WIXLIB

Drivers WantedTidwell echoes sentiments about the importanceof truck drivers and says, “We could [train] 80,000new truck drivers across the nation tomorrow, andin a year from now, we’d have to [train] 72,000 more.There is a real shortage, but that shortage is onlycompounded by COVID.” Before the pandemic,around 90 percent of people who started a truckingcareer would leave the industry, he says.EXHIBIT 4TOP 10 U.S. WATER PORTS, 2010-2020,RANKED BY TOTAL ISIANA,LALALOUISIANA,220220210210Indeed, interstatetruck drivers can beaway from home forweeks at a time. AndKen Tidwell, San Jacintofor a portion of thatCollege (Pasadena), Workforcetime, some of themDevelopment Programaren’t compensated.Many drivers are paid by the mile as independentcontractors, so when they aren’t adding miles tothe odometer, they can’t charge the employer.Federal law restricts a truck driver’s driving hoursregardless of the miles traveled. So if drivershit traffic or weather and aren’t moving, theirhourly rate K,NY,NY,ANDANDNJNJ120120San Jacinto’s CDL program doesn’t turn out a lotof licensed CDL drivers who wind up with a careerin long hauls. “It’s still there,” says Tidwell, “buta lot of what we are getting is, ‘We need lorrydrivers [short haul] taking things from the [Portof Houston].’ These drivers have a regular shiftand go home when they are done for the day.”1101101001009090SITTING ON THE NMILLIONSMedia attention has focused on a backlog of shipswaiting to unload their wares, the enormous tonnagemoving through the nation's top ports (Exhibit 4)and the ripple effect the backlog has had on the U. S.supply chain. Tidwell says the reality of the supplychain dynamic is more complex.HOUSTON,TXTXHOUSTON,270270Drivers frequently cite poor treatment by employersas a reason for leaving, but there is no gettingaround some of therealities, especially inlong-haul work. “It isa grueling, hard job,”says Tidwell. “It’s hardon families. It’s hardon relationships.”The pay structure for long-haul drivers producesincomes that are much lower than many new truckdrivers anticipate. With COVID, the unpaid wait timehas become an even bigger issue as trucks haveidled for hours while waiting to pick up freight atthe nation’s ports.2020202028028030302020101000* Tonnage totals include both domestic and foreign waterborne trade.Sources: U.S. Army Corps of Engineers, Principal Ports of the United States, Waterborne tonnagefor principal U.S. ports and all 50 states and U.S. territoriesFISCAL NOTES MARCH/APRIL 2022 5

Drivers Wanted CO U R T E S Y O F CO U R T N E Y M O R R I S , S A N JA C I N T O CO L L E G E“If you get a truck in, you have to hope that no oneis sick on the cranes,” he says. “It’s having the rightbodies, at the right time, in the right place to makeit all work. Before COVID, those in the industryunderstood how small the margins were acrossthe whole supply chain. COVID messed that all up.”Esparza points to unrealistic expectations as areason for the backups. “They want a level ofcommitment for people to work on Saturday ifthey are going to open a Saturday gate,” he says.“Just because the gates are open from 7 a.m.-6p.m. doesn’t mean you have enough peopleworking those docks to move those containers.It’s a fickle environment that can turn on a dime.”Javier Caballero, CDL student at San Jacinto CollegeSuch frustration makes it difficult to hold on tothose drivers. “We are our own worst enemy,”Esparza says. “[Some] segments of trucking willtake drivers from other segments of trucking thatperhaps are not as efficient. It’s a huge challenge.”E N D O RS E M E NTS A N D S PE CI A L R E Q U I R E M E NTSAccording to DPS, an endorsement listed on a CDL allows the license holder to operate certain types of commercialvehicles and transport specific items. Extra testing is required to earn these endorsements and having them gives thedriver a broader range of job options, such as the ability to haul hazardous material and the opportunity for higher pay.CDL holders doing short-haul driving from a seaport to a warehouse or other freight station also must have a federallymandated Transportation Worker Identification Credential.For some endorsements, the prospective license holder is required to hold a commercial learner permit (CLP) for thatendorsement for a minimum of 14 days before it can be added to a CDL.6 EndorsementCodeDescriptionHTransportation of hazardous material (CDL)NOperation of a tank vehicle (CDL, CLP)POperation of vehicle transporting passengers (CDL, CLP)SOperation of a school bus (CDL, CLP)TTowing double or triple trailers over a specified weight (CDL)XOperation of a combination of hazardous material and tank vehicle (CDL)GLENN HEGAR, TEX AS COMPTROLLER OF PUBLIC ACCOUNTS

