Health & Science

While there is a shortage of nurses, Texas has seen an increase in nurse practitioners

On Monday’s Houston Matters, Kathryn Tart, dean and professor at the University of Houston’s College of Nursing discussed how the nursing workforce is developing in the coming years.

A chair sits at the nurses station where Jennifer McClung worked as a longtime dialysis nurse at Helen Keller Hospital in Sheffield, Ala., Monday, March 7, 2022. In November of 2020, McClung, 54, tested positive for COVID-19. "Mama, I feel like I'm never coming home again," she texted her mother, Stella Olive, from a hospital bed. Her lungs severely damaged by the virus, she died just hours before the nation's vaccination campaign began on December 14. Today, a decal with a halo and angel's wings marks the place McClung once occupied at a third-floor nurses' station. "It still just seems like. She could just walk through the door," McClung's mother says. "I haven't accepted that she's she's gone. I mean, a body is here one day and talking and laughing and loving and and then, poof, they're just gone." (AP Photo/David Goldman)
FILE: A chair sits at the nurses station where Jennifer McClung worked as a longtime dialysis nurse at Helen Keller Hospital in Sheffield, Ala., Monday, March 7, 2022.

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While the demand for full-time registered and licensed vocational nurses in Texas is projected to soon exceed the supply, there’s a growing surplus of nurse practitioners, according to research from the Texas Department of Health and Human Services.

On Monday's Houston Matters, Kathryn Tart, dean and professor at the University of Houston's College of Nursing discussed how the nursing workforce is developing in the coming years.

The different types of nursing

There is an increase in nurse practitioners, research showed. But there's a difference in the degree types between full-time registered nurses, licensed vocational nurses and nurse practitioners.

"A licensed vocational nurse has a diploma or a certificate. They do not have a college degree at all. It’s a one-time, one-year program that is usually in a community college," she said. "Nurses who own a registered nurse license can get that license in a couple of ways. They have to go to a community college for a minimum of two years or they can get their bachelor’s degree at a university, and that is a four-year degree.

"Then they are eligible to sit for the licensure exam to become a registered nurse."

Advanced practice nurses go beyond a bachelor’s degree, Tart said, and into a master's program or doctoral program. They can become nurse practitioners for family medicine, psych/mental health, or other areas.

"I think one of the things that confuses folks a lot are that you’re not getting a college degree, you’re getting a license," she said. "So a registered nurse has a license. When you talk about physicians the MD is the same as the license. The medical degree is the same as the medical doctorate, so it gets a little bit confusing for people."

Tart said there has indeed been a decline in the number of full-time registered nurses and licensed vocational nurses in Texas. However, there has been an increase in nurse practitioners. Tart said partially it's because more people are living in Texas.

"Here in Texas, we have a lot of people coming into our state so we have more population, our population is getting older and needs more care," she said. "We have nurses who are retiring. We have just been through a pandemic. And there is kind of an exiting of nurses right now because of what we call post-traumatic stress; they’re exhausted. And so, either they’re taking a break, maybe they’ll come back or maybe they’re taking a break and not to come back."

But even before the pandemic, Texas was going to experience a nursing shortage of about 60,000 nurses, Tart said.

"After the pandemic, that number definitely is going to go up."

"Where's the money?"

Tart said one thing Andy and Barbara Gessner College of Nursing – UH's nursing college – wants to do is produce more nurse educators.

"It’s hard because in education, they don’t make as much money as they can, perhaps in industry," she said.

By and large, nurses still are women, but Tart added that 20% of its incoming class are men.

"I’d love to see that move up to 50%. But the national average is 6% men in nursing," she said. "So as we are trying to gather people to come in and become registered nurses with a bachelor’s degree and master’s degree, we do need more people on that educational front."

With that, Tart said it's important to pay attention to nurses’ salaries in education and allow them to also practice in their field.

"We have to hire people in their specialty areas with the graduate degrees," she said. "And so it’s really, really important then that we have scholarships that we have ways to entice faculty to come and that we encourage nurses to go forward to get their bachelors and get their graduate degrees so that they can teach."

Tart said it is a positive thing that there are more nurse practitioners because they are able to teach and practice in areas that are underserved and may not have physicians in the area.

"So for example, we have a clinic, a nurse-managed clinic on Fannin St. here in Houston and that’s run by nurse practitioners providing access to areas," Tart said. "Even though you can see the Texas Medical Center right outside the parking lot, we’re providing access to care for people who are underinsured or experiencing homelessness."

For those who may pause when seeing a nurse practitioner is providing care instead of a medical doctor, Tart said they should feel good about the care they receive.

"Because physicians and nurses should be working together, and that is one of the things that we really want to see," she said. "We have shown with research for years and years now that when physicians and nurses work together in this kind of world, we are able to see more people.”

Nurses often see patients at a level that’s different than the physician, Tart said.

"And so we each have our specialty area and we each take care of patients based on the need," she said. "It’s like triaging your patient. What is it that they need and who can provide the care right now, because why should I wait two months, two weeks when I can see somebody right now and then I can get my care right now."