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There's a nursing shortage in Texas and no, COVID isn't to blame

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As Texas continues to face a shortage of nurses from the COVID-19 pandemic, an NPR analysis shows new nurses have had to wait extended periods of times due to delays by the state Board of Nursing.

Dan Liptak was ready to start his work as a nurse in Texas. He graduated from the Masters nursing program at Kent State University, and was moving to Austin for work.
He applied for his RN license in January, knowing that he needed to have that before he could get his Texas Advanced Nurse Practitioner license. Since he already had his RN license in Ohio, he quickly received a temporary license on January 11.

But after that, nothing else about the process went quickly.

“It was a lot of waiting, a lot of waiting and a little bit more waiting after that,” Liptak recalled. “I didn't expect it to be overnight or a week or anything. But, I already had a job lined up, I had this job where I currently am lined up since February.”

He turned in everything he needed for his application by June 14, but continued to wait. When weeks turned into months, Liptak started getting nervous.

“My savings did dwindle down pretty close,” Liptak said. “I had little over $40,000 saved up before I moved. And then moving down here, expenses with actually getting licensed and taking the exam, malpractice insurance DEA license… That's all stuff that's out of pocket.”

Liptak said the malpractice insurance cost him around $1,300, and his license from the Drug Enforcement Administration was almost $900. Those expenses are on top of moving and living without a working wage for several months.

To make matters worse, Austin is the most expensive city to live in Texas, according to the U.S. Department of Housing and Urban Development.

Liptak said he thought he would have a paycheck before he actually did. He ended up calling for an update more than a dozen times, but he couldn’t get a clear answer.

“I sort of pestered them, just trying to get some sort of substantive answer out of them,” Liptak said. “I can't tell you how many times I called the Board of Nursing on the phone, and I don't think I ever once got ahold of an actual human being.”

Liptak’s experience is part of a bigger problem in Texas - one that’s been exacerbated by the COVID-19 pandemic. As hospitals around the country are short-staffed, there are hundreds of potential nurses waiting for their licenses to get approved by the Texas Board of Nursing.

NPR analyzed records from 32 states on how long it takes to process nursing licenses, and found that Texas has some of the highest median licensure times.

While the board promises to review applications within 15 business days, NPR’s analysis shows that 77 percent of applications took longer than two months to get approved, and 59 percent took longer than three months.

That can be a lot of time when Texas is facing an ongoing nursing shortage.

“Our vacancy rate, at the end of the year, was about 12.6 percent in nursing,” said Tammy Williams, the chief nursing officer at University Medical Center (UMC) in Lubbock. “That’s definitely higher than we have ended in the past six years. At the end of 2020, our vacancy rate was about 5 percent.”

Williams said that it’s gotten harder to recruit nurses too, even though they offer more benefits now to boost the job offer.

“We do offer sign-on bonuses for experienced nurses, we offer completion bonuses for our new graduates, relocation if people do want to move here,” Williams explained. “We do some foreign recruitment to see if [nurses] want to come from Canada or the Philippines because right now, we’re all fishing out of the same pond. In the US, we’re all trying to get the same group of nurses.”

UMC also offers current employees benefits such as counseling, retention bonuses and a comfortable break room. However, they are still short-handed after the Omicron variant caused another surge in Lubbock over the winter.

“It’s painful right? Because at UMC, we don’t close beds,” Williams said. “So regardless of how many nurses we have, that means we have to get our leaders, educators, other people to help staff and take care of those patients.”

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According to the Texas Board of Nursing, the licensing delay was the result of a perfect storm of events. Mark Majek, the director of operations, said the state changed licensing systems just before the pandemic, then the board had to trim its budget by 5 percent, and they were seeing a substantial increase in applications.

On top of all that, they had to adjust to everything remotely like the rest of the world.

“We’re just dealing with volume, that’s probably the biggest issue we’re having right now,” Majek said. “But our mission is to protect the public. Not that we want to be a barrier, but we still have to check to make sure that they can legally work.”

Another problem Majek said the board ran into was needing to hire more people to handle the influx of applications. However, they can’t ask for additional personnel in their budget until the next Texas Legislative Session in 2023. Instead, they had to find a way to do it with the board’s current budget.

“We decided to hire additional staff, especially in licensing already, even before we go to the legislature,” Majek explained. “The majority of our money is in payroll, it's in labor, so we couldn't hire everybody as quickly as we wanted. But trying to hire staff with a budget like we have is difficult.”

Majek said that now, for the most part, they have a better handle on things and applications are back to being processed within 10-15 working days.

“As soon as we’re fully staffed and trained, I think that’s going to make a huge difference,” Majek said.

For Dan Liptak in Austin, it took about seven months before he finally got his nurse practitioner license last summer. He considers himself lucky, though, because some people waited longer than 400 days. However, he does dread the day he may need to change something with his license.

“What if I’m an existing nurse in the state of Texas and I have a serious issue that needs to be addressed,” Liptak asked. “Or, if I want to report something. I’m glad that’s not me, but if it was, what would I do?”

He added, “I guess in that case, I would send them an email and whatever would happen, would happen. [It] would be out of my hands.”