Healthcare workers have carried communities through some of the worst of COVID-19.
But as we approach the three-year anniversary of the pandemic, there's a situation brewing within the healthcare community – a dire shortage of nurses.
Along with the rest of the country, Texas faces a critical shortage of registered nurses. It's impacting every corner of the state from big cities to rural counties.
That's why Texas Nurse Day at the Capitol, taking place this week, is bringing together thousands of nurses in Austin.
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Led by the Texas Nursing Association, the event started with panel discussions, work sessions and a luncheon on Monday to allow nurses to hear more about nursing issues, identify opportunities to influence healthcare policy, and develop a personal advocacy message.
On Tuesday, the group will meet with lawmakers to push for policies that will address the shortage, workplace violence and other concerns that are pushing nurses out of the profession.
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The shortage is a result of a number of things, from nurses retiring to total burnout during the pandemic and many searching for better pay and less stress elsewhere.
While a nursing shortage and worker burnout were happening even before 2020, all of these factors were exacerbated by the pandemic.
According to a Texas Workforce Commission analysis last year, there's a gap of about 20,000 registered nurses in Texas. Those vacancies tripled during the pandemic.
A survey of over 300 hospitals by the Texas Center for Nursing Workforce Studies in the fall of 2022 found similar results – with vacancies for licensed vocational nurses quadrupling. Pediatric ICU openings have also been the hardest positions to fill.
At the same time, demand for all healthcare occupations is expected to grow at a much faster rate than all occupations combined. According to the TWC, projections indicate employment in healthcare occupations will grow 18.4% by 2028, adding more than 190,000 new jobs. This growth will account for more than 11% of the overall expected growth in Texas.
But since the pandemic, it has been difficult for facilities to retain those workers. To meet understaffing, many hospitals have temporarily moved staff like physical therapists and respiratory technicians to support overworked nurses. Other hospitals decided to change nurse-to-patient ratios.
"You're seeing hospitals close floors and units in their facilities – so now the community is suffering if they don't have a certain surgery center that is no longer open or a certain floor is no longer open. And patients have to travel even further to get this care,” said Dan Pollock, CEO of Advantis Medical, during a panel discussion about the nursing shortage led by Molina Healthcare of Texas.
Hospitals in the TCNWS report say nurses left staff positions for higher-paying travel jobs during the pandemic, but burnout caused them to leave the profession altogether.
“Through that, burnout increased. Nurse-to-patient ratios got stretched and we saw clinicians completely leave the bedside, which further made this problem even more acute,” said Pollock. “What’s happening now, as census has somewhat normalized and dropped, we’ve seen demand for travel nursing also drop. And pay packages have declined. We’re seeing nurses go back and accept staff jobs and reapproach the original facility they left. But I think that doesn’t mean that the staffing demand at these facilities has been met.”
Either way, experts say none of this is acceptable.
“It’s really clear that if we don’t change if we stay within the status quo, things will not be sustainable,” said Nate Moore, COO of TCARE.
The nurses in Austin this week say solutions will have to come from a team effort, from both the Texas legislature and through changes from management within the industry.
To address the nursing shortage, Texas lawmakers have so far introduced several bills aimed at increasing funding for nursing education and providing incentives for nurses to work in underserved areas. Nurses are also pushing for higher pay, compensation for more experienced nurses who are training new nurses, and more resources, especially when it comes to mental health.
Additionally, healthcare facilities are taking steps to retain existing nursing staff, such as offering competitive salaries, benefits, and professional development opportunities.
