Practice Tip of the Week | Staffing Provisions Explained

By Serena Bumpus, DNP, RN, NEA-BC

On August 9, Governor Abbott announced he was bringing in additional nurses from out of state to offset the glaring staffing shortages in Texas hospitals. Accompanying that announcement was a provision indicating staffing agencies contracted with the state could not deploy Texas nurses who had been employed by or worked at a Texas hospital within the last 30 days. This spurred a lot of confusion and misunderstanding along with frustration among the Texas nursing community.

For the Record

The Governor’s announcement came after TDEM had informed hospitals and local leaders on July 29th that they would need to work within their municipalities regarding staffing needs and use ARPA funds to offset the cost of these additional staff. The Texas Hospital Association pushed back on behalf of their members by sending Governor Abbott a letter stating this was no time to pivot away from a process that had worked before due to the increasing number of patients and decreasing number of nurses. Shortly after that, on August 10, the Senate Committee on Health and Human Services conducted a special hearing to discuss the state of Texas hospitals, specifically on staffing. Only invited testimony was welcomed when the committee heard from Hospital CMO’s, CEOs, and members from the Texas Department of Emergency Management. It was after this hearing that Governor Abbott announced bringing nurses in from out of state.

Nursing’s Endemic

COVID-19 has caused many to reevaluate their priorities in life. Some RNs are retiring early, some are leaving the bedside for more lucrative positions and some are leaving the profession of nursing altogether. These departures are putting a strain on the health care system like never before. As the Delta variant emerged in Texas, the concerns over nurse staffing became equally concerning. Prior to the COVID-19 pandemic, Texas was short roughly 30,190 registered nurses and predicted to be short 36,965 by 2025 and 57,011 by 2032 . Though specific data is not readily available, the anticipated impact of the pandemic on the shortage of nurses is frightening.

Robbing Peter to Pay Paul

In 2020, the State of Texas spent 5.36 billion dollars providing healthcare personnel to hospitals. This resulted in the deployment of 23,000 healthcare workers (nurses and respiratory therapists) to support hospital staffing efforts. Of those 23,000 individuals, 6,000 of them had a Texas nursing license while the remaining came from out of state to help. Prior to COVID-19, travel nurse wages averaged anywhere from $40-75 per hour depending on specialty. When COVID-19 created a need for additional nurses, several agencies partnered with the State to provide “crisis” staffing and rates increased dramatically and ranged anywhere from $90 to $150 per hour. The rate increase was primarily due to competition and the increase in demand. This created a new market for nurses – attracting nurses working elsewhere, including Texas hospitals, to temporary travel assignments for high dollars.

Clearing the Confusion

The Governor’s new provision during this wave bans state-contracted agencies from employing Texas nurses to fill Texas crisis staffing needs using state dollars. These agencies include Krucial Staffing, Maxim, and Angel’s staffing. The intent was to draw more nurses to Texas instead of redistributing existing nurse resources, or robbing Peter to pay Paul. Some nurses have interpreted this to mean that they could not work for travel or staffing agencies. There is no restriction on where a nurse may seek employment. The only restriction is on who state-contracted agencies can hire and pay using state emergency funding. Nurses can still work as travelers or agency nurses and work in Texas – just not as a nurse under state-funded emergency staff . The staffing crisis in Texas has reached a critical point. We need all Texas nurses taking care of Texans in order to make it through this next COVID-19 wave. Bringing nurses in from out of state to support the current crisis was a strategy to mitigate our current challenges.