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Tripled pay is great for travel nurses – not for hospitals

Three health care workers wearing masks stand in a room next to IV bags and hospital equipment.
Devan Ridgway
/
WFIU/WTIU News
Nursing shortages have led hospitals to rely more on travel nurses that help plug gaps but come with big price tags.

Enid Bedford is grateful her nursing career has given her the opportunity to be closer to family.

Bedford, a registered nurse in Memphis, Tennessee, entered the field at age 50 after all her children left home. During the pandemic, she started traveling for better pay and a better schedule.

“I typically work maybe a 13- or 26-week assignment, and then I can go home for two months and be able to sit down and relax and spend time with my husband or family,” she said.

Bedford’s youngest son plays football for Indiana University – a more than six-hour drive from home. When he tore his ACL in the first game of the season, Bedford was able to land a travel nurse contract at a hospital nearby, in Bloomington.

“I wasn't here to intrude on his life as a 21-year-old college student, but to help him transition with his injury,” she said. “And now that he's doing so well, I'll finish my assignment and then I'll be on my way.”

Travel nurses fill temporary openings in hospitals across the country, often signing contracts for a few months at a time before moving on to experience a new city. The travel nurse industry skyrocketed in 2020 as hospitals struggled with staffing shortages.

a woman wearing a white collar shirt
Devan Ridgway
/
WFIU/WTIU News
Enid Bedford, a travel registered nurse from Memphis, Tennessee, has spent time in Mississippi, West Virginia and Indiana.

Travel nurse pay varies widely depending on the assignment. Estimates show hourly wages can be at least double if not triple the $39 per hour that the average staff nurse makes. But the price hospitals pay for travel nurses is significantly more than what the nurses themselves are paid, because nurses sign on with staffing agencies that enter contracts with hospitals, negotiating prices based on demand.

It’s why about a quarter of hospitals say they’re looking to decrease their dependence on supplemental staffing over the next year, according to the 2022 NSI National Health Care Retention and RN Staffing Report.

“For every 20 travel RNs eliminated, a hospital can save, on average, $4,203,000,” according to the NSI report.

Weekly pay for travel nurses has dropped since the height of the pandemic, but reliance on travel nurses continues to take a financial toll on hospital budgets, forcing many to take a deeper look at employee benefits and other retention efforts.

Higher pay, greater flexibility

Higher pay was cited as the top reason nurses chose to take on travel contracts, according to a survey conducted by the health care company Relias. Other top reasons included dissatisfaction with management, interest in exploring new locations and greater flexibility.

Patrick Smith spent two years as a staff nurse in his hometown of Tuscaloosa, Alabama, prior to becoming a traveling nurse. He said Bloomington, Indiana, is the third city he’s lived in on a travel contract.

“I enjoy getting to meet new people. I get to experience a new area that I've not been in,” Smith said. “And it's not like, oh, I visited this place. Like I actually got to live there for a couple months.”

Others have even figured out how to get the benefits of being a travel nurse without ever going too far from home. They’re known as “local travelers,” and – like Brakayla Hillis – they tend to take contracts within 90 minutes of home.

Hillis has completed contracts in several Indiana cities, including Fort Wayne and Bloomington, and now works in her hometown of Greenwood. She never expected traveling would be her life. But she said the financial and scheduling benefits were too good to refuse, especially since she’s in school to become a nurse practitioner.

A woman stands outside. In the background are a picnic table, grassy area and a basketball hoop.
Devan Ridgway
/
WFIU/WTIU News
Brakayla Hillis, a travel registered nurse from Greenwood, Indiana, has yet to take a nursing contract outside her home state.

One of her recent assignments was at a hospital that was transitioning to a new location and hoping to cut back on its reliance on travel nurses.

“We were very heavily staffed with travelers, and then when we moved to the new hospital, they kind of were trying to get back to where it was just the staff nursing and kind of weed out the travelers,” Hillis said. “So they did a major pay cut by about $2,000 a week.”

The pay cut in future contracts meant it was time for Hillis to move on. Her next contract was with another central Indiana hospital that she said offered its staff nurses triple bonuses to compete with traveler pay.

“Hospitals are trying to basically reward the staff just so that they don't have to use travelers, but it still seems to happen,” she said.

Can boosting staff morale lessen hospitals’ reliance on travel nurses?

Turnover rates for U.S. nurses vary by geographic location and specialty, but range from 9 percent to 37 percent. In 2021, more than 1 in 3 hospitals reported a nurse vacancy rate greater than 10 percent.

Another concern: Burnout seems to be contributing to a greater desire to leave the profession entirely. According to the Relias report, 29 percent of respondents surveyed in late 2021 said they’re considering leaving nursing, up from 11 percent of respondents in 2020.

The issue of understaffing is known to contribute to burnout and also raises concerns about patient safety. It’s a big part of why hospitals continue to contract with nurse staffing agencies to plug gaps.

But the high costs associated with travel nursing are causing many in the industry to take a closer look at the value of contracts between hospitals and staffing agencies, said Rachel Culpepper with the Indiana Association for Nursing Leadership.

Staffing agencies sometimes walk away with double or triple what nurses make, she said.

The “market war” between hospitals and staffing agencies is also forcing hospitals to consider ways to improve job satisfaction – by improving employee culture, increasing paid time off, or even changing standard shift hours.

“We've been doing 12-hour shifts for a long time,” Culpepper said. “And we're hearing from our team members, that might not be what they want any longer.”

Throughout the pandemic, travel nurses have helped fill “critical position vacancies,” said Cindy Herrington, south-central region chief nursing officer for IU Health, Indiana’s largest hospital system.

“We are very thankful to our temporary agency nurses for helping during times of increased need for nurses,” she said in an email. “Hospitals across America could not have gotten through the pandemic and this labor market without their great work.”

This story comes from Indiana Public Media, in collaboration with Side Effects Public Media. Follow Holden on Twitter: @AbshierHolden.