In the midst of the pandemic, the trauma unit at DHR-Health in Edinburg, Texas, is bustling.
"For those who thought we were over this, I got news for you: That's not the case," said Dr. Carlos Cardenas, chairman of the board, DHR Health.
It's an all hands on deck situation for the hospital yet again.
"The rest of illness did not stop just because there's COVID," said Cardenas. "So we have all the other emergencies, all of the other problems that can happen day-to-day compounded by the fact that in some of those cases those patients have COVID as well."
But the problem is, there aren't enough hands on deck to begin with.
Cardenas said, "We have a significant nursing shortage, not only locally but across the country."
In 2018, the Texas Center for Nursing Workforce Studies said care facilities throughout Texas were short 25,000 nurses. It predicted the staffing deficit would worsen. And that was before the pandemic hit.
It's not just here in Texas. Nationally, over the next decade, it's predicted a number of states will fall short of the registered nurses needed as the country ages.
And at this hospital, the consequence is potentially dire.
"No cavalry is coming around this time," said DHR Health chief medical officer Dr. Robert Martinez. "This time around, we're having to manage that a little differently and can't accommodate quite as many patients as the last time. There simply aren't enough nurses.”
The shortage also creates burnout on the front line.
"It's really stressed the system such that nurses are exhausted," said the CEO of the Texas Nursing Association, Cindy Zolnierek.
Pressure is on administrators, too, because some nurses get recruited by staffing agencies with promises of lucrative pay – reportedly as much as $8,000 a week in North Dakota.
Zolnierek said: "In the long run, it doesn't work because it removes nurses from the workplace for that period of time they take off. It also isn't sustainable. We're seeing this pandemic is lasting over a year now, a year and a half. You need more sustainable options than that."
DHR Health's doctors say without more help inside, everyone on the outside needs to do their part.
Cardenas said, "We have one thing we can do, each of us as individuals: If you haven't been vaccinated, for God's sake, please get vaccinated."
The hospital and its conference center is a regional vaccine hub in the Rio Grande Valley.
Back in the spring when the shots the shots were first rolled out to the masses, thousands of people were here per week getting their doses.
Since then, demand has waned down and COVID cases are back up. Hospital administrators say 99% of those new cases are happening in the unvaccinated.