After years as a pediatric hospital chaplain, Britt Luby found another kind of sacred work in nursing school.
In May, Luby told UNT System regents about accompanying a family as a hospital chaplain while life support was removed from their teenage son after a traumatic brain injury. She stayed through the night and, after he died, helped nurses provide postmortem care, wishing she could explain what was happening inside his body.
Luby enrolled in nursing school at UNT Health Fort Worth in fall 2025. During her second semester, she cared for an inmate at JPS Health Network who was handcuffed to a hospital bed. A Parkinson’s tremor prevented him from feeding himself, so Luby fed him.
“I thought this, too, is sacred work,” Luby said.
Clinical experiences like Luby’s are essential to UNT Health’s plans to train more nurses and doctors. That growth depends on securing enough placements with the right patients and health professionals who have time to teach, even as other schools across North Texas seek the same opportunities.
Christopher Ray, UNT Health’s senior vice president and provost, described healthcare education as a three-part ecosystem: classrooms, simulation and clinical training.
“When you expand one, you got to expand all three,” Ray said in an August interview.
More than 1,100 UNT Health students train in healthcare settings across Texas each year. The university coordinates more than 830 training arrangements with hospitals, clinics and other organizations, spokesperson Nicole Luna said.
The third classroom
Medical students spend their first two years largely in classrooms and labs. In years three and four, they rotate through specialties such as family medicine, pediatrics, obstetrics and gynecology, psychiatry and surgery.
UNT Health operates 13 primary and specialty clinics, but not a full-service hospital. Its Texas College of Osteopathic Medicine once operated an osteopathic hospital on what is currently the Fort Worth campus. It now relies on outside health systems for most clinical training.
“We couldn’t have a medical school without those partnerships,” TCOM’s Dean Lisa Nash said. “Our clinical access is the rate-limiting factor to how many doctors we can train.”
TCOM can enroll 250 students in each class. About 85% complete clinical rotations within the Dallas-Fort Worth area, Nash said, while others travel to rural or remote sites.
Every major North Texas hospital system takes some UNT Health students, Ray said. JPS is TCOM’s largest clinical partner and one of the university’s oldest.
A JPS placement also changed Diana Singer’s career.
As a nursing student in the mid-2000s, Singer planned to work in pediatric oncology. But her father’s emergency open-heart surgery the summer before her senior year prompted her to pursue intensive care. Her final assignment paired her with a JPS intensive care nurse.
“You’re where you’re supposed to be,” Singer remembered thinking about her new direction.
Singer became an intensive care nurse at JPS, moved into education and stayed. She now oversees the health network’s teaching operation as the executive director of academic affairs.
JPS hosts more than 3,000 students a year across more than 30 fields. It also has more than 240 resident and fellow physicians, Singer said. Some physicians who attended TCOM and completed residencies at JPS now teach TCOM students there.
“You really see that cycle develop because you’ve got that long-standing partnership,” Singer said.
A game of Tetris
A clinical slot sounds like a countable unit. It isn’t.
A placement depends on the field, the student’s training level, the available shift, the patient mix and available teachers. A nursing school may send a faculty member with a group, and a medical student may need a hospital physician one-on-one. The unit also needs the patients that the curriculum requires, from births to critical care.
“Honestly, it’s a very nuanced game of Tetris,” Singer said.
JPS has 582 beds and more than 25 community clinics, but size alone does not determine how many students it can take. A newly hired nurse may need six months to a year of experience before supervising a student, Singer said.
“Workforce capacity is not the same as educational capacity,” Singer said.
That distinction exposes a paradox: The shortage schools are trying to relieve can leave hospitals without enough experienced clinicians to train students. Nursing schools also struggle to hire faculty, in part because practicing nurses can earn more than professors, said Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council.
How North Texas health education has grown over the years
The University of Texas at Arlington’s nursing enrollment quadrupled from 6,300 students in 2010 to more than 25,000 in 2020, although much of that growth was online. UTA’s admissions rules give preference to some applicants employed by hospital partners offering clinical sites that semester.
