State of the Healthcare Workforce in Texas
Texas faced a 10% shortage of nurses at the onset of the COVID-19 pandemic, and four significant surges in cases exacerbated this issue. Although the latest surge seems to be tapering off, the possibility of another wave looms. In 2021, there was a high demand for travel nurses in Texas, as well as nationwide, to help cover workforce gaps. To address ongoing staffing deficiencies in the state, particularly in major healthcare systems, the focus of hiring must shift to attracting permanent staff. Despite the various advantages of permanent nursing roles, many travel nurses are reluctant to transition to permanent positions in Texas or elsewhere.
After confronting COVID-19 for over two years, Texas nurses, like their counterparts across the country, are experiencing significant fatigue. Burnout is widely regarded as a primary contributor to the severe nursing shortages encountered across the state, and these obstacles are projected to escalate. In 2021, the deficit of available nurses led to increased salaries and established a competitive job market, with thousands of vacancies persisting across Texas. A 2021 analysis revealed 23,000 more unfilled registered nursing positions in Texas than available nurses to take them. There's a continuing surge in demand for healthcare professionals, resulting in vast or anticipated shortages throughout the healthcare sector. While nursing isn't the sole area facing these gaps, it experiences some of the most pressing immediate challenges. Reports indicate that Texas has seen significant demand for nurses filling vacancies over the last decade; however, the pandemic has underscored the critical RN shortage both statewide and nationally. By 2032, Texas is anticipated to have a shortfall of 57,012 RNs in its labor market.
Regrettably, the sentiment towards accepting permanent nursing positions is not as optimistic, which may prolong the shortage. A recent survey queried current travel, per diem, or unemployed nurses about their willingness to transition to permanent roles. Among Texas respondents, nearly 17% expressed potential interest in permanent employment. Approximately 22% indicated they were contemplating full-time or part-time staff roles within various timelines: 21% were actively seeking positions; 8% planned to initiate their search within six months; 4% within 6 to 12 months; 11% within one to two years; and 13% stated it would take over two years before they began searching.
Another portion of the survey examined the hourly rate that would make travel nurses consider accepting a permanent nursing role. The average response was $75.97 per hour, comprised of around 16% who indicated preferences between $50 and $75, 3.5% preferring between $75 and $100, 3.5% asking for over $100, and nearly 12% who claimed no rate would persuade them to transition.
In 2021, Texas hospitals experienced unprecedented nurse staffing shortages. Still, the same survey revealed 19% of Texas participants thought staffing was worse in 2020 than in 2021, while another 46.5% felt conditions had remained stable, and 36.5% indicated staffing was indeed more inadequate in 2021. About 39% of surveyed Texas nurses sensed ongoing understaffing in their work units.
Many permanent nurses express dissatisfaction with their current positions and are contemplating changes, which may include different roles or facilities. Among the Texas nurses surveyed, just over 62% mentioned that they were considering a job change in 2022. The primary reason for this consideration was compensation, with 75% indicating that pay would impact their decision to stay or seek new opportunities. Other key factors included mental wellbeing for 49%, staff-to-patient ratios for 46%, respect for 41%, benefits for 36%, and shift flexibility for 35%.
After the most harrowing two years of their careers on the front lines during the COVID-19 pandemic, some Texas nurses are contemplating not only job changes but also entire career shifts. While about 38% expressed no intention of leaving healthcare, others planned to exit within specified timelines: 10.5% within the next six months, 8% within seven to twelve months, 18% within one to two years, and 26% within three to five years. The inclination to depart from nursing is potentially rooted in stress and unaccommodating workplace conditions affecting mental health. Nearly 68% of Texas nurses reported a decline in overall morale compared to last year, with 78% feeling their employers were not adequately supporting their mental health needs.
The challenges of staffing remain prominent for Texas employers in healthcare. Whether based in Houston or Dallas, the foremost demand for RNs and LVNs will be in inpatient settings. As predicted, the supply and demand for nurse full-time equivalents through 2032 will encounter shortages across several nursing categories. By that year, the supply of RN full-time equivalents in Texas is projected to increase by 30.5%, while demand is expected to surge by 38.8%, resulting in a significant RN shortfall of 57,012. This disparity between available nurses and required staffing is set to persist unless substantial changes take place.
In February 2022 was introduced an initiative designed to assist healthcare employers statewide. In this initiative, a $15 million funding allocation aims to facilitate the development of a state-wide healthcare apprenticeship program, enhancing career opportunities for RNs and other healthcare professionals. The Statewide Healthcare Registered Apprenticeship Initiative offers an innovative approach for healthcare employers to recruit and train up-and-coming nurses and healthcare professionals, while simultaneously providing expanded opportunities for students seeking RN certification. The initiative will also simplify application processes and promote collaboration across various areas of the workforce.
Hospitals faced significant hurdles in retaining and attracting adequate staff during the pandemic. Throughout this period, healthcare facilities nationwide recognized the importance of forming partnerships with reliable staffing agencies to swiftly address staffing needs. The initiative underscored that qualified staffing partners provide not only short-term crises staffing solutions but also assist in shaping post-pandemic workforce strategies aimed at alleviating pressure on hospital personnel.
