Valley News – Travel nurses have been essential during the pandemic – but at a cost
Editor’s Note: This story was first published on New Hampshire Bulletin.
Nurse Nick Caruso has worked at eight hospitals during the pandemic and undoubtedly his favorite is Dartmouth-Hitchcock Medical Center in Lebanon. He likes the camaraderie and support among staff and says it’s his first hospital to properly use personal protective equipment.
However, he will not stay.
Caruso is one of thousands of short-term travel nurses who have helped New Hampshire hospitals and long-term care facilities keep beds open during a time of unprecedented staff shortages and record admissions. It was a solution with a cost.
Traveling nurses are expensive, with recruitment agencies charging $200 to $300 an hour to recruit candidates, and nurses earn two to three times what staff nurses make. Those lucrative pay rates combined with the exhaustion, stress, and attrition of the job have lured salaried nurses away. And a traveler’s typical 13-week contract means hospitals are continually training newcomers.
But throughout the pandemic, travel nurses have been essential.
Before the pandemic, Wentworth-Douglass Hospital in Dover, New Hampshire, typically employed about 25 traveling nurses with 500 to 600 nurses. Today it’s 120, said Sheila Wooley, chief nursing officer.
The Catholic Medical Center in Manchester has gone from 10 traveling nurses to 50 over the course of the pandemic to cover day and night shifts and a variety of positions, said Jennifer Torosian, associate chief nursing officer. Demand is faltering as COVID-19 waves bring in more patients and leave more staff infected and quarantined at home.
Hospital leaders expect demand to continue even as they try to retain burned-out staff with bonuses and other incentives.
The Office of Professional Licensing and Certification received 22,000 applications for emergency licenses following the outbreak of the pandemic, a requirement for traveling nurses to work in the state. Citing the urgent need for medical workers, Gov. Chris Sununu issued an executive order in November that gave the bureau additional staffing and resources to process applications faster.
Nationwide, nursing jobs have increased by 70% since December 2020, said Dr. Amy Matthews, chief nursing officer and vice president of patient care services at Cheshire Medical Center in Keene, NH. Even when recruitment agencies charge high rates, which she says nurses don’t pay, she competed for employment.
“I would talk to all my newest managers and directors and say, ‘If you see a good resume, call them within the hour and make the offer at the time of the interview,'” she said. “Because if you don’t, these quality travelers will go elsewhere.”
For Caruso, 26, of North Carolina, COVID-19 started his plan to try travel nursing. He left his staff position for a temporary contract in New York City at the beginning of the pandemic. The ability to travel is not the only motivator, he said.
As hospitals have shed staff, remaining nurses have had to take on more responsibilities and have been denied vacation time — even as the pandemic has made the job more difficult and stressful. Until hospitals improve the conditions, pay and benefits for their nurses, they will continue to rely on traveling nurses, Caruso said.
“I’ve had racist patients (and) patients who spat at you,” he said. “If I can do this job and stay somewhere and make good money or travel and make four times as much money, why shouldn’t I travel?”
Caruso also understands the financial burden this places on hospitals.
“Some of the wage rates are astronomical,” he said. “And I’ll be honest, they’re not sustainable. The pre-COVID rates were also unsustainable.”
A job site this week offered 13-week nursing positions in Lancaster, NH, and Keene at about $4,000 a week. A job as a respiratory therapist in Manchester has been advertised at $3,700 a week. However, this figure includes not only wages, but also grants for room and board. In addition, traveling nurses continue to pay their rent or mortgage at home.
Money also prompted South Carolina’s Haydee Diaz to quit her hospital job and accept her first traveling assignment at Cheshire Medical Center. When her husband’s cancer progressed to the point where his oncologist recommended he temporarily stop working, she sought out travel nursing due to financial distress.
“There’s no way I can keep up with all our utilities at home and pay for his medicine with what I earned in South Carolina even if I could work every day,” she said. “I expressed in my resignation letter that I love my job. But in those three months I do what I would do at home for a whole year.”
Meanwhile, the hospital she left is hiring traveling nurses to fill vacancies, at much higher wages than she earned.
“It was like a vicious cycle,” Diaz said. “I don’t know how they would get out of this rut.”
Matthews is understanding when a nurse leaves on a travel contract. She lets them know that they can come back anytime.
“Maybe they got student loans. Maybe they’re entry-level professionals who aren’t tied to a school system or location,” she said. “We have nurses who say, ‘Hey, I’m pretty happy here, but I can’t turn down this amount of money because I can have a down payment on my house in a short amount of time. I can pay off student loans.” And the risk is very low because everyone knows that everyone needs nurses.”
Diaz, who cares for patients on the hospital’s medical/surgical floor, was concerned about the reception she would receive from the nurses, who earn less and do the same work. She hoped they would feel like they were in South Carolina when a traveling nurse arrived.
“Man, that’s not fair, but this girl is nice and thank god she’s here to relieve the stress of being undercast,” Diaz said. “They are there to help us catch up.”
The same scenario has played out here: as nurses leave for higher traveling salaries and hospitals depend on traveling nurses, demand – and the prices charged by recruitment agencies – increases.
“It’s kind of continued for the past two years,” Wooley said.
US Reps Annie Kuster and Chris Pappas signed a January letter urging the White House to investigate whether staffing agencies, which they say are increasing rates by three times pre-pandemic levels and 40% retained for profit, violate consumer protection.
“My primary concern is to ensure patient access to care and the fair treatment of our nation’s health workers,” Kuster said in a statement. She said discussions with hospital leaders sparked her interest in investigating the “anti-competitive activities of nursing services, which have increased their costs during recent increases to improve their bottom line, underpaid the nurses they employ and overtaxed the hospitals they serve.” .
Matthews believes that at this point in the pandemic, travel nursing is less of a threat to staff retention and hiring than the fatigue and morale burden of being so thinned out that it becomes impossible to provide patients with the appropriate level of care .
People development is a must, she said. In New Hampshire, nursing programs reject applicants because they have too few nursing instructors. Equalizing travel salaries is not an option, Wooley said, but higher pay and other benefits could help.
“In my opinion, and I hope that’s true, the pandemic has made society better understand the value of health workers alongside doctors,” she said. “And I hope … the pay gap closes a bit. And I think hospitals are realizing that the people who are doing that work are getting, or need to get, other benefits.”
These could include sabbaticals, loan forgiveness, scholarships, and better retirement benefits.
“I think hospitals are going to look at this and do better packages for very important people who need them to run the show,” she said.
Mariah Blum is one of those people who left her staff position for financial reasons.
In February 2021, she traded her position as an intensive care unit nurse in Massachusetts for a spot on the Catholic Medical Center’s intensive care unit team. Blum was motivated, among other things, because she wanted the challenge of having to quickly familiarize herself with the job after landing at a new location.
However, better pay was also a tie because it pays off student loans.
Travel work is not without challenges, said Blum. It can be lonely, especially for nurses who are leaving families behind, and you need to be comfortable when you need help. But the benefits have been worth it, she said.
She enjoyed her work at the Catholic Medical Center so much that she has renewed her contract several times. “The people here are amazing and have never made me feel like I didn’t belong or that I wasn’t part of the team,” she said.