With Texas facing a nursing shortage, UNT Health Science Center is racing to open new program in a year

“We found data showing that our schools and colleges in our region in the state of Texas were not able to keep up with demand. They were turning away thousands of highly qualified applicants who wanted to be nurses,” said HSC Provost Charles Taylor.

And so began the process to build a new college of nursing anchored to the university that boasts five other professional health schools. The UNT System Board of Regents approved the nursing school in February and HSC announced the college’s founding dean, nurse practitioner Cindy Weston, in May.

The program plans to admit its first classes in the fall of 2024, leaving a yearlong sprint to finalize curricula, hire faculty, find clinical training spots at local hospitals and recruit students. Weston’s currently tiny team is racing against a nursing shortage worsening with each passing year.

The Lone Star State will be short more than 57,000 registered nurses by 2032, leaving more than 16% of projected demand unmet, according to Texas Department of State Health Services data. North Texas fares only slightly better than the state overall, with about 15% of demand projected to go unmet in 2023.

A large chunk of the area’s population is nearing retirement, requiring more advanced care, as the nurse workforce follows a similar trajectory. Early-career nurses are leaving the field, burnt out by relentless waves of sick patients and staffing woes. Faculty shortages limit available spots for potential nursing students.

Weston’s first day isn’t technically until July 1, but she’s already left the starting blocks.

“We have hit the ground running,” Weston said. “It’s a lot of thinking about where we are and what we need and how we’re going to get there. That’s my day-to-day right now, charting the course for where we are going to produce the premier nurses that will be able to serve not only today, but health care in the future.”

A higher degree

HSC has added a number of graduate and professional schools to its campus in its more-than-50-year history. Originally anchored by the Texas College of Osteopathic Medicine, the health institute now includes schools of biomedical science, public health, health professions and pharmacy. The school only recently expanded into undergraduate degrees, which demand a different set of eligibility requirements.

The biggest void in the university has been nursing, which it hopes to start with next year.

In fall 2024, the College of Nursing will offer only “post-licensure programs,” or pathways for registered nurses to receive bachelor’s degree and graduate degree-level training. A pre-licensure program, for students who have not yet become registered nurses, will be “right on its heels,” Weston said.

Texas has 60 accredited baccalaureate nursing programs, according to Texas Board of Nursing data. The Dallas-Fort Worth metro area, where more than a fourth of the state’s population lives, is home to nine of those programs, not including HSC.

The state also has 69 associate degree nursing programs and one nursing diploma program.

“We have nursing programs in North Texas, but the need is so great that we’re not able to keep up with the supply that this particular geographic area needs,” Weston said.

There are three avenues to licensure as a registered nurse: accredited nursing diploma programs, associate degree nursing programs and baccalaureate degree nursing programs, also known as Bachelor of Science in Nursing degrees.

Registered nurses, regardless of degree program, sit for the same licensing exam, perform the same tasks and care for the same patients. Research shows, however, that differences in training bleed into differences in patient outcomes.

A study of hospital outcomes between 2013 and 2018 found that hospitals with higher percentages of nurses with Bachelor of Science in Nursing degrees saw better survival rates in patients who had in-hospital heart attacks. Every 10 percentage point increase in BSN nurses was associated with a 24% greater chance of such an in-hospital heart attack patient surviving to discharge.

Patients in hospitals that increased the number of nurses with bachelor’s degrees over time saw shorter lengths of stay and reduced chances of being readmitted, another study said

The National Academy of Medicine recommended in 2010 that 80% of nurses should be trained in bachelor’s level or higher nursing programs by 2020. About 72% of nurses hit that goal as of 2022.

Lessons and teachers

More than a year out from the first day of school, HSC is more focused on crafting classes and hiring faculty than advertising to prospective students.

An advisory board of nurses working at the school is helping shape the fledgling College of Nursing.

“Some of the really exciting things about nursing practice and health care education today compared to when I was going to training is that there really is more focus on holistic, whole person care,” said Bobbie Bratton, clinical executive of HSC’s SaferCare Texas program, who is on the advisory panel.

There are other preadmittance checklist items for new nursing schools including accreditation and forming partnerships with local health centers for clinical training. Nearby health systems already work with HSC students from other disciplines, including medicine and physical therapy.

But the curriculum is the heartbeat of a successful nursing program, said Kathryn Tart, founding dean at the University of Houston’s Andy & Barbara Gessner College of Nursing. She stood in Weston’s shoes less than a decade ago, overseeing the UH nursing program’s move to the school system’s flagship location.

“The curriculum, it’s like a living entity. It has to speak to the needs of the population and the community that it’s serving,” Tart said. “It has to be up to date and it has to be forward-thinking, because what we teach our students today may not be how they’re practicing five to 10 years from now.”

Weston already has a stack of applications for senior leadership and faculty positions to craft the school’s curriculum. She said the university, with an already robust staff of nurses, will have the faculty needed to lead the program.

Faculty bottlenecks have plagued colleges of nursing, which are required to meet certain faculty-to-student ratios in clinical settings. The problem isn’t that there’s a lack of qualified instructors, Weston said, but that salaries are typically higher for practicing nurses than in faculty roles.

HSC will hire a few full-time undergraduate and graduate faculty during the curriculum-development phase. That number will grow as the school welcomes students to campus in just over a year.

Weston’s team has yet to set an expected size for its first classes. Student recruitment will start in the coming months, although it likely won’t be a difficult task given the number of qualified applicants currently living in Texas.

HSC will partner with local school districts to advertise degree options to students who may not otherwise be exposed to the nursing field.

“I didn’t have a nurse in my family and I didn’t know about nursing as a career,” Weston said. “Introducing this as a career choice early in someone’s foundational educational journey helps to match those who are interested.”