Healthcare leaders were concerned with nursing shortages long before the COVID-19 pandemic. According to the United States Bureau of Labor Statistics Employment Projections 2019-2029, registered nursing is one of the top occupations in terms of job growth through 2029. The Bureau of Labor Statistics projects about 175,900 openings for RNs annually from 2019 through 2029 when retirements and workforce exits are factored into the number of nurses needed.

While the shortage of nurses loomed before the pandemic, COVID-19 and its impact on the healthcare system exacerbated the problem. Hospitals operating with negative margins are unable or unwilling to increase staff nurse wages, and when coupled with constant turnover and burnout, the nursing shortage shows no signs of slowing. Some nurses have chosen to leave the profession entirely, but others have decided to leave traditional employment and choose travel nursing due to its temporary nature and comparatively high wages.

What is Travel Nursing?

Travel nurses are registered nurses who take short-term roles in healthcare settings ranging from hospitals to family clinics. Travel nurses help healthcare systems continue to provide quality patient care in areas where there are nursing shortages. One of the primary reasons staff nurses are leaving their positions in favor of travel nursing is the pay.

Typically, staff nurses in a hospital setting receive a set salary commensurate with their levels of education and experience, and their salaries generally factor in any benefits packages offered with the position. Travel nurse salaries are quite different, and at the moment, much pay much more than their staff counterparts. In part, this is because travel nurse salaries are “a bit of a gray area,” according to Nurse.org. Pay packages for travel nurses have several components, some of which include hourly pay, non-taxed housing stipends, non-taxed per diems, and travel reimbursements.

Currently, the pay for travel nurses is at a high. According to a recent article in Time magazine, the current rate of pay for contract travel nurses is often two to four times higher than what the same staff positions earn.

Travel Nursing and Turnover

Nursing turnover has increased exponentially in the aftermath of the COVID-19 pandemic. Burnout is one of the most common reasons for nurses to leave positions. The work registered nurses do is difficult and has very real demands physically, mentally, and emotionally.

Contract travel nursing becomes a very attractive option for nurses who wish to continue in the profession but are looking to avoid burnout. Per the Time magazine article, the rapid turnover of nurses into contract nursing “has triggered a costly feedback loop: hospital administrators, facing shortages in staff nurses, spend a mint hiring contract nurses, which makes them less able or willing to increase their staff nurses’ pay.” Without the potential to earn higher salaries, more staff nurses quit their positions to become contract nurses which further lowers the supply of nurses and increases the demand for travel nurses.

Travel Nursing and the Healthcare System

With the increased demand for contract nurses, contracting nursing agencies have continued to raise their prices. The Time article notes that “the advertised pay rate for travel nurses has surged 67% from January 2020 to January 2022, according to Prolucent Health.” Other staffing agencies reported to Time that “pay rates for travel nurses at facilities they work with rose by 164% from the fourth quarter of 2019 to the fourth quarter of 2021.”

This jump in pay results in significant profits for travel nurse staffing agencies, prompting some hospital administrators and lawmakers to ask Congress to step in. During COVID, many hospital administrators experienced a severe dwindling in profits and are now arguing that nursing staff agencies are exploiting the circumstances of the COVID-19 pandemic. The American Hospital Association (AHA) notified the Federal Trade Commission of their concerns over the potential price gouging as far back as January of 2021. Recently, the AHA and other lawmakers have urged further federal intervention as travel nursing costs continue to rise.

While hospital administrators are arguing that staffing agencies are exploiting the pandemic, staffing agencies maintain that healthcare facilities are paying higher prices simply due to an increase in demand. At the same time, nurses argue that the staffing shortage crisis could have been avoided in the first place had administrators improved working conditions and paid staff nurses better from the start.

Where do healthcare systems go from here?

The answer is not simple. While it is easy to suggest that healthcare administrators simply improve working conditions and raise salaries for staff nurses, in practice, this can be very difficult to achieve. As noted by the AHA in a report from September of 2021, many hospitals are experiencing negative margins in the wake of the COVID pandemic. The projected loss for hospitals nationwide is “an estimated $54 billion in net income over the course of the year, even taking into account federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funding from last year.”

Still, even with the challenges facing them, many hospitals and healthcare systems are attempting to increase pay for staff nurses. Additionally, hospitals are looking at how else they can entice staff to remain in their positions with some healthcare systems offering flexible scheduling for a better work/life balance and counseling services to tend to staff’s mental health. While the current staff nursing shortage does not appear to be eliminated anytime soon, healthcare systems are working to improve working conditions and pay to maintain current staff nursing positions.