Resources: Nursing Shortages and Workforce Trends in Texas and the U.S.

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Supply and Education; U.S. vs. Texas

In order to create relevant plans of action, we are tasked with analyzing the workforce, circulation and educational paths of nurses in the United States. Understanding how this data affects Texas is the first step in producing meaningful change to Texas’ nursing opportunities, support and incentives.

The U.S. Nursing Workforce vs. the Texas Nursing Workforce

There is an estimated 3 million-plus licensed Registered Nurses living in the US, with, roughly, 2.6 million-plus of those nurses currently employed. This translates to less than 1% of the population of the United States. In addition, recent statistics have dictated that by 2020, the United States will be crippled by an absence of up to one million nurses in the nation, a 29% greater need for nurses than will be available. Registered nurses currently make up the largest anticipated shortage area in the healthcare industry. Today, 75% of all hospital openings are for nurses. (Newsom, M., 2013) (Education Career Articles, Aug. 16, 2013) (KidMedic, 2008)

As of November, 2012, approximately 184,562+ RNs worked either full- or part-time in health care settings in Texas, making the RN profession the largest health care occupation in the state. Barely 7.1% of the entire RN workforce in the United States is gainfully employed in Texas, which boasts the second largest population in the US. In order to balance the need for nurses by state, Texas would have to maintain a closer ratio to its state vs. national population, which sits at 8.3%. That 1.2% difference may seem small but becomes nearly 32,000 RNs missing from hospitals, physicians’ offices, home health care services, and outpatient care centers. (United States Census Bureau, Apr. 1, 2010) (Schlesinger, R., Dec. 1, 2011)

These deficiencies exist even before calculating the mass exodus the nursing field is expected to feel between 2012 and 2020, as the Baby Boomer generation retires and nursing schools struggle to maintain a high enough staff for the influx of potential nursing students. The average age of a working RN in Texas (as of Sept. 2010) is 46. Compounded with the average age of faculty members at Texas nursing schools at over 50, Texas could lose more than 40% of its working nurses in the next 10 years due to retirements. Currently, Texas ranks in third for shortage of primary care and mental health professionals. (Winter, R., Sept. 22, 2009) (Texas Hospital Association, Apr., 2011) (Childs, B., Feb. 7, 2012)

Student Increases and Decreases, U.S. vs. TX

Student incentives hard at work, the US saw an increase of nursing students in the US from 259,100 baccalaureate-seeking students in 2010 to 238,799 in 2011. This number is an encouraging indication of the upswing in interest in the nursing profession. It does not, however, reflect the increasing number of qualified nursing school applicants being turned away due to the depletion of faculty. (Rosseter, R., Mar. 22, 2012)

In 2005, the US suffered the loss of 33,279 qualified nursing school applicants from baccalaureate programs, citing a lack of faculty as a key factor. Amplify this in 2012, when the US was forced to turn away another 79,659 qualified applicants from nursing schools offering baccalaureate and graduate nursing programs, due to an inadequate number of faculty, clinical sites, laboratory space, clinical preceptors, and economical constraints. (Secretary of the U.S. Department of Health and Human Services and the U.S. Congress, Aug., 2010) (Rosseter, R., Jan. 21, 2014)

Texas nursing schools, in turn, were forced to turn away over 8,000 students in 2008 and another 11,217 qualified applicants in 2010, primarily due to lack of faculty. (Texas Nursing Workforce Coalition, 2009) (Texas Hospital Association, Apr., 2011)

64.1% of U.S. nursing schools surveyed on the resolution to refrain from hiring additional full-time faculty for the 2012-2013 academic year blamed insufficient funds. (Fang, D. & Li, Y., 2014)

State and Federal Incentives for Decreasing Nursing Shortages

When challenged with the dire need for new nurses and nursing positions, the federal government responded by championing new programs like the Nurse Faculty Loan Program and the Faculty Development: Integrated Technology into Nursing Education and Practice Program. Unfortunately, further provisions are required to fight the faculty shortage felt by the nation as a whole. As the American economy continues to recover, the circumstances that initially created the nursing shortage are likely to reappear. The nursing debt is widely predicted to spike abruptly as nurses who put off their retirement see the economy improve, and remove themselves from the labor force in a lone devastating blow to the healthcare industry. (Secretary of the U.S. Department of Health and Human Services and the U.S. Congress, Aug., 2010)

