Life on the Road

Nurses who move on from full-time positions to become travelers create openings that need to be filled. It’s a zero-sum game that’s worsening an already tenuous situation. Overworked nurses who are being pushed to their limits aren’t always grateful when reinforcements arrive. “It’s a weird environment,” says Ms. Harris. “Full-time staff see travelers coming in who are getting paid more than they are and that frustrates them.”

In this current climate, she’s heard of fellow travel nurses who’ve been treated like outsiders during their assignments and made to handle the thankless daily tasks the full-time staff wants to avoid. “For the most part, though, I’ve had really positive experiences,” she says. 

Andrea Dyer, MSN, RN, CNOR, a travel nurse for the past eight years, is currently on assignment in the outpatient surgery department at St. Mary’s Regional Medical Center in Lewiston, Maine. The hospital’s staff and leadership have been supportive and welcoming, but that hasn’t always been the case at her other stops. Ms. Dyer, who’s president of her local AORN chapter, recalls being in the process of leaving a hospital for a higher-paying assignment when a surgeon cornered her in the hallway. “She said, ‘You’re not part of the solution, you’re part of the problem — and you don’t even care,’” recalls Ms. Dyer.

That struck a nerve. “I was the one at the hospital who reached out to local senators to procure PPE and N95 masks during the height of the pandemic,” she says. “To me, it seemed like I was one of the only ones who did care.”

Ms. Harris runs a Facebook group for travel surgical nurses, and she’s noticed postings of pay rates that have doubled in recent years to $140 to $160 an hour — what essentially amounts to crisis pay. That’s good money, but travel nurses are often being asked to work 48 to 60 hours per week, according to Ms. Harris, who wonders how long they’ll be able to keep up that pace before burning out, which no amount of money can prevent.

Working in different parts of the country and learning new skills from other talented surgical professionals sounds appealing, and in many ways it is, but Ms. Dyer says those on the outside of the lifestyle don’t understand the stress of living out of a suitcase, spending extended time away from family, receiving minimal training before being thrown into the fray and going without paid time off, disability insurance and matches to 401(k) accounts. She points out that travelers are the first to get laid off if elective surgeries are canceled due to COVID-19, a constant threat during the continuing pandemic.

“I can’t deal with the uncertainty anymore,” says Ms. Dyer. “It’s just too much to handle. I used to love the culture of travel nursing. Not anymore.”

Widespread staffing shortages will continue for the foreseeable future because the workplace stresses caused by the pandemic have forced many older nurses to opt for early retirement and many younger nurses are deciding to leave health care altogether for the relative calm of another career. There simply aren’t enough nurses in the pipeline to fill the positions vacated by those who are fleeing the profession. Enter travel nurses, whose ranks are increasing with an inflow of former full-time nurses. Healthcare leaders are taking notice and putting plans in place to stem the tide.

Ms. Harris says a former traveler who is now on permanent staff at a hospital in Alabama has been offered a short-term contract that would pay her the same higher rate as the travel nurses she works with. When the contract expires, her pay will revert to her lower base salary. Another hospital with which Ms. Harris has connections is increasing the hourly rate of its OR staff by $10 an hour to entice them to stay. 

To attract and retain highly skilled nurses and surgical technologists to its workforce, the University of Pittsburgh Medical Center (UPMC) created an in-house travel staffing agency, believed to be the first of its kind in the country. UPMC will offer travel nurses $85 an hour and surgical technicians $63 an hour, as well as travel allowances given each time they begin new assignments, a sum that equates to $2,880 every six weeks. Nurses and techs who are accepted into the program earn a comparable wage to what travelers earn at outside agencies.

UPMC created the program with the goal of relying less on outside agencies to fill open positions and to encourage its employees to work in the health system’s hospitals across Pennsylvania, Maryland and New York — wherever and whenever the need is greatest. The program, which launched at the end of 2021, will provide needed staffing support to the system’s frontline caregivers and additional career opportunities for UPMC nurses and surgical technologists.

The health system’s leadership developed the in-house staffing agency after listening to the staff’s needs and challenges. “They’ve been through this pandemic for almost two years, and it’s been quite the high burden for them to see so much illness,” says John Galley, BS, MBA, senior vice president and chief human resources officer at UPMC. “They’re asking for help and solutions.”

UPMC has been losing nurses to outside travel agencies, and its nursing staff turnover rate has doubled in recent months, according to Holly Lorenz, RN, MSN, chief nurse executive of UPMC’s Center for Nursing Excellence. “We’re seeing rates we’ve never seen before,” says Ms. Lorenz. “We believe that’s driven by some of the incredibly high agency rates that are out there. We’re creating a competitive rate matched with what we believe is a best benefit package and a preferred place to work.”

The in-house staffing agency is a way for UPMC to reconnect with nurses who have left for outside agencies and bring them back into the fold, points out Mr. Galley, who adds, “It gives our employees a career choice, which is something they’re seeking.”

