 12-hour shifts, which sounds great if you’re thinking, ‘Oh, well that means I get to work fewer days,’” Schumann said. “Well, that’s true, but if you’re so tired that you’re sleeping through all your days off, then that’s not very helpful. COVID has been very difficult for nurses and health care workers.”
Though that exhaustion has led some nurses away from the profession, others have chosen to persevere, Brownewell said.
“Some people have moved out of hospital nursing at least temporarily but others, thankfully, want to continue to be nurses,” Brownewell said.
Bailey said applications to both medical and nursing schools are at an all-time high. However, due to a limited number of seats available, the DSHS reported 54% of qualified applicants were not granted admission to one of the region’s 27 prelicensure registered nurse education programs in 2019.
The Texas Legislature approved the creation of the Nursing Shortage Reduction Program in 2001, allowing the Texas Higher Education Coordinating Board to provide funds to nursing programs that increase the number of nursing graduates.
Still, a shortage of qualified nursing faculty and a scarcity of clinical settings also contribute to the nursing shortage, officials with the Texas Board of Nursing said.
But some nursing education programs have found creative ways to offer clinicals and keep students progressing toward graduation even during the pandemic, board officials said.
At the UH College of Nursing, students were able to get paid while meeting clinical requirements this past year thanks to an opportunity through the National Council of State Boards of Nursing. They were able to get experience assisting health care workers swamped with patients, Tart said.
“It helped our nurses; it helped our students; and most importantly, it helped the patients,” Tart said.
From an education perspective, addressing the shortage long term will require creating a pipeline in which students are encouraged to pursue the field and current nurses plan to transition into nursing education to train the younger generation, Tart said.••“It’s the will of our educators and our nurses to say, ‘I want to be the educators for the future of our profession,’” Tart said. “It’s the will of our … legislators to say we are going to support nursing and nursing education because we know that this is a wonderful way to provide access to care.”
Danica Lloyd and Matt Stephens contributed to this report.