A critical balancing act

A graphic image of an unbalanced scale with a crowd of patients on one said and two nurses on the other.

How UT Health San Antonio is addressing the growing local and statewide shortage of nurses

By Rosanne Fohn

It’s no secret that there is a nurse shortage — nationally, statewide and locally. And this shortage has been building for at least a decade. More nurses are retiring at the same time more baby boomers are expected to live longer with chronic conditions, increasing the number of those who need care. Add to that imbalance the nurses who have left or are taking a break from the profession following the stress and pressures of the COVID-19 pandemic.

Two nurses in full personal protective equipment sit exhausted in a clinic hallway.This year in Texas alone, the shortfall of full-time registered nurses is projected to be 33,340, and by 2030, the shortfall is expected to be 49,946, according to the Texas Department of State Health Services’ Workforce Demand and Supply Projections. In South Texas, 965 more full-time nurses are needed this year, and 1,942 will be in demand in 2030.

Another sobering statistic: Texas ranks near the very bottom in a state-by-state breakdown of the number of nurses per 1,000 residents. According to recent data published by NurseJournal, only Georgia and Utah have a lower comparison than Texas, at 7.47 nurses per 1,000 residents. Among the contributing factors cited for the shortage in addition to an aging workforce and burnout is a lack of educators.

Local workforce demand

In San Antonio, the construction and expansion of several hospitals slated for completion within the next few years will push the local demand for nurses to a new high.

One of the five new hospitals coming online in San Antonio to serve the city’s growing population is the UT Health San Antonio Multispecialty and Research Hospital, expected to open at the end of 2024. The hospital will require 600 nurses, according to hospital Chief Nursing Officer Nancy Doolittle, DNP, MBA, RN, NE-BC.

“It is imperative for the School of Nursing to produce as many [baccalaureate] BSN nurses as possible to care for the citizens of San Antonio,” said School of Nursing Dean Sonya Hardin, PhD, MBA/MHA, APRN, FAAN.

“Increasing the number of RNs and higher-level nurses is important, but the elephant in the room is that we can’t increase our number of nursing students without adding the funding for more teaching faculty,” said Sara Gill, PhD, RN, FAAN, professor and associate dean for graduate studies.

Grant to address faculty shortage

Fortunately, the School of Nursing received a $425,000 grant in February from The Texas Higher Education Coordinating Board to address the shortage of nursing faculty members by retraining non-teaching faculty, recruiting and training full-time adjunct faculty to become teachers and exposing more graduate students to teaching by becoming graduate teaching assistants.

Gill, along with Cynthia O’Neal, PhD, RN, and James Cleveland, PhD, MSN, RN, are co-principal investigators of the one-year grant. O’Neal is a professor and associate dean of undergraduate studies. Cleveland is an assistant professor and director of the Center for Simulation Innovation in the School of Nursing.

“The American Association of Colleges of Nursing reported that in 2020, baccalaureate nursing programs denied admission to 66,274 qualified applicants. The primary reason reported for denying admission to these applicants was insufficient faculty numbers,” said O’Neal, adding that 419 qualified undergraduate nursing students were denied admission to UT Health San Antonio’s nursing program last year due to a lack of funding for faculty.

“Many PhD programs only minimally prepare students for teaching, and teaching is not included in most DNP [Doctor of Nursing Practice] programs,” Gill said. “This grant will help us encourage our junior and mid-career, non-teaching faculty members to consider teaching by providing a 12-session teaching program provided by our university — UTeach — a certification program focused on in-person and virtual teaching and mentoring to help these faculty members make the transition to teaching,” Gill said.

The same program will be offered to full-time adjunct faculty members they plan on recruiting through the grant, she added.

On the other end of the spectrum, the grant will also fund the hiring of more graduate teaching assistants to work with undergraduate faculty and students.

“This will offer graduate students an opportunity to experience academic teaching,” Gill said. “We hope it will help increase the pool of qualified candidates for our faculty teaching program.”

The grant also funds several new support positions, including a third staff member to negotiate more clinical rotation positions for UT Health San Antonio nursing students at area hospitals.

Stronger clinical partnerships

Doolittle said the new hospital will work with the university’s School of Nursing to provide clinical education opportunities.

“We will be actively partnering with the nursing programs at UT Health San Antonio to ensure the successful education and transition of our students into their clinical nursing careers,” said Doolittle.

That is welcome news to O’Neal.

