Texas legislators advocating for more support for nurses, including protections against workplace violence


Boram Kim


After several high-profile shootings at healthcare facilities in Texas in 2022, including a murder-suicide outside a children’s hospital in Houston on Monday, officials are calling for legislation to support and protect nurses.


Stay one step ahead. Join our email list for the latest news.



Rep. Donna Howard (D- Austin), a former licensed nurse practitioner and nursing educator in the state, has refiled House Bill 112 in the upcoming legislative session that aims to prevent workplace violence at healthcare facilities. Howard introduced a similar measure in 2021 that failed to pass.

A 2018 state survey on workplace violence against nurses found that 85% of hospital nurses had reported at least one incident of workplace violence. While 90% of hospitals had some sort of violence prevention programs and policies in place, the Texas Nurses Association (TNA) said the majority of incidents against nurses goes unreported while the number of incidents continued to climb during the pandemic.

Of the surveyed nurses who experienced workplace violence, only 40% actually reported the incident and cited reasons related to workplace culture as justification for not reporting the incident, worried that management would either retaliate against or ignore their claims. 

HB 112 would require hospitals and its employees to report all incidents of workplace violence and put in place enforcement mechanisms to ensure reporting compliance and protections for those who come forward.

“What we’ve done since [last session] is create policies for hospitals that require [providers to establish] a workforce safety committee that includes bedside nurses and has a plan and training in place,” Howard told State of Reform. “There’s been, unfortunately, [insufficient] enforcement for that happening. We’ve gotten an agreement this time around, which we actually had in 2021 but ran out of time to pass it.

[We have] an agreement from the [Texas] Hospital Association, the Medical Association, and the Nursing Association for some enforcement mechanisms that would ensure that there’s no retaliation for reporting the violence and it will ensure that the violent situation whatever it is, would be addressed and that the nurse and other healthcare workers would get the follow up treatment, whether it’s physical or mental, [to address the trauma incurred].”

TNA said the past year has been a challenging one for the state’s nurses as long work hours and the lingering trauma from COVID-19 continue to weigh on its members. Jack Frazee, Director of Government Affairs and General Counsel for TNA, said more support for nurses is needed in the upcoming session.

“Workplace violence prevention is extremely important,” Frazee said. “The two main things that I hear nurses talk about when I go out and speak with them on the road are insufficient staffing and workplace violence.

Those two issues just come up over and over again. And there is a lot of data coming in from research about workplace violence in the healthcare setting that shows there’s been a really significant uptick in workplace violence over the course of the pandemic.”

TNA has been working closely with Gov. Gregg Abbott on improving the nursing pipeline since he announced last December $25 million from emergency education relief would go to fund financial support for nursing students. 

Working with the Higher Education Coordinating Board, TNA initiated a broader loan repayment pilot program for nursing faculty in early 2022 that has yielded positive results. 

“There’s a program called the Nursing Faculty Repayment Program that is designed to try and get loan repayment to faculty so long as they are working in a nursing program,” Frazee explained. “Typically, [loan repayment] is only reserved for faculty that work full-time. But over the past couple of decades, we’ve seen a trend in faculty in nursing programs where about half of them now are part-time and half are full-time. And so half of the faculty that’s working in nursing programs is not eligible for this loan repayment.

We worked with the Higher Education Coordinator Board to use the discretion that’s available in these emergency relief funds to pilot what [it would] look like if we could make these funds available to part-time faculty as well and if that works well, is that something we should implement in the coming session? So that has gone very well.”

State Republican leadership has introduced two measures, HB 104 and Senate Bill 244, that propose student loan repayment for nurses in long-term care facilities and post-secondary education for nursing faculty respectively.

SB 244, sponsored by Sen. Lois Kolkhorst (R – Brenham), aims to broaden the pilot program statewide. Rep. Stephanie Klick (R – Fort Worth), a licensed nurse with over 40 years in the profession, filed HB 104 to address the nursing shortage at long-term care facilities. 

The Texas Health and Human Services Commission estimates a shortage of 10,000 certified nurse aides (CNA) at long-term care facilities to meet federal regulatory requirements. CMS recently approved the extension of a blanket waiver to utilize temporary nurse aides that removes federal regulatory requirements surrounding CNA deployment at such facilities through the end of the public health emergency.

“We have a workforce crisis in healthcare,” Klick told State of Reform.  “It’s in acute care as well as long-term care. But I think long-term care is probably particularly hit by it because nurse health aides, they do not make as much in long-term care as they do in acute care. By doing the long-term care loan forgiveness program, it’s a means of attracting professionals to the long-term care space, and that loan forgiveness may help subsidize the payment.”

TNA has been working with a coalition of healthcare industry groups in 2022 on policies and use of funds to address nursing shortages and recruitment. 

“We’ve been talking to the [Texas] Hospital Association, Medical Association, a bunch of long-term care organizations, the health plans, a really large segment of the healthcare economy,” Frazee said. “What we’ve done is put together a coalition, what we’re calling the Nursing Shortage Reduction Coalition. That is a group that now includes 27 different healthcare organizations that are all trying to figure out ‘how do we deal with the nursing shortage and make sure that we have sufficient workforce?’

We realized really early on in the discussions that this is an industry wide problem, and we all have shared interests in addressing this. So I’m happy to say that we’ve been able to provide research to the legislature with a unified voice, and we plan on continuing into the upcoming session.”