Texas Christian University, which opened its medical school in 2019, admits 60 students a year. Its clinical partners include JPS, Cook Children’s, Baylor Scott & White and Texas Health — systems that also train UNT Health students.
Tarleton State Fort Worth opened a $66 million health-education building in 2024, and the university’s nursing admission webpage notes that enrollment may be limited by available faculty and clinical resources.
Tarrant County College offers more than 20 health fields and nursing partnerships for JPS and Medical City employees. Texas Wesleyan’s family nurse practitioner programs require 855 to 1,035 clinical hours, and students arrange placements with university support.
The council’s placement system connects about 80 hospitals with 18 universities. Schools submit the training students need, and hospitals post what they can accommodate.
Competing priorities among schools can make finding placements difficult, Love said.
Pressure is greatest in specialized settings such as mental health, women’s health and critical care, Singer said. Nash identified pediatrics, obstetrics and gynecology, psychiatry and general surgery as difficult placements for medical students. For nursing students, pediatrics and labor and delivery are hardest “hands down,” founding nursing Dean Cindy Weston said.
Out-of-state U.S. schools and international medical schools also seek rotations in North Texas, Nash said, sometimes paying for placements or approaching physicians in private practice.
Does that mean Tarrant County is full?
UNT Health officials remain careful on that answer. Ray said local partners meet the university’s current needs. Singer said JPS reassesses clinical capacity regularly, which can change from month to month.
“I don’t think you’re ever going to be able to answer that with a yes or a no,” Singer said.
The controlled patient
Simulation eases some pressure by giving UNT Health a patient it can control — or at least a convincing version of one.
At its 16,000-square-foot Regional Simulation Center, students work with actors and mannequins that breathe, bleed and deteriorate on cue. Faculty can present every student with the same rare emergency, pause the case and evaluate the response.
UNT Health’s nursing program uses simulation for about 43% of its required 810 clinical hours, Weston said. Texas rules allow qualifying nursing programs to use simulation for up to half of a course’s clinical hours.
“When I say competency education, it’s not just, ‘What do you know?’” Weston said. “It’s, ‘Show me what you know and demonstrate to me what you can do.’”
Still, a programmed patient cannot fully replace Luby’s inmate or Singer’s intensive care patient. Simulation can create the medical problem. It cannot on cue recreate every relationship, uncertainty or consequence of caring for someone.
The bottleneck can reach admissions. Texas nursing programs received nearly 10,000 more qualified applications than admission offers in the 2024-25 academic year. The state counts applications, not people, because one student may apply to several programs. Among programs that turned away qualified applicants, lack of clinical space ranked first.
By 2036, the state projects demand in North Texas will exceed supply by about 19,400 full-time-equivalent registered nurses.
A wider map
UNT Health is looking beyond Tarrant County as it plans its growth.
Regents cleared the way in May for UNT Health to offer nursing courses at UNT Dallas as early as fall 2027. The program will begin with 30 students each fall and spring, Weston said.
Ray said Dallas hospitals and community groups have responded warmly.
“We are well on the way to securing the clinical sites we need to provide the educational experiences we want for our students,” he said.
In August, regents authorized UNT Health to acquire UNT’s 52,000-square-foot Inspire Park building in Frisco as it plans a TCOM expansion. Ray envisions other programs following in phases if demand and clinical capacity support them.
The wider map does not replace Tarrant County, Ray said. It reflects a basic constraint: Hospitals need graduates, but training them requires experienced clinicians, suitable patients and time.
Singer herself has lived through that cycle. Her father’s surgery changed the kind of nurse she wanted to become. A JPS placement led her to practicing intensive care — first a job then a career in education. Now, she helps decide how many students can follow.
“It’s the clinical experience,” Singer said, “but also the human experience.”
Dang Le is the higher education reporter for the Fort Worth Report. Contact him at dang.le@fortworthreport.org.
The Fort Worth Report partners with Open Campus on higher education coverage.
The Report’s higher education coverage is supported in part by major higher education institutions in Tarrant County, including Tarleton State University, Tarrant County College, Texas A&M-Fort Worth Christian University, Texas Wesleyan University, the University of Texas at Arlington and UNT Health Fort Worth.
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