With health care permeating Houston as one of the largest industries, it is no wonder that the nursing shortage is hardest hit locally. The problem of decreased nursing supply is multiplied by the decrease in educational opportunities to train more nurses and the increase in Houston's hospital growth requiring more nurses.
According to a September 2007 report by the Texas Nursing Association, Harris County employs 20,563 full-time and 3,282 part-time RNs, 5,949 full-time and 560 part-time LVNs, and 296 full-time and 420 part-time APNs. But this is not enough. To meet the increasing demand, it is estimated that 36 percent more nurses will be needed by 2020.
Alexandra Ochoa, BSN, RN at Texas Children's Hospital comments on how the nursing shortage has affected her work. "I notice it the most when I'm working with patients and don't have a lot of time. You don't get to be as individualized with each patient as you would like to be. You have to prioritize." On the other hand, Ochoa notes the benefits to having nurses in high demand. "Our hours are very flexible and we get to make our own schedules. Overtime is optional, and with the nursing shortage, if we want overtime we can have it."
Several factors are attributed to the increasing demand for nurses. The population of Texas, as well as the increased average life span of residents, is driving up the demand for health care services per person. In the past 15 years, the number of people aged 65 and over increased by 30.5 percent. In addition, the status of patients with chronic illness requiring more nursing care is on the rise.
With the average age of nurses in Houston at 45 years, at least half of the current nursing workforce is expected to retire within the next 10 years. This, combined with fewer persons choosing nursing as a career over the past 15 years, will create a steady decline in the number of nurses in Houston.
Demand for health care services in Texas is rapidly growing due to births as well as immigration from other US states and foreign countries. In 1990, Texas' population was nearly 17 million; by mid-2006 it grew to 23.5 million-a 38.4 percent population increase of 6,521,273 residents. The US Census Bureau projects that by 2015 the Texas population will exceed 25 million and by 2025 it will reach 28 million.
Declining educational opportunities for nurses also contribute to the nursing shortage. In 2006, Texas' 81 state-and community-financed professional nursing programs had to turn away more than 55 percent (11,000) of the qualified applicants seeking admission due to lack of funding for sufficient faculty staffing and classroom facilities.
Local Hospital Expansions Require More Nurses
Houston already is home to the largest medical center in the world. The medical services are increasing at a rapid rate with the numerous hospital expansions. Baylor College of Medicine has broken ground on a new 600-bed hospital, and The Methodist Hospital is in the midst of constructing a new outpatient center.
As the suburban Houston population expands, community hospital growth is increasing to meet the needs of patients beyond the downtown medical center. In addition to St. Luke's upcoming opening of the 100-bed Sugar Land hospital, Children's Memorial Hospital is currently undergoing an expansion project in Southeast Houston including a 240-bed facility. In response to a projected explosive population growth in west Houston, Texas Children's Hospital is expecting to complete a new 141-bed hospital by 2010. The Methodist Hospital also has broken ground on a new 200-bed hospital in west Houston.
Increasing Nursing Faculty: The First Step
The obvious answer to increasing the nursing workforce is providing more educational opportunities. According to the Nursing Workforce Data Section of the Texas Department of State Health Services, the schools of nursing in Texas have been working hard to increase capacity in order to admit and graduate more students. Their 2005 report states, "Graduation trends from 1998 to 2004 show a 63.6 percent increase in graduates of BSN programs and a 15.3 percent increase in graduates of ADN programs." Nonetheless, in a study done in 2005 by the Texas Higher Education Coordinating Board, approximately 4,220 qualified applicants were denied admission to the state's initial RN-licensure programs, which represented 34 percent of total applicants during academic year 2003. This is an indication that the demand exceeds the capacity of nursing schools to educate more students.
Factors such as the shortfall of nursing professors created by an aging cohort of faculty; seventy percent of Texas' 1,800 nursing faculty are 50-years or older. Approximately 1,250 faculty members are expected to retire over the next 3-12 years. Other problems impacting the capacity of Texas schools of nursing to admit more students include non-competitive faculty salaries and insufficient funds to hire more faculty.
Outlook for Nurses
Texas population growth increased by two percent, while the nursing population increased by 3.7 percent. Although this statistic appears to be a step in the right direction, this increase only results in a ratio of 639 nurses per 100,000 residents, which ranks Texas as 47th out of 50 states in number of nurses employed per 100,000.
To attract and retain qualified nurses, hospitals may offer signing bonuses, family-friendly work schedules, or subsidized training. A growing number of hospitals also are experimenting with online bidding to fill open shifts, in which nurses can volunteer to fill open shifts at premium wages. This can decrease the amount of mandatory overtime that nurses are required to work.
"We have a dynamic recruitment team in HR working to meet the needs of our community," said Rene O. Brown, MSN, RN, Assistant Director of Nursing at Texas Children's Hospital. "We staff from within and encourage our nurses to be active within their communities, which results in better satisfaction."
Several hospitals, including Christus St. Catherine, The Methodist Hospital and Texas Children's Hospital offer clinical ladder programs, encouraging nurses to increase their potential and earn bonuses for services.
The most effective approach to increasing nurses in Houston is to offer more educational opportunities - and make them appealing to students. The first step is attracting faculty, which appears to be a "catch-22." How can we find more nursing faculty if there are not even enough nurses to fill patient needs in Houston? To meet the increased demand for new RNs by 2010 requires Texas' nursing programs to increase the total number of FTE faculty positions by 61 percent.
With the increased media coverage of the nursing shortage, some agencies are actively pursuing methods to increase nurses. The Good Samaritan Foundation, through its mission to promote nursing education, has worked diligently to encourage nursing as a profession, primarily by giving financial assistance for tuition, books and fees to those nursing students who demonstrate a monetary need. During its 56 years of operation, the Foundation has given direct financial assistance of more than $14 million to approximately 12,000 nursing students. In recent years, the Foundation has also supported other initiatives to train new nurses, and retain and improve job satisfaction for practicing nurses.
To help ease the growing shortage of nurses, a regional coalition of hospitals, nursing schools and nursing organizations joined Johnson & Johnson for the Promise of Nursing for Houston/Galveston. This coalition and The Johnson & Johnson Campaign for Nursing's Future, recently raised $300,000 for regional nursing school grants, faculty fellowships and student scholarships. A local Houston publication Business Wire reported on efforts to raise money for nurses in February 2007, and quoted Barbara Summers, chief nursing officer, M.D. Anderson Cancer Center in Houston, as commenting, "Houston continues to feel the pinch of the nursing shortage, and as the demand for healthcare continues to rise, the growing shortage will only intensify. Nurses are central to patient care, and events like The Promise of Nursing for Houston/Galveston demonstrate how much we can accomplish together to continue to ensure a skilled and adequate nursing workforce in the future."
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