Health care workers on the front lines of the pandemic since early last year are running on empty, worn out by the long hours and serial outbreaks of the coronavirus despite the availability of a vaccine. 

The famously public outpouring of gratitude and admiration for the nation’s “health care heroes” during 2020 has waned. 

Facing a growing number of hostile and abusive patients and their family members, nurses are burnt out and exhausted and leaving a profession already experiencing widespread shortages before the pandemic. 

At an event Wednesday to highlight the problem and recognize nurses during National Emergency Room Nurses Week, a cadre of the city’s top hospital executives including George Hernández, president and CEO of University Health, told U.S. Sen. John Cornyn (R-Texas) they need help. 

“When we think about the pandemic, it caused some of the strongest among us — nurses are notoriously strong — to really feel defeated and hopeless,” said Jane McCurley, chief nursing executive at Methodist Healthcare. “It’s disrespectful. It’s very discouraging to our health care providers when a year ago … we were hailed as heroes.”

The situation is concerning in a state where the nursing shortage was already severe before the pandemic and the need to recruit new nurses is a constant challenge. 

In Texas, about 20,000 more nurses are needed, and within 10 years, that number will increase to 58,000, said Dr. Nelson Tuazon, vice president and associate chief nursing officer at University Health who represented the Texas Nurses Association during a roundtable discussion with Cornyn. 

In the San Antonio metropolitan area, the number of job postings for registered and licensed vocational nurses reached 3,040 in the last 90 days, according to data provided by Workforce Solutions Alamo.

At University Health, there are 242 openings for full-time and part-time staff nurses dedicated to direct patient care mostly at University Hospital. About half of the unfilled positions are new openings to accommodate growth, according to human resources officials.

“COVID-19 has definitely been traumatizing for nurses, and particularly for our colleagues in critical care and emergency nursing,” Tuazon said. “We need to do something to overcome that. COVID-19 has underscored the importance of nurses. I say this very humbly, we can have all the [physical therapists] and providers we have but without nurses, frontline care and treatment goes to a grinding halt.”

The need for experienced and specialized nurses has been crucial during the pandemic. But a survey in August of 6,000 nurses by the American Association of Critical-Care Nurses found that 66% have considered leaving their jobs because of the pandemic.

To stem the tide, Tuazon asked Cornyn to help pass legislation, the Workplace Violence Prevention for Health Care and Social Service Workers Act, currently pending in the Senate. 

“Violence against nurses has escalated during the pandemic, and the passage of this legislation not only will improve the nurses’ environment but may keep our nurses at the front line,” Tuazon said. 

“When you hear from nurse executives that mid-career and advanced nurses are leaving, it really is a possible break in the chain that has pulled us along for centuries,” said Dr. Charles Hankins, senior vice president of pediatrics and chief medical officer at Christus Santa Rosa Hospital. 

The recent late-summer surge of the virus has had the greatest impact on the problem, Hankins said. 

“What we’re seeing now, when nurses are taking care of patients their own age, that are dying … I think it’s not compassion fatigue as much as it is a stress builder,” he said, describing situations in which nurses witness a new mother with COVID-19 but no underlying health conditions dying shortly after giving birth.  

A “second pandemic” is also testing the health care system. But it’s one that no one is talking about, he said. The impact of the pandemic on mental health is affecting everyone from adolescents to the elderly. “It really is causing our ER nurses to become behavioral health nurses as well,” Hankins said. 

U.S. Sen. John Cornyn (R-Texas), left, listens as medical professionals speak to him about the need for nursing.
U.S. Sen. John Cornyn (R-Texas), left, listens as medical professionals speak to him about the growing need for nurses.

Cornyn said he would welcome specific ideas for how to solve the nursing shortage in the state.

“I’ll be working with the folks here and try to get their best advice on what Congress might be able to do to facilitate that,” he said.  “We need to come up with more innovative and creative ways to provide the nursing that we’re going to need … in the next five to 10 years.”

The hostile working environment in hospitals was “the most surprising thing” Cornyn heard during the discussion, he said. “I was not aware that was such a big problem currently, and we’ll try to do what we can.”

Rocio Garcia, executive director of emergency services at University Hospital, said the nursing shortage is a multifaceted problem, but one contributor is the level of pay. The average base pay for a registered nurse in Texas is $35.80 an hour, according to the online job posting site Indeed.com.

Nurses are leaving for “more lucrative opportunities,” she said. “If we could find a way to make that more equitable, I think it would help all of us.”

Shari Biediger

Shari Biediger is the development beat reporter for the San Antonio Report.