Editor’s Note: This story was first published on New Hampshire Bulletin.
Nurse Nick Caruso has worked in eight hospitals during the pandemic and, hands down, the Dartmouth-Hitchcock Medical Center in Lebanon is his favourite. He enjoys the camaraderie and support among staff and says this is his first hospital to use personal protective equipment correctly.
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 staffing shortages and record admissions. It is a solution that has a cost.
Traveling nurses are expensive, with recruiting agencies charging $200 to $300 an hour to recruit applicants, and nurses earning two to three times what nurses earn. These lucrative pay rates combined with the exhaustion, stress and drudgery of the job attracted nurses. And a traveller’s typical 13-week contract means hospitals are constantly training new arrivals.
But throughout the pandemic, travel nurses have been essential.
Before the pandemic, Wentworth-Douglass Hospital in Dover, NH, which has 500 to 600 nurses, typically had about 25 travel nurses on staff. Today there are 120, said Sheila Wooley, head nurse.
Manchester Catholic Medical Center has grown from 10 travel nurses to 50 during the pandemic to cover day and night shifts and a variety of positions, said Associate Chief Nursing Officer Jennifer Torosian. The need fluctuates as COVID-19 surges 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 burnt-out staff with bonuses and other incentives.
The Office for Professional Licensure and Certification received 22,000 applications for emergency licenses after the pandemic, a requirement for traveling nurses to work in the state. Citing the desperate need for healthcare personnel, Gov. Chris Sununu issued an executive order in November that gave the office additional staff and funds to process applications more quickly.
Nationally, nursing vacancies have increased 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. with recruiting agencies demanding high rates, which she noted is not the rate paid nurses, she competed for hires.
“I would talk to all of my new managers and directors and say, ‘If you see a good resume, call them within the hour and be ready to make the offer at the time of the interview,'” she said. said “Because if you don’t, those quality travelers will go somewhere else.”
For Caruso, 26, from North Carolina, COVID-19 kicked off her plan to try travel nursing. He left his post at the start of the pandemic for a short-term contract in New York. The chance to travel wasn’t the only motivation, he says.
As hospitals have lost staff, the remaining nursing staff have had to take on more tasks and been denied vacations – even as the pandemic has made the job harder and more stressful. Until hospitals improve the conditions, salaries and benefits of their nurses, they will continue to depend on traveling nurses, Caruso said.
“I’ve had racist patients (and) patients who spit on you,” he said. “If I’m going to do this job and I can stay somewhere and make money or I can travel and make four times as much money, why wouldn’t I travel?”
Caruso also understands the financial pressure this places on hospitals.
“Some of the pay rates are astronomical,” he said. “And I’ll be honest, they’re not durable. Pre-COVID rates were also not sustainable.
At a job site this week, 13-week nursing positions in Lancaster, NH, and Keene offered about $4,000 a week. A respiratory therapist position in Manchester was advertised at $3,700 per week. This figure, however, includes not only salaries, but also allowances for housing and meals. In addition, traveling nurses continue to pay their rent or their mortgage at home.
The money also prompted Haydee Diaz, from South Carolina, to quit her job at the hospital and go on her first travel assignment to Cheshire Medical Center. When her husband’s cancer progressed enough that his oncologist recommended that she temporarily stop working, she turned to traveling nursing out of financial necessity.
“There’s no way I could keep up with all of our utilities at home and pay for his medications with what I made in South Carolina, even though I could work every day,” she said. “I expressed in my resignation letter that I love my job. But during this three-month period, I will earn what I would earn for the whole year at home.
Meanwhile, the hospital she left uses traveling nurses to fill vacancies, at salaries much higher than what she was earning.
“It was like a vicious cycle,” Diaz said. “I don’t know how they could get out of this rut.”
Matthews is understanding when a nurse leaves for a travel contract. She lets them know that they are always welcome.
“Maybe they have student loans. They may be young careerists who are not tied to a school system or a place,” she said. “We have nurses who say, ‘Hey, I’m pretty happy here, but I can’t refuse this amount of money because in a short period of time I can get a down payment on my house. I can repay student loans. And there’s very little risk because everyone knows everyone needs nurses.
Diaz, who provides patient care on the medical/surgical floor of the hospital, worried about the reception she would receive from staff nurses who earn less and do the same job. She hoped they would feel like she did in South Carolina when a traveling nurse arrived.
“Man, it’s not fair, but this girl is nice and thank goodness she’s here to help relieve the stress of being shorthanded,” Diaz said. “They are there to help us catch up.”
The same scenario has happened here: as nurses leave for higher travel salaries and hospitals depend on traveling nurses, demand – and the prices charged by recruitment agencies – increases.
“It’s kind of perpetuated over the last two years,” Wooley said.
US Representatives Annie Kuster and Chris Pappas signed a January letter asking the White House to investigate whether recruiting agencies, which they say are raising rates three times pre-pandemic levels and retaining 40% for profit, violate consumer protection.
“My primary concern is to ensure patient access to care and fair treatment for our nation’s healthcare workers,” Kuster said in a statement. She said conversations with hospital executives prompted her to investigate ‘anti-competitive activity by nursing services that have increased their costs during their recent bottom line increase, underpaying the nurses they employ. and overcharging the hospitals they serve”.
Matthews believes that at this point in the pandemic, travel nursing is less of a threat to staff retention and recruitment than the fatigue and moral distress of being so exhausted that it becomes impossible to provide the level of appropriate patient care.
Workforce development is essential, she said. In New Hampshire, nursing programs are turning away applicants because they have too few nursing instructors. Matching travel salaries isn’t an option, Wooley said, but higher salaries and other benefits could help.
“My opinion is, and I hope it is true, that the pandemic has made society better understand the value of health workers, in addition to doctors,” she said. “And hopefully… the pay disparity will narrow down a bit. And I think hospitals have recognized that people who do this work need to be awarded or provided with other benefits.
This could include sabbaticals, loan forgiveness, scholarships and better retirement benefits.
“I think hospitals are going to look at that and do better packages for the really important people that they need to run the show,” she said.
Mariah Blum is one of those people who left her staff position for financial reasons.
She traded her job as a critical care nurse in Massachusetts in February 2021 for a spot on the critical care team at Catholic Medical Center. Blum was motivated in part because she wanted the challenge of having to get up to speed quickly after landing at a new site.
A better salary was also an asset, as she pays off student loans.
Travel work doesn’t come without challenges, Blum said. It can be lonely, especially for nurses leaving family behind, and you need to be comfortable talking when you need help. But the benefits were worth it, she said.
She enjoyed her assignment at Catholic Medical Center so much that she renewed her contract several times. “The people here are amazing and never made me feel like I didn’t belong on the team or was out of the team,” she said.