“We have been seeking to increase the content of oncological nursing in our curriculum and look forward to opportunities for collaboration with Mays Cancer Center and the UT Health San Antonio Multispecialty and Research Hospital,” said O’Neal.

Devising a transition to practice pathways for graduates with potential clinical placement opportunities will provide rich learning for undergraduate students, she added.

O’Neal noted that the school’s undergraduate program already has strong clinical partnerships with the major hospital systems in San Antonio, including Baptist Health System, Methodist Healthcare, University Health and Audie L. Murphy Memorial Veterans’ Hospital.

“Furthermore, we are excited about the unique and innovative clinical models we have developed with Christus Santa Rosa Westover Hills, Methodist Healthcare, University Health and Audie L. Murphey Memorial Veterans’ Hospital,” said O’Neal.

The School of Nursing’s Bachelor of Science in Nursing program ranks in the top 5% of all BSN programs nationally.

New hospital, new opportunities

A artist's rendering of the new UT Health San Antonio Multispecialty and Research Hospital.With the projected opening of the new UT Health San Antonio Multispecialty and Research Hospital, set for late 2024, the recruitment of key leaders and directors is underway.

“We will begin hiring front-line clinical staff in the next fiscal year,” said the hospital’s Chief Nursing Officer Nancy Doolittle, DNP, MBA, RN, NE-BC. As with any new hospital, nurses will be the core of the workforce.

“Ideally, we will want all levels of registered nurses and advanced practice nurses, including MSNs, DNPs and PhDs,” said Doolittle

The $470 million, 144-bed, in-patient facility owned by the university will offer cancer care, including immunologic and stem cell therapies. Interdisciplinary research also will be a strong emphasis at the new hospital.

With the choice of several new hospitals opening in the region in the next several years, why should nurses consider working at UT Health San Antonio Multispecialty and Research Hospital?

“We will value and support the success of all nurses from new graduates to experienced, expert nurses,” Doolittle said. “We will support professional development with certifications, tuition reimbursement and a clinical ladder to advance our team members,” she added.

“With this new facility comes the opportunity for nurses and team members to support the creation of a unique and different culture, one they have always wanted,” said Doolittle. “Employees will have the opportunity to find fulfillment, camaraderie and a true sense of contribution and accomplishment here.”

Retention is key to addressing nursing demand

$3 million grant to enhance mentoring, engagement 

When she first came to the School of Nursing, Lauren Zambrano said she felt a little lost and confused. She was glad to learn there was a mentoring program in place.

“It helps to have a mentor guiding you along the way,” said the first-generation college student from Houston, who has been both mentored and hired to mentor students through the School of Nursing’s Student Success Center. She said both experiences helped her acclimate to a new school and city.

With a new five-year grant of almost $3 million from the U.S. Department of Education, the School of Nursing aims to boost Hispanic, low-income student engagement at a time of peak nursing demand.

The Developing Hispanic-Serving Institutions Program grant will increase research and clinical mentorship, expand students’ well-being through counseling and wellness programs and address a need for data regarding Hispanic student success. Vanessa Meling, EdD, MBA, associate dean for admissions, student success and engagement, and assistant professor for research with the School of Nursing, is the principal investigator for the grant.

The Student Success Center will accomplish these goals through enhancements to existing programs such as the Summer Undergraduate Research Immersion Experience, which includes a seven-week research experience. The 10 SUNRISE scholars will receive a $2,700 stipend for participating in and presenting at regional and national conferences and will be matched with a research faculty member who will serve as mentor.

The grant also will create a new program, the Nursing Advancement in Clinical Translational Science, which includes a weeklong clinical research immersion program. At the end of the program, participants will continue to meet for an hour each month during the academic year for guidance and mentorship on research topics. In addition to being assigned a UT Health San Antonio research mentor, participants will give presentations on their discoveries at University Health Research Day and at regional conferences.

Funding from the new grant will increase the number of students mentoring their peers from 39 to 85 annually, and some will see stipend pay increases — as high as $400 per semester, according to Meling.

Because attending college is a major life change for first-generation students in particular, students will have access to a psychologist and a financial aid counselor to improve their financial literacy. All these changes will help students like Zambrano, who identifies as Hispanic, to more confidently navigate new educational challenges.

Zambrano said the new program should help keep more nursing students in school and will create a community of lifelong friendships.

“I’ve made so many connections here. A lot of people come here and don’t know anyone. But through clinicals, you form friendships. As long as you put yourself out there, you will form impactful friendships.”

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