Texas reported a nursing shortage as early as 2001, with major cities Austin and San Antonio ranked number 1 and 2 respectively on’s ‘Highest Shortages in Nursing by City’ list. In the same year, to combat the shortage of nurses, Texas introduced the Professional Nursing Shortage Reduction Program and the Nursing Innovation Grant Program in 2001 in answer to the reported shortage. 2003 saw the introduction of the Texas Center for Nursing Workforce Studies as a resource for exploration about instruction and employment styles regarding the nursing workforce in Texas. In 2009, House Bill 4471 was signed into effect to aid the Professional Nursing Shortage Reduction Program. House Bill 4471 helps stem the shortage of nurses by awarding high-yielding nursing programs with up-front financing to employ additional staff, while simultaneously holding these nursing programs liable for generating new motivations for institutions to admit and graduate more nurses. Texas has gained more than $108 million to direct towards the nursing shortage since 2001, including $5 million dedicated to the Governors Hospital-Based Nursing Education Partnership Grant Program (born in 2007 to expand nursing education. (Education Career Articles, Aug. 16, 2013) (Office of the Governor Rick Perry, Aug. 26, 2009) (Office of the Governor Rick Perry, 2012)

Texas nursing schools graduated 7,689 new RNs in 2008 alone, a 69.7% increase over the number produced in 2001. (Office of the Governor Rick Perry, Aug. 26, 2009)

Age; Education; Workplace; Diversity Trends in Nursing, U.S. vs. TX

Age: Within the next 10 years we will see nearly one third of the working nurse population retire, as the majority of working RNs are over 50 years of age (the average age of the RN population is 44.6 years).  The median age for male RNs licensed in 2000 or later is 35, compared with 31 for female RNs. If educational availability and incentives are not improved and maintained, the United States looks at a continual stream of employable RNs working for a mere 15 years at a time, as the licensure-to-retirement difference is too small to afford a real career. (United States Department of Labor, 2011) (Health Resources and Services Administration Bureau of Health Professions, April 2013) (Minority Nurse, 2014)

Education: The proportion of nurses with a BSN currently sits at 50%, an 86% increase in bachelor’s degree nursing graduates in just four years. (United States Department of Labor, 2011)

Workplace: Hospitals are the primary practice setting for about 63.2%, or some 785,200, of all RNs. Nursing care facilities take second place for highest number of employed RNs with 7.4%, followed by physicians’ offices with 4.8% and outpatient care centers with 4.6%. Home health care services, which is growing in popularity amongst working RNs, claims 3.8% of the current nursing workforce. (Minority Nurse, 2014)

Diversity: As of 2008, women made up 92% of all employed registered nurses. According to the Bureau of Labor Statistics, in 2008 10% of RNs were black, 8% Asian and 5% of Hispanic origin. From 2002-2011, nursing schools documented an increase of almost 12% in minorities participating in baccalaureate degree programs. By 2010, minority groups made up 24.7% of the entire RN population. The percentage of men in baccalaureate and master’s nursing programs are 11.4% and 9.9%, respectively. The highest percentage of males was among nurse anesthetists, at 41%. (American Association of Colleges of Nursing, 2012) (Health Resources and Services Administration Bureau of Health Professions, April 2013) (Rosseter, R., Mar. 22, 2012) (Payne, C., Feb. 26, 2013)

Nurses will maintain an important role in the healthcare industry in the coming healthcare dependency crisis. Texas has made great advancements towards meeting the needs set before us by our expanding population and increased healthcare requirements. Texas will continue setting the example for improving nurse education, incentives and support for the nation as a whole.

Further Reading

Texas has a wide variety of options for RNs looking to continue their education and take advantage of local, state-wide and national incentives for BSN opportunities. With an increasing dependence on higher educated nurses and a greater demand on our healthcare system with the baby boomers leaving the workforce, RNs with a BSN are more necessary than ever. Texas cities like San Antonio, with several fully accredited, fully online degree programs make it easier for working RNs to move forward with their careers without disruption to their employment. View this list of San Antonio RN to BSN programs for more information.


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