The program also makes good financial sense for UPMC. Pre-pandemic, says Mr. Galley, the health system could hire an agency travel nurse for $85 an hour, and the nurse would take home about $50 of the fee. He’s now seeing rates between $200 and $280, which means the nurses are making about $90 per hour. The agencies are collecting the difference, which has more than tripled in some cases.

“That’s profiteering on the pandemic,” says Mr. Galley. “This is a way for us to restore some balance to the equation.”

UPMC is aiming to eventually recruit 800 nurses into the program, but Mr. Galley concedes that will take time. “This is a short-term solution,” he says. “It’s not going to fix everything, but we think there’s a place for it. We’re also working on long-term efforts to grow the pipeline of new nurses.”

Mr. Galley believes the program will be needed to combat a nursing shortage he expects to last at least a couple more years. “Offering workers the same choices that are in the market is what needs to be done,” he says. “We must be creative and thoughtful in developing innovative staffing solutions.”

Surgery centers are also feeling the downstream effects of the nursing shortage. Advanced Eye Surgery and Laser Center in Gainesville, Ga., is dealing with staffing shortages but does not employ travel nurses, according to Surgical Manager Gail Forrester, MSNEd, RN. Most of the facility’s nursing staff are per diem employees who work only when the center’s surgeons perform surgery, which averages out to five days per month. “It’s hard to find staff who want to work this limited schedule,” she says.

Most of the center’s nurses also hold full-time positions at the local hospital. “As the hospital’s COVID cases increase, so does the hourly pay for nurses who agree to work overtime shifts,” says Ms. Forrester. The ophthalmic ASC does not match the hourly rates the hospital pays full- or part-time nurses, and this pay disparity can create acute issues on any given surgery day.

“The nurses will call out at our ASC to work a higher-paying job,” she says. “Because our practice is small, we cannot compete with these high salaries. My only hope is to find nurses who want to work two days a week and are willing to take the hourly salary.”

Another issue at play, she notes, is the fact that PRN positions do not offer benefits. Because the salaries offered at Advanced Eye are comparable to those offered at other area ASCs, Ms. Forrester delivers a pragmatic message to local nurses who, despite the pay disparity, still would prefer not to work at a hospital. “We have suggested that they take two PRN jobs at two separate ASCs so they can get more hours per week,” she says.

Brian Bizub, BSHA, executive director and CEO at Raleigh (N.C.) Orthopaedic Clinic, finds his facility in a much busier situation. His ASC is riding the wave of outpatient total joints procedures, of which it is performing more than ever before. Maintaining such a constant, brisk volume has been challenging given the staffing crisis. Last year during the fall — as at many ASCs, the busiest time of year because of patients’ deductibles — his facility filled in staffing gaps with per-diem nurses.

Market forces, says Mr. Bizub, are making it very difficult to get — and remain — fully staffed. He says local traveling nurses often receive $20 more per hour than his ASC offers; two of his nurses have left to become local travelers. Another factor, he says, is that insurance companies are hiring nurses for work-at-home jobs. “For people who have children and a $1,000 daycare bill, being able to work from home fits their lifestyle,” he says. “The market supports that.”

Mr. Bizub has heard about incredible pay packages being offered to travelers. One offer to nurses for interim ASC work particularly stood out, involving about $4,000 a week, a $3,000 traveling stipend, and $3,000 in car and living expenses. He believes some nurses are prepared to ride the high-compensation wave as travelers until the situation settles down, at which time he expects many will return to full-time jobs.

“It’s hard to pass up $4,000 a week,” he says. “I don’t blame them. If I were younger, I’d probably do the exact same thing.”

Ms. Harris points out that travel nursing has exposed her to new specialties and incredible surgical professionals throughout the country. It has expanded her knowledge base and clinical expertise, and made her a better all-around OR nurse.

“Travel nursing has provided me an amazing life of working all over this beautiful country and the flexibility to work when I want, where I want and for as long as I want,” she says. “The current increase in pay is a bonus to my lifestyle.”

Ms. Dyer says traveling is beginning to lose its luster, partly because the current climate feels so competitive. There’s nothing wrong with earning what the market will bear, but Ms. Dyer has always worked hard to ingratiate herself in the communities where she has worked. By the time she left her assignments, she felt more a part of the culture than some of the full-time nurses.

Ms. Dyer believes her traveling days are coming to an end. She’s currently applying for permanent nurse educator positions in the Boston area, although her love of life on the road lingers. “Part of me knows I’ll never make this salary again,” she says. “And part of me doesn’t want to be around when the bubble bursts.”

Ms. Dyer feels a strong pull to focus her skills, experience and background on mentoring the next generation of providers. “One of my former directors reminded me of all the nurses I could inspire in an education role,” says Ms. Dyer. “That’s way more important to me than money.” OSM