Drivers Wanted“If you are looking for and need a job that is going to paya family-supporting wage, truck driving is one of the best optionsout there. I can’t say you will be in it for 20 years,but there is no better program out there that can do that.”– Ken Tidwell, dean, Workforce Development Program, San Jacinto College (Pasadena) CO U R T E S Y O F CO U R T N E Y M O R R I S , S A N JA C I N T O CO L L E G EOTHER ROADBLOCKSEsparza says labor shortages currently represent trucking’sbiggest problem but cites other challenges as well — likewhat he pegs as “frivolous lawsuits” and changes to training.Lawsuits “are driving companies out of business,” he says.“If we are triaging the trucking industry today, you areprioritizing the companies thatare going out of business becausetheir insurance is doubling andtripling overnight in annualrenewals at a time when theydon’t even have an accidenton their record.”Lawmakers addressed this issueduring the 87th Legislature. HB19 allows a trial against a carrierto have two phases: The firstJohn Esparza, TexasTrucking Associationaddresses only the crash at issue,and a determination of whetherthe carrier is grossly negligent in that crash. A second phasecan include all evidence related to the carrier’s operations.On the training side, Esparza says a 2016 federal changeto skills tests reduced the availability of test sites. Thechange effectively added pieces to the skills test, he says,and reduced what were 200 available testing locations toabout 25. There were two-month waits to get CDLs, andunfortunately, two months down the road, potentialdrivers already might be working elsewhere.For all the complexities of trucking issues today, the jobremains appealing to many, Tidwell says. “If you are lookingfor and need a job that is going to pay a family-supportingwage, truck driving is one of the best options out there.I can’t say you will be in it for 20 years, but there is nobetter program out there that can do that.”Brionne Boston, CDL student at San Jacinto CollegeAUTOMATION ON THE HORIZON?The industry is exploring automation as one way to fill thegap between drivers needed and drivers available. “Texas isleading the way in its application,” says Esparza. “[Automatedtrucks] are already on Texas roads.” As an example, one majorshipping company is using partially automated trucks alongInterstate 45 between Dallas and Houston.“Someone is in the back of the cab, monitoring the systems,but in the next couple of years, that person won’t be there,”says Esparza. “It will be touchless. It’s a part of the solutionto the driver shortage.” FNTo learn more about the supply chain and current disruptions, see our past Fiscal Notes issue about the “Good for Texas Tour:Supply Chains” at FiscalNotes.org/2022/jan/tour.php.FISCAL NOTES MARCH/APRIL 2022 7

Nursing in TexasBy Jessica Donald and Lisa MintonCHARTING THE STATE’S NURSING PROFESSIONNURSING WORKFORCE IN TEXASNursing today has come a long way since the days ofFlorence Nightingale and Clara Barton and involves abroad scope of duties requiring extensive education anda technical skill set. Nursing is one of the most in-demandfields in the health care industry. It also is one of the mostchallenging. Nurses are responsible for providing highquality and high-volume patient care while applyingthe latest medical technologies — often in stressful anddifficult situations — and the need for nurses oftenoutpaces the supply.In 2021, nearly 400,000 nurses were working in Texas,representing different levels of the profession: certifiednursing assistants (CNAs), who are unlicensed but ancillaryto the nursing profession; licensed vocational nurses(LVNs); registered nurses (RNs); and advanced practiceregistered nurses (APRNs) such as nurse midwives, nursepractitioners and nurse anesthetists. Each category requiresa progressively higher level of education and training.EXHIBIT 1TEXAS NURSING WORKFORCE PROFILEEMPLOYMENT,EMPLOYMENT,JULY 2021JULY 2021CERTIFIED NURSING ASSISTANTSCERTIFIED NURSING ASSISTANTS80,20680,206LICENSED VOCATIONAL NURSESLICENSED VOCATIONAL NURSES66,40366,403REGISTERED NURSESREGISTERED NURSESNURSE MIDWIVESNURSE MIDWIVESENTRY LEVELENTRY LEVELMEANMEAN42142116,96116,961NURSE ANESTHETISTSNURSE ANESTHETISTS3,4813,481398,520398,520 0 0 20,000 20,000 40,000 40,000Source: JobsEQ8 EXPERIENCEDEXPERIENCED231,048231,048NURSE PRACTITIONERSNURSE PRACTITIONERSTOTALTOTALWAGES, 2020WAGES, 2020GLENN HEGAR, TEX AS COMPTROLLER OF PUBLIC ACCOUNTS 60,000 60,000 80,000 80,000 100,000 100,000 120,000 120,000 140,000 140,000 160,000 160,000 180,000 180,000 200,000 200,000

