Recently, the landscape for facilities in Texas has undergone significant changes. In 2024, a federal staffing mandate was announced, affecting all nursing homes receiving Medicare and Medicaid funds.
Two points of this rule were particularly controversial: (1) Facilities must have a registered nurse (RN) on duty 24 hours a day; and (2) Facilities must provide a minimum of 3.48 hours of nursing care per resident per day (specific portions of the 3.48 to be provided by registered nurses, certified nurse aides (CNAs), and other nursing clinicians).
The implementation of this rule began in 2024, with full compliance of nursing facilities nationwide expected by 2029. This rule was intended to improve the often poor quality of care residents receive in nursing homes. However, many nursing home executives and organizations agreed that the federal mandate was unrealistic and would lead to the closure of many facilities, thereby reducing access to care for many individuals.
In April 2025, Judge Kacsmaryk of the US District Court for Northern Texas struck down this mandate, relieving Texas nursing facilities from the staffing requirements.
But what are the consequences, and what does the future hold for facilities?
The Staffing Situation in Texas
Texas’ facilities have several staffing issues. For example, there are both nursing and clinician shortages. Staffing shortages are already chronic in many facilities, with no sign of letting up in the near future. According to a 2024 report by the Texas Department of State Health Services (DSHS), half of Texas nursing facilities reported that they will need more registered nurses (RNs), and more than 60 percent will need more certified nursing assistants (CNAs) within the next two years.
High turnover of clinicians is also an issue. Nursing homes are experiencing high turnover rates, which compromises patient care and further exacerbates staffing challenges.
Facilities have difficulty filling positions. Facilities are finding it increasingly difficult to fill nursing positions. According to the Texas DSHS report, approximately a quarter of facilities report that it takes 31-60 days to fill direct care RN and CNA positions. Residents experiencing substandard care: When facilities are understaffed, patient care outcomes worsen.
Despite the court’s decision, facilities should continue to seek long-term solutions to these recurring staffing issues.
Avoid Future Short Staffing Situations in Your Texas Facility
What are some solutions for facilities? The scenario is difficult for facilities. However, there are solutions that can help improve staffing issues. For example, facilities can explore the following: Improve compensation and benefits packages; Partner with educational institutions such as nursing schools and CNA training programs; Use software and digital platforms to reduce their own administrative burden; Develop contingency plans and protocols for emergencies; and Integrate flexible staffing models, such as per diem or PRN nurses.
If facilities do not implement these solutions, they risk understaffing, burnout, and increased turnover. They also compromise patient care, which can lead to many facilities going out of business. The solutions are simple but require time to implement as well as leadership skills and creativity to adopt.
Flexible Staffing Solutions With a Platform
The bottom line is that every facility in Texas needs a new perspective on healthcare staffing. Although Texas facilities face operational challenges, making smart investments in staffing has long-term benefits. This will ensure they can maintain safe staffing ratios, which reduce workload and, in turn, decrease burnout and turnover, ultimately improving patient care outcomes.
For example, Nursa is a PRN healthcare staffing platform that offers digital solutions to address staffing shortages in Texas facilities. Some of the advantages that Nursa offers include: No contracts; Responsive staffing to fill planned schedule gaps and last-minute needs; Access to local clinicians who are looking for work; No hire-away fees if a facility decides to offer a PRN clinician an employee position; Full control and transparency in pricing; and Background checks and license verification.
Proactive strategies, such as partnerships, contingency planning, and the integration of digital tools like Nursa, are essential to addressing the problems experienced by Texas’s nursing facilities.
What Does the Future Hold?
Staffing challenges for Texas facilities won’t simply disappear. Even with the federal mandate’s staffing requirements vacated, Texas’s healthcare workforce shortages are increasing. Due to an aging population, there is a growing demand for skilled nursing care.
Although the mandate has not been passed for the time being, several changes to national legislation regarding Medicaid payments are expected. These anticipated changes will make it difficult for facilities to meet their clinicians’ needs.
Facilities should adopt flexible staffing solutions and engage in long-term planning to ensure that they can maintain and improve the quality of care they provide to patients.
