Facing a growing aging population, reports from state agencies show that Central Texas is expected to experience nursing shortages in the future.

An October 2016 nursing supply and demand report co-authored by the Texas Center for Nursing Workforce Studies and the Texas Department of State Health Services, or DSHS, projects that nursing supply will not keep up with demand over the next decade.

Another report issued in 2015 by the Texas Center for Nursing Workforce Studies showed that Williamson County ranked No. 63 in the state that year for its supply of registered nurses, with a ratio of 565.2 nurses per 100,000 residents. Travis County ranked No. 23 overall in that same report, with a ratio of 943.1 registered nurses per 100,000 residents.

Central Texas combined is expected to experience a shortage of 7,459 registered nurse full-time equivalents by the year 2030, an employment trend exacerbated not only by baby boomers entering in-home care but experienced nurses leaving the workforce altogether.

“We’re getting a ‘double whammy’; we’re getting an increased demand … at the same time a good portion of the nursing population is retiring,” said Dr. Cindy Zolnierek, executive director of the Texas Nurses Association, a statewide professional association of licensed nurses.

According to the DSHS 2016 report,  Central Texas will face nursing shortages for positions across the board, including registered nurses, or RNs, licensed vocational nurses, or LVNs, nurse practitioners, or NPs, certified registered nurse anesthetists, or CRNAs, and certified nurse midwives, or CNMs, by the year 2030.

When the nurse-to-patient ratio dips too low, Zolnierek said patients experience longer rates of stay and a slew of adverse outcomes, such as pressure ulcers or falls.

“What nurses do is knowledge-based work—looking at that individual person and understanding what that risk is. The nurse understands what those risk factors are and is vigilant. That’s what slips between the cracks when you don’t have enough nurses,” Zolnierek said.

GROWING SUPPLY, BOOMING DEMAND
The largest contributing factor to the projected nursing shortage is the sharp uptick of demand, according to the state reports. The area not only has a ballooning population but also a growing number of senior residents.

According to the most recent demographics data from the U.S. Census Bureau, from 2010-16 the number of residents age 65 years or older in Cedar Park grew by approximately 2,000 and  represented 7.9 percent of the population. That age group also represented about 7 percent of Leander's population at the time the data was gathered.

Those climbs may seem insignificant, but as the average lifespan extends, so too does the amount of time required for geriatric health care, Zolnierek said.

Sheila Fata, chief nursing executive for St. David’s Central and West Texas Division, said the health care system has been watching the nursing shortage for quite some time. Fata said the St. David’s hospital system has not experienced a great overall shortage of nurse supply, but that one particular kind of worker is leaving with few replacements.

“We’re finding a shortage of supply in the high-experience domain,” Fata said.

Fata claims the hospital network is increasingly watching experienced nurses retire, a sentiment echoed by Janice Walker, senior vice president and nurse executive for the Central Texas Division of Baylor Scott & White.

According to them, there is currently an experience gap—that is, there are fewer nurses with extensive work experience poised to step into those roles.

“There are pockets of talent related to seasoned nurses, which is another reason why you need to stay ahead of recruitment,” Walker said.

A low comparative pay rate may also contribute to the projected shortage. Statistics from the U.S. Department of Labor reveal that RNs in the Austin Metropolitan Statistical Area on average make $10,000 a year less than their peers in Houston and $5,000 a year less than nurses in Dallas.

Officials from St. David’s and Baylor Scott & White provided statements that said their respective companies rely on data reporting to construct “competitive” nursing wages and benefits packages. Jeffrey Ward, the human resources director with Cedar Park Regional Medical Center, or CPRMC, said the hospital assesses and updates salaries based on market data at least annually.

"We are in a hypercompetitive environment and it's important to attract nurses with excellent pay and benefits," he said.

There does not seem to be an industry consensus on why the wage gap exists. Zolnierek contends that it may be because the Austin area is still considered “non-urban,” and she has been told the pay is less because the Austin area is considered a desirable place to live. Essentially nurses will move to the area despite a lower salary.

FINDING SOLUTIONS
To continue attracting nursing candidates both from within the region and abroad, hospital officials say the area’s medical centers are working on enhancing the working environment within the hospital itself.

Fata and Walker both said their respective hospital systems are working on developing leadership from within through initiatives such as unit councils, which are meetings where unit-specific nurses are invited to review materials relevant to their practice. Krista Baty, the chief nursing officer for CPRMC, said the hospital offers two councils for nursing and ancillary staff.

According to Dr. Marla Erbin-Roesemann, professor and director at St. David's School of Nursing at Texas State University, the schools and hospitals meet quarterly as part of a coalition to open dialogue.

Student nurses from every program do their clinicals at St. David’s, Seton or Baylor Scott & White medical centers as well as clinics throughout the area. According to Baty, CPRMC also has agreements with nursing programs in the area to provide clinical education at the hospital.

"Developing a strong relationship with students to promote mentorship and clinical excellence is paramount," Baty said.

Additional reporting by Caitlin Perrone.