TNA Staffing Summit

Emerging Themes and the Nurse Staffing Statute

By Jack Frazee, J.D.

At TNA's 2024 Annual Conference, the Texas Nurses Association asked members about nurse staffing using the World Café model to support discussions of the issues with nurses from a myriad of practice settings. Here is what we learned.

TO OPEN OUR 2024 ANNUAL CONFERENCE, the Texas Nurses Association held a summit with our members dedicated entirely to the topic of nurse staffing, the nurse staffing statute, and whether the spirit of the law was holding up in practice. The summit used the World Café model to layer presentations and panels with audience roundtable discussions of the issues. Nurses from a variety of practice settings and positions participated in the event.

These observations came with self-reflection on the role nurses play in the process as well. Many participants reported difficulty in recruiting front-line staff to participate in nurse staffing committees or offer feedback.

Altogether, participants’ observations reflect a broader theme we have observed in the literature and in our conversations and surveys of members: Nurse staffing requires a significant amount of coordination among all involved. From the governing body of the organization to front-line nurses, there needs to be a clear, consistent plan to address the staffing needs of the facility. This level of coordination is difficult to achieve when a facility is overtaxed and under-resourced. Nonetheless, it is imperative to improve upon current practices to protect nurses and patients alike.

TNA has a significant role to play in improving this situation. Participants in the summit echoed concerns we have heard universally throughout the state: The current laws have not been adequately enforced. As nurses and facilities refocus on their staffing policies and plans, state agencies have an important role to play in enforcing minimum standards under existing law. The public health emergency declaration in effect during COVID facilitated crisis staffing during a time when it was desperately needed. Now, nurses find the return to prepandemic order has been slow, uneven, and lacking a state enforcement response when facilities fail to meet the standards imposed by law and regulation.

When minimum standards are not met, the state should intervene and protect this vital healthcare workforce. Without adequate support, nurses will continue to experience burnout, turnover, and ultimately leave the profession. This pattern is not sustainable and squanders the taxpayers’ investment in the education pipeline.

In a time when the state is making enormous investments in nursing education, it is imperative that facilities do their part to protect and retain licensed nurses. When minimum standards are not met, the state should intervene and protect this vital healthcare workforce. Without adequate support, nurses will continue to experience burnout, turnover, and ultimately leave the profession. This pattern is not sustainable and squanders the taxpayers’ investment in the education pipeline.

Many participants also confirmed the enormously positive impact of adequate staffing. There were many examples of facilities engaging in best practices, and nurses who worked for those facilities reflected on the positive impacts on their work-life balance and patient outcomes. Nurses reported many innovative practices adopted by their facilities that demonstrated there is no one-size-fits-all solution to staffing problems.

Nurses who reported positive experiences with staffing were often able to point to facility policies that facilitated their positive experiences, reinforcing the notion that good policy, when well communicated and meaningfully enforced, makes a difference.

Nurses who reported positive experiences with staffing were often able to point to facility policies that facilitated their positive experiences, reinforcing the notion that good policy, when well communicated and meaningfully enforced, makes a difference. TNA will continue to advocate for safe staffing and engaging state policymakers in this effort. Keep an eye out for more information on TNA’s policy recommendations as the 89th Legislative Session, scheduled to begin in January 2025, approaches.

While ther is much work to do, there were many examples of facilities engaging in best practices, and nurses who worked for those facilities reflected on the positive impacts on their work-life balance and patient outcomes.

EMERGING THEMES

Noteworthy themes surfaced from the members in attendance, including:

• The significant lack of awareness and knowledge around the Texas nurse staffing statute. Many agreed that Texas nurses would benefit from more education about the staffing law;

• State mandated ratios are inflexible and do not account for patient acuity;

• Sufficient staffing has a significant impact on nurse satisfaction and patient outcomes and remains a top priority;

• “Sufficient staffing” differs depending on the facility, with rural and urban settings presenting different needs;

• Reimbursement models fail to adequately capture the value of nursing services;

• The importance of maintaining nurse agency and autonomy;

• Insufficient staffing is a significant driver of stress, burnout, moral distress, psychological safety, and turnover;

• Nursing schools have a significant role to play in training students to understand the state’s staffing law and how to leverage the tools available;

• Facilities need to coordinate nursing, finance, and HR more closely to address staffing challenges, so that each department understands the needs and constraints of the other;

• Reporting from staffing committees should flow up to governance and back to front line staff to maintain consistent communication;

• Administrative burden is significant and increases demands on short staff;

• Weak enforcement of nurse staffing laws leads to lax implementation in practice;

• The experience level of nurses on staff can significantly affect what is considered “adequate staffing” for a unit; and

• Insufficient staffing is a significant driver of medical errors