A pandemic marked by demanding conditions for hospital nurses, understaffing and workplace violence has contributed to the worst labor shortage in recent Texas history.
Job vacancies for registered nurses have tripled from about 6% in 2019 to 17% in 2022, according to new data released by the state. The shortage of registered professional nurses has more than quadrupled over the same period.
“It wasn’t surprising to me,” said Serena Bumpus, president of the Texas Nurses Association. “Our patients arriving at the hospital are much sicker than we have ever seen before. Our hospitals are full most often because of COVID – patients who (delay care) and who now have problems with long term. We face long COVIDs too.”
The shortage, which is present in all regions of Texas, was most severe in central Texas. Openings in pediatric intensive care were also the most difficult positions to fill.
Texas Center for Nursing Workforce Studies
The survey of more than 300 hospitals was conducted by the Texas Center for Nursing Workforce Studies. It provides the clearest picture to date of the nursing landscape in Texas, after numerous anecdotal reports of burnout and grueling conditions.
“Nurses are now finding their voice and saying, ‘we shouldn’t have to tolerate this anymore,’ especially around workplace violence,” Bumpus said. “So some nurses choose to leave to find other places to work outside of the hospital setting.”
Most of the hospitals in the report saw nurses leave for travel jobs, leave due to understaffing or decide to retire early – the three main consequences of the COVID-19 pandemic on the profession.
Erica Yu, associate dean at UTHealth’s Cizik School of Nursing, conducted exit interviews with nurses who left their jobs in the past year.
“The number one reason is money,” Yu said. “Nurses take this opportunity to earn higher salaries, whether they move to another hospital with sign-up bonuses or travel assignments. D ‘Other reasons are that they are unhappy with their current position or burnout.’
Hospitals across the state have used a series of recruiting strategies to attract talent to apply for open positions, according to the report. These include standard offerings such as paid vacation and health insurance, but also flexible hours, merit bonuses and even sabbaticals in some cases.
As for the immediate issues of understaffing, many hospitals have temporarily moved staff like physiotherapists and respiratory technicians from their traditional roles to support dispersed nurses. Other hospitals have decided to change nurse-patient ratios.
The report’s main recommendations to address the shortage are to ensure safe working conditions for nurses, particularly in relation to staffing levels.
“We want to find that sweet spot in terms of best patient care ratio where we are able to provide high quality and safe care while preventing nurse burnout,” Yu said.
Another solution detailed in the report is to address workplace violence through ongoing monitoring and creating a culture that encourages reporting.
The impacts of understaffing ultimately trickle down to patients and the quality of their care, Serena Bumpus said. Fewer nurses could affect the quality of care and increase emergency room wait times.
“First and foremost, the more patients a nurse has, the less time she can spend with the patient,” Bumpus said. “Sometimes that means hospitals having to close beds and patients sitting in the ER for hours or days. Being treated in the ER – it’s a very hectic and chaotic environment, not a healing environment.”
These negative patient experiences due to understaffing can then backfire and further hurt nurses.
“We also found that in understaffed hospitals, the rate of workplace violence incidents was higher,” Bumpus said. “It’s down to the simple frustration that our patients have to wait longer, so they or their family members get upset and it exacerbates behaviors that we shouldn’t have to tolerate.”
Hospitals are aware of the pressing need to invest in more nurses. The growing demand for healthcare, both in terms of patient volume and degree of patient illness, has prompted the majority of hospitals surveyed to increase their budgets for registered nurses in recent years.
But that supply will not keep up with demand, according to the report’s projections. The shortage is expected to reach 57,000 registered nurses in Texas by 2032.
Bumpus said solutions to the problem must come from a coordinated effort — both support from the Texas legislature and changes within the industry.
“We can continue to take nurses out of nursing schools all day, however, if the work is not done inside the organization to foster a healthy work environment, we will continue to see nurses leave the bedside,” Bumpus said. “It has to happen on both sides.”
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