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 could be attributed to population growth, which is creating a greater demand at the hospital and at ambulatory care centers. Between 2005 and 2020, demand for registered nurses in Texas is expected to increase by 86 percent, while supply is expected to increase by 53 percent, according to the Texas Center for Workforce Studies.



"It's really unbelievable the amount of growth we are experiencing in the 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 adding additional stress to a profession already faced with shortages, she said.



"The aging workforce is going to be an issue for the next five to 10 years," she said. "We're 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 that 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.



Dr. Kent Erickson of Kelsey Seybold –The Woodlands said nursing shortages could ultimately affect patient care.



"Hypothetically, if you don't get enough nurses, it will affect the patient care," he said. "So you're not going to be able to serve the volume coming in. If you don't have enough nurses, you're not going to be able to see enough patients."



Erickson said nursing shortages affect wait times and scheduling for patients.



"Patients wait longer, and if you don't have a nurse, you know you're not going to be able to see 100 percent of the capacity," he said. "If you don't have enough manpower to handle the calls, that will hinder the patient care."



Nursing schools



The nursing shortage in the workforce extends into nursing schools as well, which are seeing shortages in faculty, Giegerich said.



"What we don't have is the faculty," she said. "It's not as severe as it once was, but nursing education is not the place to go if you want to make a good living. As a result our nursing schools really struggle and compete for talent."



Several colleges in the Greater Houston area offer nursing programs designed to help address the shortage in the community. Voters approved a Lone Star College System bond Nov. 4 that includes funding for new health care instructional facilities at LSC–Tomball.



In higher populated areas, demand for RNs with a bachelor's degree 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."



As a more immediate fix, Lacourse said hospitals may employ traveling nurses—temporary nurses who are paid per diem as a salary—as one way to temporarily fill the demand for nurses.



"Sometimes hospitals would have a short-term shortage, maybe in particular specialty areas," he said. "So they hire travel nurses from a company and fill the need for a short time."



However, 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.



"The increase in graduates hasn't quite reached those levels, but one must consider that nursing education programs are, on average, about two years in length, so the lag between enrollments and graduations is also about two years," Van Deusen said.