Data from the Texas Department of State Health Services shows the nursing shortage is particularly bad in the Gulf Coast region, which includes Brazoria and Galveston counties. Jack Frazee—director of government affairs and general counsel for the Texas Nurses Association, which aims to advance the profession across the state—said there is a shortage of about 27,000 nurses statewide. It’s expected to grow to 57,000 by 2032, he said.
“Obviously, the trend line is going in the wrong direction,” he said. The registered nurse turnover rate in the Gulf Coast region in 2022 was nearly 30%, and the vacancy rate of registered nurses was almost 16%—the highest in both areas since 2014. For licensed vocational nurses, the vacancy rate in the Gulf Coast region was 41.8%, said Pamela Lauer, manager for the Texas Center for Nursing Workforce Studies, in an email.
“The entire health care team is impacted by any type of provider shortage,” she said.
Local college officials said they believe the problem is not necessarily a lack of students interested in nursing but a shortage of teachers willing and able to educate them. Research shows an average of 10,000 applications to nursing education programs are denied annually due to a lack of space, Frazee said.The number of qualified applicants to nursing education programs in the Gulf Coast region dipped by 3.5% in 2022 for the first time since 2014, according to data from the state department. The number of nursing graduates in the region also dipped 5.7% in the same time period.Lack of teachers
The University of Houston-Clear Lake at Pearland has a program that allows registered nurses to obtain their Bachelor of Science in nursing, opening career advancement opportunities. The program started in 2014, and there’s been a growing interest in it, said Karen Alexander, director of nursing and associate professor at the university.
“We did that in ... answer to the call of the National Academy of Medicine that said we need more nurses with bachelor degrees,” she said.
UHCL’s program allows students to attend classes online or in person to cater to their needs. The university is considering starting a graduate program, Alexander said. “The real shortage is the shortage of nurse educators, actually,” she said. “You can’t put nurses out there to work if you don’t have educators to educate them.”Tori McTaggart, Alvin Community College’s vocational nursing coordinator, said one of the biggest reasons there are fewer nursing program graduates is because many students have families and are both unable to commit the hours needed to graduate and also need to be in the workforce to provide for their families.
To provide more opportunities for nursing students to become certified, the community college secured approval from the Texas Board of Nursing in April to launch a licensed vocational nursing program. The program, which will launch in summer 2024, will allow students who have completed certified nursing aide and medication aide programs to transition into a vocational nursing program without retaking those classes, McTaggart said.
Also contributing to the problem are pay disparities, Alexander said. Nurses generally make more money practicing than they do teaching. Additionally, the barriers to becoming a nursing instructor are high, so few become teachers, Alexander said.
Alexander, who has a doctorate, said her salary would be twice as high if she worked in a corporate setting. “You really have to do this because you love this,” she said.
Lauer said Texas nursing schools are generally increasing the number of nurses they graduate each year. However, more barriers—such as a lack of clinical space to train nursing students and recruiting nurse educators—must be addressed to increase the number of graduates even more, she said.
“The education pipeline is absolutely critical to meeting demand for nurses, but closing the demand gap will likely require interventions in other areas, too,” she said.
Aging workforce, population
Another factor pushing the nursing shortage is an aging workforce and population.
People live longer than they did decades ago, which means there’s an increased demand for medical care, including from nurses, Alexander said. Additionally, many nurses—and nurse educators—are age 56 and older, and will soon leave the workforce, she said.
“We’re going to see a mass retirement,” she said.
In 2001, 15.6% of Brazoria County nurses and 13.7% of Galveston County nurses were age 56 and older. As of 2019, those percentages had grown to 19.7% and 27.1%, respectively, demonstrating the aging nurse workforce in both counties, according to state department data.
During the height of COVID-19, Frazee said he met a nurse in her 60s who worked 100 hours in a week. In addition to working long hours, she was watching patients die every day.
“People were working really long hours,” he said. “It has been very traumatic for nurses.”
Lauer said age is a big factor in the problem.
“The growing and aging population is a big driver for increased demand for nurses, and that demand is projected to grow at a much higher rate than the supply of nurses,” she said.
While the trend of people leaving the profession has been steady, McTaggart suspects there could be an upswing in the upcoming years, especially since vaccination requirements and the stress COVID-19 put on hospitals had a big impact on both nurses’ and nursing students’ decisions to leave their industry the past three years.
Legislative efforts
Bills were considered in the 88th Texas Legislature's regular session, which ended May 29, to address the nursing shortage.
Adjusted for inflation, the last time legislators considered such a high amount of spending on the nursing shortage problem was 2011. This session marked the largest amount of funding—about $80 million—for nursing education and related bills the state has considered, Frazee said.
However, many bills did not pass the House and Senate by the end of the session, including Senate Bill 1700—also known as the Healthcare Expanded & Accessed Locally Act. The bill would have removed regulations to allow nurse practitioners to provide care to areas with nursing shortages.
Cindy Weston—president of Texas Nurse Practitioners, the largest state association of nurses in the U.S.—said in a released statement prior to the session’s end that the organization supported the bill.
One that did pass was SB 25, which supports nursing students with scholarships, nurses and nurse faculty with loan repayment help, and nursing education programs with grants. As of press time, the bill awaited approval from Gov. Greg Abbott.
Well over 12 legislators authored the bill, including Sen. Mayes Middleton, R-Galveston.