Nursing in TexasFifty-eight percent of nurses in Texas are RNs, followedby LVNs at 16.7 percent and CNAs at 20.1 percent. APRNsare a comparatively small group, comprising just 5.2percent of Texas nursing employment, but they commandmuch higher wages (Exhibit 1). The annual wages of RNsin Texas typically start at 57,300 and increase to 86,500,depending on their level of experience. On average,nurse anesthetists are paid the most, with someearning more than 200,000 per year.According to the Texas Board of Nursing’s 2021 AnnualReport, new licenses are growing the fastest for advancedpractice registered nurses in Texas — a 12 percent increasefrom fiscal 2020 to fiscal 2021. New RNs increased by3.5 percent during the same time, but the number ofvocational nurses declined by 1.7 percent.Though 41.1 percent of Texas nurses work in hospitals,nurses also fill a variety of positions in other health caresettings such as long-term care facilities, doctors’ offices,schools and businesses (Exhibit 2).EXHIBIT 2TEXAS NURSING WORKFORCE BY INDUSTRY, JULY sesNurseMidwivesGeneral medical, surgicaland specialty hospitals23,6377,912127,113118Nursing, long-term careand assisted living facilities32,92417,87910,420Home healthcare services11,29017,89431,017Offices of physicians andother health 85,7401,7296481,471963,944Psychological andsubstance abuse hospitals7412,9821093,832Colleges, universitiesand professional schools5312,645Outpatientcare centersEmployment servicesElementary andsecondary schoolsIndividual andfamily servicesResidential intelligence anddevelopmental disabilities,mental health and substanceabuse facilitiesOtherSource: JobsEQ8619064,2764,632NurseNursePractitioners Anesthetists3,8111,154TotalNursesSHARE OF 0%   30%   40%FISCAL NOTES MARCH/APRIL 2022 9

Nursing in TexasNURSING SHORTAGEEXHIBIT 3The quality of health care and Texans’ access to it could be atrisk due to a nationwide nursing shortage. As our populationages and the demand for health care continues to grow, thenumber of nursing school graduates simply is not keeping pacewith demand. In a 2019 survey by jobs site CareerCast, RNs werethe fifth most in-demand profession in the United States.According to a March 2022 NurseJournal analysis of U.S.Bureau of Health Workforce data, Texas had the fourthlowest nurse-to-population ratio among all states,with only 9.25 nurses per 1,000 residents (Exhibit 3).The Texas Center for Nursing Workforce Studies (TCNWS),part of the Center for Health Statistics at the TexasDepartment of State Health Services, conducted a March2021 study of the projected demand for nurses in Texas.The Updated Nurse Supply and Demand Projection,which used 2018 as its baseline year and projectednursing demand through 2032, concluded that Texasfaces an increased shortage in every nursing category if,as expected, demand continues to outpace the supply.The supply of vocational nurses, for example, is expectedto grow 13.8 percent by 2032, but the demand will growby 45.5 percent. The outlook for RNs also is dire: The studyestimates that 16.3 percent of the projected demand forregistered nurses in 2032 will not be met.Kathy Thomas, Texas Boardof NursingAlthough the demandfor nurses is expected toincrease in all settings, thelargest shortage of RNsis expected primarily ininpatient hospital settings.Shortages of vocationalnurses are expected to fall oninpatient hospital settings andnursing homes almost equally(see “Elder Care in Texas”on next page). Shortagesare expected to be worsein rural areas of the state.The state’s aging population — which comes with a higherdegree of chronic medical conditions such as diabetes,obesity and dementia — puts pressure on Texas’ alreadyoverburdened nursing workforce, and the COVID-19pandemic hasn’t helped. Because of the pandemic, nurseshave been working longer hours, seeing more difficult casesand dealing with the constant threat of exposure to a deadlydisease — with a dramatic impact on the nursing workforce.“COVID-19 has really increased the shortage,” says TexasBoard of Nursing’s executive director, Kathy Thomas.“Nurses are walking out. They’re worn out, they’reburned out and they’re stepping away from their jobs.”10 GLENN HEGAR, TEX AS COMPTROLLER OF PUBLIC ACCOUNTSNURSES PER 1,000 POPULATION:5 HIGHEST AND 5 LOWEST STATESWYOMINGVERMONTNORTH EVADASOUTH CAROLINAUNITED STATES02468101214161820Source: NurseJournalThomas is particularly concerned about what she called a“severe” shortage of vocational nurses in long-term carefacilities such as nursing homes. “Many new nursing graduateswant to go work in the emergency room or the ICU, not anursing facility — but that’s where the need really exists.”

