The Workforce Problem

Texas hospitals seek multi-pronged legislative help


Understanding the depth of today’s hospital workforce problems requires understanding that they didn’t start with the COVID-19 pandemic.

Unlike many societal issues that COVID-19 seemed to foster from scratch, workforce had been an issue for hospitals before the pandemic, with a lack of adequate nursing, medical and other health care staff. Over the past three years, the pandemic’s ripple effects turned Texas’ workforce concerns into a critical need.

Hospitals are struggling, and they need help to replenish their workforce numbers and bolster their health-serving, life-saving mission.

“We have a shortage of nurses, we have a shortage of techs, we have a shortage of physicians. You name it, there’s a shortage of it,” says Cameron Duncan, J.D., THA’s vice president of advocacy and public policy, who focuses on workforce matters.

Why Workers Are Leaving

The pandemic generated new issues contributing to the workforce crisis and intensified old ones: Competition for wages, health care worker burnout and workplace violence all reached new heights and contributed to thinning out the ranks of hospital workers. Nurses left at a record rate due to the pressures of COVID-19, which pushed their colleagues remaining at hospitals to work longer hours and intensified exhaustion and mental strain. Meanwhile, filling the state’s pipeline with replacements has proven to be its own challenge. Texas nursing schools turned away 15,709 qualified applicants in 2021 due to nursing faculty and clinical education capacity shortages.

“There’s been a false narrative that things like vaccines or other social issues have driven health care workers away from their positions,” Duncan says. “But in reality, they’ve left because of greater pay, [or] because they were burned out.”

Additionally – as a survey conducted by the Texas Hospital Association in late 2022 shows – health care workers experienced higher rates of workplace violence during this time, especially nurses. Nearly every hospital responding to the survey – all but one – reported workplace violence had increased or stayed the same during the pandemic, with 61% reporting that violence severity increased. As nurses left, salary competition between hospitals grew. Today, hospitals struggle to keep up with the needs of their communities in both rural and urban settings. THA’s workforce survey showed 64% of hospitals are operating with fewer beds and reduced services because of nurse staffing shortages. Boosting nurse numbers is paramount to Texas hospitals’ efforts to serve communities and save lives.

The shortages in hospitals have created holes in Texas’ health care infrastructure and exacerbated other problems beyond hospital walls. As the Texas Tribune recently reported, mothers in East Texas must drive more than an hour to deliver their babies due to the dearth of obstetricians in the rural east. The Tribune also reported this month that Texas’ jails are holding inmates who must wait over a year for treatment because of lack of staff in psychiatric hospitals.

Building for a Rebuild

During this session of the Texas Legislature, lawmakers have a historically massive budget surplus to work with – more than $32 billion. So relative to other legislative years, the Legislature is flush with funds. And, in early iterations of the next budget, lawmakers have demonstrated a heartening commitment to Texas Hospital Association-prescribed solutions to rebuild the state’s hospital workforce.

THA is supportive of the Legislature’s current plans for workforce funding in 2024-25, including:

  • $46.8 million for the Nursing Shortage Reduction Program, an increase of more than $26 million;
  • More than $7 million for the Nursing Faculty Loan Repayment Program, which more than doubles that program’s current allotment;
  • A whopping $26 million increase, to $28 million in funding, for the Loan Repayment Program for Mental Health Professionals, which encourages those workers to practice in a mental health professional shortage area; and
  • $233 million for the Graduate Medical Education (GME) Expansion Program, which would maintain the 1.1-to-1 ratio of residency slots to medical school graduates. GME funding is especially important because data has shown that medical students who undertake their residency in Texas typically stay in Texas to practice.

Workplace violence must receive targeted legislation in its own right to be addressed properly. THA supports House Bill 112 by Rep. Donna Howard (D-Austin) and Senate Bill 240 by Sen. Donna Campbell, MD (R-New Braunfels), which require hospitals to create a workplace violence committee and perform individualized training at least annually.

More information can be found in the video above, and in THA’s recent white paper, Soaring Staff Vacancies Results in Reduced Hospital Services.