Both Harris and Montgomery counties are low on nurses, and both areas parallel a nursing shortage that can be seen at the national level.

The U.S. Bureau of Health Professions projects a shortage of 808,000 registered nurses nationally by 2020. Retiring nurses and increased demand following the implementation of the Affordable Care Act are both expected to contribute to the shortage.

Catherine Giegerich, chief nursing officer at Memorial Hermann The Woodlands Hospital, said the shortage in Montgomery County can be attributed to population growth, which is creating a greater demand at the hospital and on ambulatory care centers. Between 2005 and 2020, demand for registered nurses in Texas is expected to increase by 86 percent, while supply is only expected to increase by 53 percent, according to the Texas Center for Nursing Workforce Studies.

"It's really unbelievable the amount of growth we are experiencing in [Montgomery County]," Giegerich said. "And that's not expected to end anytime soon."

Despite the total number of RNs steadily increasing each year, bringing in enough new nurses to keep up with demand continues to be a struggle. Aging nurses are also adding stress to the profession that is already faced with shortages, she said.

"The aging workforce is going to be an issue for the next five to 10 years," Giegerich said. "[Older nurses are] retiring and, as long as the stock market behaves, I think you're going to see a real exodus from the profession."

Defining "shortage"

Determining where a nursing shortage exists at the county level can be difficult given there is no quantified definition of having enough nurses, said Chris Van Deusen, spokesman for the Department of State Health Services. Although both Harris and Montgomery counties have seen the total number of RNs per 100,000 people increase, those numbers might not tell the whole story.

"Our assessment of the workforce is based on relative growth," Van Deusen said. "Simply assessing the number of nurses in a county doesn't take into account the bigger issue of access to care."

The skyrocketing population in Houston puts significant stress on the system, but Van Deusen said both the total number of nurses and the nurse supply ratio—a figure determined by comparing population to total number of RNs—have increased as well.

Van Deusen said the nurse supply ratio increased 47.6 percent in Texas from 2007 to 2013. However, the ratio for Montgomery County remains below the state average, Van Deusen said. The nurse supply ratio for Texas is 737 per 100,000 people, which falls well below the national ratio last measured at around 920 in a 2010 American Community Survey.

Meeting the growing demand

Several colleges in the Greater Houston area offer nursing programs designed to help address the shortage in the community. The Lone Star College System called for a bond election on Nov. 4 that included funding for a build-out of the Health Science building at LSC–Tomball. In higher populated areas, the demand for four-year degreed RNs is increasing, said Michael Lacourse, dean of the Sam Houston State University College of Health Sciences.

"Montgomery County hospitals are hiring nurses with bachelor's [degrees] over those with [associate degrees], which is a shift that has taken place over the last few years," Lacourse said. "[Hospitals are] not having any problems finding bachelor-trained nurses in that area. Students with [associate degrees] are more likely to find jobs in more rural areas."

Nursing school enrollment appears to be trending toward alleviating the nursing shortage, Van Deusen said. Enrollments in pre-RN licensure education programs have increased by about 30 percent in Harris and Montgomery counties since 2010, according to data from DSHS.

MISD nursing partnership

Authored by state Rep. Cecil Bell Jr., R-Magnolia, and signed into law by Gov. Rick Perry in June 2013, House Bill 842 allows students to earn an industry certification or an associate degree through an apprenticeship or training in high school.

For the first time, Magnolia ISD has entered into a partnership this year with the Vocational Nursing Institute to offer nursing certification training courses for high school juniors and seniors, said Matt Clark, MISD director of career and technical education.

"Curriculum is in place based strictly on skills required by [the Department of Aging and Disability Services] on the state and federal level, and the kids must pass their objectives," Clark said. "We have a laboratory at each high school, beds, cots and mannequins. There's a lot of tactile skills involved in that."

With room to accommodate up to 20 people, Clark said 15 students are enrolled in the inaugural VNI program and are able to graduate with a nursing certification and work in the field directly after high school. Students attend nursing classes for an average of two hours each day and must complete a 40-hour practicum at local facilities, he said.

"I think the rigor of our program is very hard," Clark said. "These kids want to be there, they have the desire to learn, and we prepare them across the board and dovetail other curriculum. Those who want to go medical school get a leg up—that's our goal."

Bell said he is in the process of working with local school districts and community colleges in District 3 to further expand nursing training for students.

TISD nursing training

At Tomball ISD, up to 20 students are able to enroll in the health science program to receive training for a career in the medical field, said Gary Moss, director of career technology education. After enrolling in prerequisite classes, junior and senior students are eligible to enroll in the health science courses, shadow health care professionals and receive hands-on experience in local senior facilities, Moss said.

The curriculum teaches students a variety of skills, including performing basic vital signs, hand washing, infection control, CPR and other common nursing methods, he said. Through the program, students are able to graduate as a certified nursing assistant and work directly in the field, or further their education at a university.

"There is a huge demand for nurses across the state and even the country," Moss said. "The [certified nursing assistant] program is often a stepping stone for students who pursue nursing or other careers within the medical profession."

LSC–Tomball nursing program

Catherine Gray, director of nursing programs at LSC–Tomball, said the campus offers a one-year Licensed Vocational Nursing program each spring and a two-year RN associate degree path each fall.

An estimated 85 percent of students passed the RN certification test at LSC–Tomball in 2013, scoring 3 percent higher than the national average, Gray said. On average, 50 students graduate from LSC–Tomball with an RN certification each year, and many opt to work in the field while completing a bachelor's degree at a university, she said.

"Our focus at Lone Star [College] is not just the science of nursing but the art of it," Gray said. "We focus a lot of our attention on training our students to be able to look at the whole picture of the patient—not just a specific disease."