Hospitals are relying more and more on expensive travel nurse agencies to fix staffing shortages, an issue that has been exacerbated by the COVID-19 pandemic. And that’s hurting their bottom line and alienating full-time nurses, health care industry experts say.
For nearly two years, hospitals have continuously sourced nurses from external staffing and travel nurse agencies to fill the gaps created by the coronavirus pandemic.
The use of travel nurses isn’t new. Historically, hospitals have used travel nurse agencies to bolster their staff during times of high need. But COVID-19 has changed the frequency at which hospitals lean on external staffing help.
Health care staffing shortages, which began years before the pandemic, are worsening because of the long and draining hours demanded by COVID-19. Each new surge of COVID-19 brings unprecedented patient volumes, putting more pressure on an already shrinking workforce. The need for nurses is higher than ever.
Though hospitals normally go directly to staffing agencies to hire temporary workers, the staff shortages caused by COVID-19 led the state to step in at times. The state provided up to 1,000 travel nurses to North Texas at the height of the omicron variant outbreak in January.
“By and large, all hospitals throughout the nation are looking for supplemental staffing. The demand exceeded the supply,” said Steve Love, CEO and president of the Dallas-Fort Worth Hospital Council. “You can go back to basic economics. What many of the staffing agencies did was raise their prices.”
Hospitals are stuck in a loop of paying more for temporary nurses, said Cindy Zolnierek, CEO of the Texas Nurses Association, which represents registered nurses across the state.
“It became this vicious cycle where you’re chasing your tail and it’s escalating,” she said.
Travel nurses make more on average than most nurses employed full-time at hospitals, as travel nurse agencies charge high premiums to fill staffing holes. Many nurses are leaving full-time positions for more lucrative travel jobs, opening even more positions for hospitals to fill.
With every new opening, travel agencies are able to hike up their rates. However, hospitals don’t blame travel nurses on their increased supplemental staffing expenses, Love said.
“For the nurses that enter the workforce and go to be traveling nurses, we’re certainly not being critical of them in any way,” he said. “We understand. They have to look at their own individual situation and make their best choice.”
The average salary for a travel nurse in Texas is nearly $115,000, not including overtime, according to Indeed.com data. The annual mean wage for registered nurses in Texas as of May 2020 was $76,800, the U.S. Bureau of Labor Statistics reported.
Many travel nursing agencies also offer benefits that match those offered by hospitals to full-time employees. Aya Healthcare, a national health care staffing company, offers paid company housing or a housing stipend; medical, dental and life insurance; paid sick time and 401(k) matches, according to its website.
And there’s no shortage of travel nurse postings. One listing on Indeed.com for a medical-surgical travel nurse in Dallas offers $3,204 per week, with a housing stipend and up to $1,000 reimbursement for travel to the assignment.
While Love didn’t know the exact amount North Texas hospitals have spent on external staffing, it’s “easily doubled from what we had been paying pre-pandemic,” he said.
That’s problematic, especially for cash-strapped hospitals.
Beyond the high price-point of travel nurses, hospitals also have to continuously train short-term staff to their specific systems and practices. Nurses have to acclimate to new work environments in areas far from home.
While high-paying travel nurse jobs may be appealing to new nurses, they come with their own set of challenges, said Meagan Rogers, associate chair for undergraduate nursing at the University of Texas at Arlington.
Travel nurses often walk into new hospitals where full-time nurses may resent that amount of money they’re making, she said. Both the travel nurses and full-time nurses also have to adjust to working with each other.
“It can be really unsafe for nurses who aren’t experienced to be serving as travel nurses,” Rogers said.
In her conversations with nurses across the state, Zolnierek said a majority of nurses working at one hospital full-time are not resentful of travel nurses coming into the hospital, but of the rates their employers are willing to spend on short-term staff.
Hospitals are looking for a way out of the cycle of spending more and more for travel nurses. The American Hospital Association and a group of lawmakers are calling on the White House to investigate alleged price gouging by health care staffing agencies.
But capping the amount travel nurse agencies can charge hospitals will only be solving a symptom of a larger, longer-term problem, Love said. This year, the U.S. will need an additional 1.2 million nurses to meet patient demand and replace nurses leaving, said Dr. Ernest Grant, president of the American Nurses Association, according to U.S. News and World Report.
Hospitals need to find a way to attract – and keep – full-time staff beyond just the pandemic.
The pandemic could serve as a wake-up call for the health care industry to put more value on nurses and the critical care they provide, Zolnierek said. Showing that value goes beyond just increased salaries.
“I am afraid it’s too little, too late. How do we put our money where our mouth is and really show nurses that we value them?” she said. “And some of that is in compensation, but some of it is involving them in decisions in their workplace.”