The Texas Department of State Health Services projects a significant shortage of most types of nurses by the year 2032. However, this concern is not new to hospitals across the state including the Houston region, said Dr. Renae Schumann, former dean and current professor at Houston Baptist University’s School of Nursing and Allied Health.

Schumann is also president-elect for Texas Nurses Association District 9, which covers 11 counties in the Houston-Galveston region. She said the supply of nurses has not kept up with demand as the population has grown.

In 2018, the state health department estimated about 11% of the demand for nurses was not able to be met, and that number is expected to rise to 16.3% by 2032.

Community Impact Newspaper interviewed Schumann in early May about what factors have contributed to this shortage—especially in the wake of the COVID-19 pandemic—and some potential solutions to the problem.

This Q&A has been edited for length and clarity.

Experts estimate Texas will have a significant shortage of nurses in the coming years. Has this always been a concern? To what extent has the COVID-19 pandemic affected these projections?

I’ve been in nursing for more than a quarter of a century, and it’s been around that entire time. The nursing shortage is something that will continue through the years, according to all the projections that I see.

Now, COVID has impacted nursing, but it depends on who you’re asking what the impact is going to be. There were probably a lot of nurses close to retirement age who would have stuck around in full-time positions considerably longer, but maybe with COVID now they’ve decided to go into travel or contract assignments to get out of the full-time stressors that nursing holds.

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.” 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 in general.

I will have to say that nursing comes out looking pretty good because of the hero aspect that’s being rightly so promoted. So many people who hadn’t known anything about nursing before now say, “Oh, look, nursing is actually more than just this—it has all these other pieces to it.”

So, 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.”

What are some other factors contributing to this shortage?

One of the big things that contributes to it is not enough faculty to be able to teach the nursing students because to be a nursing school faculty, you have to have an advanced degree. Sometimes getting a master’s or a doctorate in nursing is not the most cost-effective thing you can do with your time. Also, because schools don’t pay as much as hospitals, that makes it not quite as desirable as it would be to work in the hospital.

Another part is just the stressors of working in the hospital. The supply of nurses to work in the hospital setting is so much lower than the demand. There are other areas where the nursing shortage is felt but not nearly quite as much as it is in the hospital setting.

Working in the hospital can be very difficult because you have the long hours, patients are sicker, and there’s all kinds of things they have to know how to do and be able to manage. Sometimes that’ll just get hard to do, so looking for another field of nursing to go into or working part time might be more desirable for people.

The hospitals are very much aware this is happening, and there are all kinds of programs hospitals are trying to put in place right now. One of the big factors with health care in general—especially in light of COVID—is nurses’ well-being. The mental health of nurses is very much at stake. Nurses’ self-care and things that they can do to make themselves feel better [is crucial] so that they have more of themselves to give to patients and the patients’ family. So, hospitals are looking for ways to promote nurses’ mental health and improve their practice environment so the nurses will want to stay there.

Nurses went into nursing for a reason—they went into nursing because [they] felt the need to be able to help people. The fact that they’re getting so tired that they can’t work or they feel like they’re not able to give their best is very distressing to nurses. They don’t want to leave nursing, it’s just that it’s wearing them out.

How has COVID affected nursing education programs?

In Texas, the schools are required to maintain a student-to-faculty ratio of 10 students to every 1 faculty person in a clinical setting. That’s great when the hospitals will allow that, but during COVID, hospitals pretty much shut down for a couple months in some areas and weren’t accepting students at all.

Some of the hospitals are easing back into it, and the ones that used to take a 10 to 1 student ratio are now only accepting six or eight. If you don’t have a place to put the students in clinical, you can’t accept them because clinical is a requirement for passing nursing school—the State Board of Nursing and all the accreditors require it. Faculty issues aside—and those are big—where we’re going to put students in clinical is still a big deal. A lot of schools have really good simulation labs, but it’s not the same as working with a person.

Some of the things the schools did when they didn’t have access to the hospitals before the vaccine was created was help with contact tracing. A lot of community agencies that don’t normally have a lot of students with them were able to take them, so students got to see a whole different side of nursing that would not normally have been part of their curriculum. When the vaccine came out, a lot of students were helping to give the vaccine as part of their clinical groups.

Now that they’re being re-established, they still have the issue of not having enough hospital capacity to manage all the nursing students. Therefore, there are a lot of schools that are regrouping the way they do clinical. They’re not staying out of the hospitals, but they’re just reformatting the way clinical is being done so students can still get what they need to graduate and pass the licensure exam.

Is there any particular legislation you’re following this session or other potential solutions that could address the state’s nursing shortage?

There’s a Nursing Shortage Reduction Program that works with the Texas Higher Education Coordinating Board that offers money to schools who can admit or graduate more students. It would be great if the Legislature could fully fund this program.

We absolutely need more faculty, which means that the schools have to pay the faculty something that they consider desirable enough to leave the hospital. Being able to pay faculty what they’re actually worth would be huge.

Another thing is the way clinical is currently being done. Getting a nursing student into a hospital for clinical is a big, huge deal. Going to nursing school is very hard, and it’s expensive. Not only do nursing students have the cost of the school itself, but because they’re going into a hospital and they have to follow all the hospital’s rules—having all kinds of shots and being updated on all their insurance—it’s very difficult for people to finish nursing school. I’ve seen students have to quit because they weren’t able to meet the requirements just to get into clinical.

I don’t expect the hospitals to change that because this is part of running a hospital. That’s why I think that clinical in general can be done in some place other than a hospital, and COVID has helped us prove that.

To get enough students in to make a huge difference, some of the schools honestly don’t have the space and other resources to do that. If the schools aren’t able to manage that, they’re not going to be able to admit the number of students that would be able to help with the shortage.

Growing population also means that you need more nurses. Redoing nursing curriculum so that there’s a greater focus on community health or prevention, ambulatory care instead of the acute care settings like the hospitals—that’s going to be big in helping to get more nurses in.