Written by Aisha Ainsworth

Shortly after she graduated from nursing school, Melani Johnson, RN, landed a job in Dell Seton Medical Center at The University of Texas’s new Level I Trauma Center in Austin—an impressive first job for a recent nurse graduate. Johnson earned her Bachelor of Science in Nursing from The University of Texas Health Science Center at Houston and interned at Methodist Health System in Houston during school, but her clinical practice—as with most recent nurse graduates—was not fully developed. With Dell Seton’s job offer, Johnson began a one-year nurse residency program tailored specifically for work in the hospital’s Trauma Center. Johnson is part of a wave of new nurses that Texas hospitals are hiring across the state.

What the Nurse Shortage Means for Texas Hospitals

Like hospitals in much of the rest of the United States, Texas hospitals are no stranger to nurse workforce storages. The result of a perfect storm of challenges: an aging and growing population, an increase in chronic illness, an aging nurse workforce and limited capacity of nursing schools. The shortage of nurses seems here to stay.

The Texas Department of State Health Services predicts that Texas will experience shortages for nearly all types of nurse positions through 2030. According to TDSHS’ Nurse Supply and Demand Projections, 2015-2030, the statewide “demand for inpatient care is expected to grow by 57 percent,” which accounts for more than half of the demand growth for registered nurses across all care settings. By 2025, the RN shortfall is expected to be “more than twice as large as any nurse shortage experienced since the introduction of Medicare and Medicaid in the mid-1960s,” according to nursing researchers at Vanderbilt University.

As the Baby Boom generation ages, the demand for health care services increases as does the need for nurses. However, like the patients they serve, Texas’ nurses also are aging. According to a 2017 survey of registered nurses by AMN Healthcare, an overwhelming majority of Baby Boomer nurses indicated they plan to retire in less than three years.

Conversely, a study published in Health Affairs found that millennials are joining the nurse workforce at twice the rate of Baby Boomers. The number of young registered nurses ages 21 to 34 doubled from 2000 to 2015. As a result, the workforce is expected to increase 36 percent to just over four million RNs between 2015 and 2030”—a rate of 1.3 percent annual per capita growth.

However, just hiring new, younger nurses to fill the vacancies left by retiring nurses isn’t straightforward. According to Sally Hurt-Deitch, RN, FACHE, vice president for patient care services and chief nursing officer at the Dallas-based Tenet Healthcare Corporation, the average age of nurses at United Surgical Partners International—the largest international surgical provider and a subsidiary of Tenet Healthcare—is 51. “Nurses working in surgery centers are given more responsibility to run the operating rooms so those facilities require extensive OR experience as a result,” Hurt-Deitch explained.

So how do hospitals get experienced nurses in an environment where seasoned talent is exiting the workforce? Simply put: “You grow your own,” Hurt-Deitch asserted. 

Residency Programs Prove Successful

Some hospitals may be wary of hiring young nurses right out of school, but for Susan Griffin, RN, chief nurse executive at Methodist Healthcare, San Antonio, attitude is everything. “Methodist embraces new nurses,” she said. Methodist, San Antonio’s second largest private employer, sees their entrance into the workforce as an “opportunity to help develop new nurses’ skills and fill critical specialty and general nurse positions across the system.” Through its nurse residency program, Methodist trains about 500 nurses entering into practice each year. Residencies can last 10 weeks to six months, depending on the level of training required for a given position or department. The residency program is so successful—it yields a 99 percent retention rate—that the health system “has invested significant resources over the course of the program’s 10 years” to include increased space for simulation labs where residents do hands-on training and more staff dedicated to the program, Griffin said.

Texas Hospitals and Nursing Schools Join Forces

While residency programs yield high rates of success, they are cost and time intensive. Health systems like Methodist also offer an internship, in which nursing students can gain clinical experience in a hospital setting while receiving school credit. In partnership with the School of Nursing at The University of Texas Health Science Center at San Antonio, nursing students in the last semester of their session year selected to intern at one of the San Antonio-area Methodist hospitals spend more than 300 hours in the hospital setting, developing their clinical aptitude and honing their critical thinking skills. 

The dean of the School of Nursing at UTHSC San Antonio, Eileen Breslin, Ph.D., RN, supports the opportunity for her nursing students. The health care system needs nurses who can access evidence-based practices and use effective communication and teamwork to treat today’s patient population. According to Breslin, “getting novice nurses experience to deliver complex care under supervision by expert nurses is simply invaluable in developing their critical thinking and decision-making abilities.” But establishing practice partnerships between hospitals and institutions of higher education can be a complex regulatory maze to navigate.

The Path to Train New Nurses Varies, but the Mission is the Same

While large urban hospitals may have a limited number of clinical places where fledging nurses can gain practice experience, some low-volume hospitals in rural regions of the state have little or no capacity to train new nurses. For Faith Community Hospital, a 17-bed facility northwest of Fort Worth with a daily census of about five patients, “a nursing class of 35 wouldn’t be a good fit” for the facility, explained Joy Henry, RN, chief nursing officer at Faith Community.

Although Faith contracts with nursing schools to offer limited clinical rotations in the geriatrics and emergency departments, the clinical experience of new nurses hired by Faith varies greatly from that of individuals who are hired and participate in big health systems’ residency programs.

With three licensed vocational nursing programs within driving distance of the hospital, Faith often hires new nurses who have been through clinical rotations but haven’t yet developed practical skills. “They have never worked in a hospital before,” Henry said.

The tradeoff is that like the health systems with refined residency programs, Henry still gets to train and cultivate the skills of the new nurses she takes on in the way that works best for her staff and the new hires. Being a rural facility, “things move slower, making it easier for new nurses to learn,” Henry explained.

While all industries experience workforce shifts and challenges at various points, Texas hospitals are working to turn a perceived challenge—the struggle to hire and adequately train new nurses to replace the tsunami of retiring nurses—into an opportunity. By investing in a younger pool of talent and developing their skills and clinical intuition, Texas hospitals are doing their part to ensure that young nurses can find meaningful work and Texas patients can access necessary medical treatment.  For Dell Seton’s Johnson, “being given the opportunity to learn and improve means everything.”