Nursing in TexasElder Care in TexasBy Jodi GonzálezMore Texans are turning 65, but the number ofnursing facility employees needed to care for themisn’t keeping pace.Almost 13 percent of Texans — 3.7 million people —are in the 65 and older age bracket, and the figureis expected to rise to 17 percent by 2050, accordingto the Texas Health and Human Services Commission.As many as 70 percent of people hitting 65 can expectto need long-term care at some point, accordingto Long-TermCare.gov.Since COVID-19 was declared a pandemic, the nursinghome industry has lost almost 400,000 jobs nationally,with many employees leaving for jobs with betterpay and working conditions. The Texas Health CareAssociation (THCA) and the education and advocacygroup LeadingAge recently surveyed more than 200nursing facilities and more than 30 assisted livingfacilities, and the results illustrate a dire situation in thestate as well. All surveyed facilities had open positionsfor Certified Nurse Aides, and 94 percent had unfilledLicensed Vocational Nurses spots. At 63 percent of thosefacilities, no one had applied for the open positions.Such a severe shortage of staff and applicants movesmore of the caregiving to families who might not beprepared for those duties. Though Texas saves money incare costs when families provide for their aging loved ones,many caregivers who choose not to work or are unableto work outside the home while providing care forfeitpotential income and limit their discretionary spending.The latter helps generate more sales tax revenue —currently 59 percent of Texas’ state collections.“In our society, there is so much focuson raising children, and there isn’ta whole lot of cultural knowledgearound [elder] caregiving.”– Annette Juba“What I see in general is [that] family caregiving islargely a fly-by-the-seat-of-your-pants thing,” saysAnnette Juba, chief program officer with AGE of CentralTexas, an organization focused on providing informationand resources for older Texas adults and their caregivers.“In our society, there is so much focus on raising children,and there isn’t a whole lot of cultural knowledgearound [elder] caregiving.”“Given rapid population agingin Texas, more institutionalarrangements are neededthat address the preferencesand needs of older adultsand their caregivers.”– Jacqueline AngelJacqueline Angel, University ofTexas at Austin, Center for Healthand Social Policy at the LBJ SchoolLast year’s third calledspecial legislative sessionprovided some relief forTexas’ skilled nursingindustry. Lawmakersagreed to allocate 378million in grants from thefederal American RescuePlan Act to nursinghomes and assistedliving facilities. Someof the money is beingused for recruitmentand retention bonusesfor care positions,according to the THCA.These positions, andothers focused on eldercare outside of facilities,will continue to bein high demand.“Given rapid populationaging in Texas,more institutionalarrangements areneeded that addressthe preferences andAnnette Juba, AGE of Central Texasneeds of older adultsand their caregivers,”says Jacqueline Angel, professor of public affairs andsociology at the University of Texas at Austin Centerfor Health and Social Policy at the LBJ School. “Stateagencies serving the elderly and family caregivers areusing new technologies to creatively disseminate asmuch information about senior services as possible toas many as possible. These agen

number of workers, some college or associate degree 6,408 796,592 5.1 billion alvin community college brazosport college college of the mainland community college galveston college houston community college lee college lone star college system san jacinto college wharton county junior college ˆ ˆ ˆ ˆ