Higher pay is driving staff nurses to take jobs as travel nurses, leaving their former employers even further understaffed, creating tension between nurses and raising questions about the consequences for quality of care.
While travel nurse contracts often don't include the same benefits as salaried nurses, the higher hourly wage is an appealing trade-off for many, especially as COVID-19 overwhelms hospitals in some states, and intensifying the need for nurses and driving up compensation costs.
Financially robust hospitals can pay travel nurses anywhere from $6,000 to $10,000 a week, often along with a stipend to cover housing and travel expenses.
"The travel nursing situation has essentially created a bidding war between hospitals," said Dr. Phillip Coule, vice president and chief medical officer of Augusta University Health System in Augusta, Georgia. "A nurse can leave a facility, go on a 'travel contract' for a facility across the street, and earn more than double what they were making, while still living at home."
Rising need and constrained labor supply has in turn led to rapidly escalating pay, said Kathy Kohnke, senior vice president of client relations at Fastaff Travel Nursing.
But when hospitals offer those higher wages, it can worsen staffing problems at hospitals with fewer resources, which can't match the compensation available to nurses elsewhere, Coule said.
Since the pandemic began, the the dire need for travel nurses to fill workforce gaps has dramatically increased. Demand is 284% higher than it was at this time last year, according to the medical staffing firm Aya Healthcare.
As the delta variant drives up COVID-19 caseloads, there are now more than 40,000 travel nurse positions available on any given day, Kohnke said.
In 2020, 90% of hospital executives hired travel nurses to bolster their teams during the pandemic. The previous year, before the COVID-19 arrived in the U.S., fewer than 60% brought in travel nurses, according to a 2021 survey of 100 executives by the staffing agency Avant Healthcare Professionals.
"The delta virus is causing even more competition for scarce talent, and our clients are citing problems not only with permanent hiring but also with retention," Susan Salka, CEO of staffing company AMN Healthcare, said in a statement. "Demand has been complicated by leaves of absence, clinician fatigue, rising patient volumes and operating room backlog—and our clients are telling us that this is unlikely to change anytime soon."
In addition to higher pay, travel positions provide nurses with an easier way to support their families, pay off student loan debt and avoid excess burnout through more flexible scheduling, according to a spokesperson for the American Nurses Association.
Travel nursing was meant to be a short-term solution in areas with critical need, the ANA spokesperson said. But under the present circumstances, the demand for medical care has overburdened the entire nursing workforce, including both employed and contract nurses.
As staff nurses become increasingly disgruntled about working conditions and frustrated with employers over longstanding workforce shortages, furloughs during the pandemic and pay disparities between staff and travel nurses, it's driving them away, said Patricia Pittman, professor of health policy and management at the School of Public Health at George Washington University.
"The good part of travel nursing is that when there's a natural disaster or there are very irregular levels of demand, hospitals can use travel nurses to sort of patch up the gaps," Pittman said. "The bad side of travel nursing is that it becomes an excuse to not invest in your regular nursing staff. It's a double-edged sword."This can further breed resentment among staff nurses who have borne a heavy burden since the beginning of last year.
Offering bonuses to attract travel nurses and not to staff members is a "slap in the face," Kelly Rivera-Craine, business agent for Teamsters Local 332 and a registered nurse at Ascension Genesys Hospital in Grand Blanc, Michigan.
Salaried nurses should treated better after staying loyal to their employers, toiling through the pandemic and enduring inadequate staffing when hospitals violate nurse-to-patient ratio rules, Rivera-Craine said.
Bringing on travel nurses also can disrupt workflow and clinical care because they typically don't get as much training from their temporary employers as staff nurses do and they don't stay long enough to build relationships with patients, Rivera-Craine said.
A nurse who's worked at a hospital for eight weeks cannot have the same understanding of the facilities processes, patients and problems as a staff nurse with along tenure, Coule said. "When you go substituting team members, it certainly has the potential of impacting the quality of care," he said. "The potential for error, for communication issues will most likely go up."Forty full-time registered nurses resigned from Augusta University Health System last month, lured away by high-paying travel nurse gigs, Coule said. "As fast as we can get traveling nurses, we're losing staff to traveling contracts," he said
In some hospitals, turnover is so high that the majority of the unit is composed of travel nurses during some shifts, said Matt Calzia, a nurse practice consultant with the Oregon Nurses Association.Another downside to hospitals hiring travel nurses from around the country worsens staffing shortages in rural and underserved areas, which have with fewer resources and are home to marginalized communities with poor access to care, Calzia said. And those are the hospitals that can least afford to hire workers back, he said.
"You're perpetuating the disparities within the healthcare system overall," Calzia said. "We are taking nurses from areas that really need nurses, but don't pay as well, and moving them into areas that might pay better, who also really need nurses."
Due to unsustainably high travel nursing pay, the American Hospital Association asked the Federal Trade Commission in February to investigate reports of nurse staffing agencies' anti-competitive pricing.
Because of how unaffordable the travel nursing industry has become for some hospitals, more are beginning to realize it was a mistake to furlough nurses rather than investing in and treating them as a crucial workers, Pittman said.
Employers have been reluctant to listen to nurses' cries for help, and offer virtually meaningless bonuses and wellness workshops instead of addressing the systemic issues making nursing so challenging, Pittman said.
"The silver lining of this crisis is that it is forcing nurse leaders and hospital leaders to take the nurse staffing situation much more seriously," Pittman said.
