Nurse Nick Caruso has worked in eight hospitals during the pandemic and, hands down, Dartmouth-Hitchcock Medical Center in Lebanon is his favorite. He likes the camaraderie and support among staff and says this is his first hospital that’s used personal protective equipment properly.
He won’t, however, be staying.
Caruso is one of the thousands of short-term travel nurses who’ve helped New Hampshire hospitals and long-term care settings keep beds open during a time of unprecedented staff shortages and record-level admissions. It’s been a solution with a cost.
Travel nurses are expensive, with staffing agencies charging $200 to $300 an hour to recruit candidates and nurses earning two to three times what staff nurses make. Those lucrative salaries combined with the exhaustion, stress, and grind of the job have lured staff nurses away. And a traveler’s typical 13-week contract means hospitals are continuously training new arrivals.
But throughout the pandemic travel nurses have been essential.
Prior to the pandemic, Wentworth-Douglass Hospital in Dover, which has 500 to 600 nurses, typically had about 25 travel nurses on staff. Today there are 120, said Sheila Wooley, chief nursing officer.
Catholic Medical Center in Manchester has gone from 10 travel nurses to 50 since the pandemic to cover day and night shifts and a variety of positions, said Chief Nursing Officer Jennifer Cassin. The need fluctuates as COVID-19 surges bring more patients in and leave more staff infected and quarantining at home.
Hospital leaders expect demand to continue even as they try to retain burned-out staff with bonus pay and other incentives.
The Office for Professional Licensure and Certification received 22,000 applications for emergency licenses after the pandemic hit, a requirement for traveling nurses to work in the state. Citing the desperate need for health care staff, Gov. Chris Sununu issued an executive order in November that gave the office additional staff and funding to process applications more quickly.
Within the Dartmouth-Hitchcock Health System, nursing vacancies are up 70 percent since December 2020, said Dr. Amy Matthews, chief nursing officer and vice president of patient care services at Cheshire Medical Center, which is in the system’s network. Even with staffing agencies demanding high rates, which she noted is not the rate paid to nurses, she competed for hires.
“I would talk with all of my newest 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. “Because if you don’t, those high-quality travelers are going somewhere else.”
For Caruso, 26, of North Carolina, COVID-19 jump-started his plan to try travel nursing. He left his staff position at the start of the pandemic for a short-term contract in New York City. The chance to travel wasn’t the only motivator, he said.
As hospitals have lost staff, the remaining nursing staff has had to absorb more duties and been denied vacation time – even as the pandemic has made the job harder and more stressful. Until hospitals improve conditions, pay, and benefits for their staff nurses, they’ll continue to depend on travel nurses, Caruso said.
“I’ve had racist patients (and) patients who spit at you,” he said. “If I’m going to do this job and I can stay somewhere and make OK money or I can travel and make four times as much money, why would I not travel?”
Caruso understands, too, the financial strain this puts on hospitals. “Some of the pay rates are astronomical,” he said. “And I’ll be honest, they are not sustainable. The pre-COVID rates were not sustainable either.”
On one job site this week, 13-week nursing positions in Lancaster and Keene were offering about $4,000 a week. A respiratory therapist position in Manchester was advertised at $3,700 a week. That figure, however, includes not just wages but also stipends for housing and meals. Additionally, travel nurses are required to continue paying their rent or mortgage at home.
Money also prompted Haydee Diaz of South Carolina to leave her hospital job and take her first travel assignment at Cheshire Medical Center in Keene. When her husband’s cancer progressed enough that his oncologist recommended he temporarily stop working, she looked into travel nursing out of financial necessity.
“There’s no way I can keep up with all our utilities at home and pay for his medicine with what I was making in South Carolina, even if I could work every single day,” she said. “I did express in my resignation letter that I love my job. But in this three-month period, I’ll make what I would make for the whole year at home.”
Meanwhile, the hospital she left is bringing in travel nurses to fill staff vacancies, at much higher wages than she was earning. “It was just like a vicious cycle,” Diaz said. “I don’t know how they’d get themselves out of that rut.”
Matthews is sympathetic when a staff nurse leaves for a travel contract. She lets them know they are always welcome to return.
“Maybe they’ve got student loans. Maybe they’re early careerists that aren’t tied to a school system or location,” she said. “We have nurses who are like, ‘Hey, I’m pretty happy here but I can’t turn down this amount of money because over a short period of time, I can have a down payment for my house. I can pay off student loans.’ And there’s very little risk because everyone knows that everyone needs nurses.”
Diaz, who is doing patient care on the hospital’s medical/surgical floor, was anxious about reception she’d receive from staff nurses making less and doing the same job. She hoped they would feel as she did in South Carolina when a traveling nurse arrived.
“Man, that is not fair, but this girl is nice and thank god she is here to help relieve that stress of being short-handed,” Diaz said. “They are there to help us play catch up.”
The same scenario has played out here: As nurses leave for higher travel salaries and hospitals rely on travel nurses, demand – and prices charged by staffing agencies – increase.
“It’s kind of perpetuated itself through the past two years,” Wooley said.
U.S. Reps. Annie Kuster and Chris Pappas signed onto a January letter asking the White House to investigate whether staffing agencies, which they say are increasing rates by three times pre-pandemic levels and keeping 40 percent for profit, are violating consumer protection.
“My primary concern is ensuring patient access to care and the fair treatment of our nation’s health care workforce,” Kuster said in a statement. She said conversations with hospital leaders prompted her interest in investigating the “anticompetitive activity of nursing services that have hiked their costs during the recent surge to pad their bottom lines, underpaying the nurses they employ and overcharging the hospitals they serve.”
Matthews thinks that at this point in the pandemic, travel nursing is less a threat to staff retention and recruitment than is fatigue and moral distress of being stretched so thin that it becomes impossible to provide the appropriate level of care to patients.
Workforce development is one must, she said. In New Hampshire, nursing programs are turning away applicants because they have too few nursing instructors. Matching travel salaries is not an option, Wooley said, but increased pay and other benefits could help.
“My opinion is, and I hope this is true, that the pandemic has made society understand the value of health workers, besides doctors, better,” she said. “And I am hoping … the disparity in salaries will close a little bit. And I think hospitals have recognized that the people doing this work need to have other perks assigned or provided to them.”
That could include sabbaticals, loan forgiveness, scholarships, and better retirement benefits. “I think hospitals are going to look at that and make better packages for very 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 ICU nursing position in Massachusetts in February 2021 for a spot on the ICU 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.
Better pay was also a draw, though, because she’s paying off student loans.
Travel work doesn’t come without challenges, Blum said. It can be lonely, especially for nurses who leave families behind, and you have to be comfortable speaking up when you need help. But the benefits have been worth it, she said.
She’s enjoyed her assignment at Catholic Medical Center so much that she’s renewed her contract several times. “The people here are amazing and have never made me feel like I didn’t belong or that I wasn’t part of the team,” she said.