Wage Discrepancies Between Staff Nurses & Travel Nurses
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“I’d love to see a way for us to be able to elevate nurses, close the wage gap, and show all nurses that we value them.”
Rachel Norton, Critical Care RN
The Covid-19 pandemic highlighted several problems in how health systems staff their facilities, with one of the starkest consequences being the wage discrepancy between core nursing staff and travel nurses. At the height of the pandemic, during the omicron variant’s surge, some travel nurses earned up to $10,000 weekly; the average nurse salary nationwide is well under $2,000 per week (BLS May 2021).
For decades, travel nurses have been used as a way to handle short-term upward fluctuations in patient flow, especially during flu epidemics. But typically, those fluctuations would only last a few weeks, with travel nurses providing core nursing staff with a temporary boost. The persistent and severe wage discrepancies during the pandemic created a vicious cycle: as more staff nurses took on travel jobs to capture higher pay, more staff shortages appeared, increasing demand for travel nurses to fill the gaps.
As the urgency around Covid-19 begins to subside, wage discrepancies between staff nurses and travel nurses have shrunk slightly, but they’re still inordinately high. Part of the reason for this is that the underlying issues related to nurse staffing existed long before the Covid-19 pandemic, and they persist today. Nurses and nurse advocates are now looking beyond short-term fluctuations and working to put systems in place that properly value and support nursing staff.
Meet the Experts: Dr. Katie Boston-Leary & Rachel Norton
Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC
Dr. Katie Boston-Leary is the director of nursing programs and co-lead for Project Firstline at the American Nurses Association (ANA). She has been an RN for 27 years, specializing and certified in perioperative nursing, nursing administration, and executive leadership. She is also adjunct faculty at the University of Maryland School of Nursing and adjunct faculty at the Frances Payne Bolton School of Nursing at Case Western Reserve University.
Dr. Boston-Leary has been invited to Capitol Hill in Washington, DC with the American Organization of Nurse Leaders to discuss the havoc of regulatory burden on hospitals. In 2019, she was identified by Health Leaders Journal as One of Five Chief Nursing Officers Changing Healthcare.
Rachel Norton, BSN, RN
Rachel Norton has been an RN since 2007. She has always worked in critical care, spending the first 12 years of her career based in Albany, working for a level I trauma center in their surgical neuroscience trauma ICU.
Norton also worked as a flight nurse for LifeNet of New York on various bases across the state, took on multiple travel assignments since 2010, and ultimately landed in Denver, where she remains per diem in the ICU at The Medical Center of Aurora. As a user researcher at National Hiring Marketplace Vivian Health, she advocates for healthcare workers and works to help bridge the gap between employee and employer expectations.
The Origins of the Wage Discrepancy Between Staff Nurses & Travel Nurses
Travel nursing was already growing in popularity between 2009 and 2019, but the pandemic completely broke the old models of its math. In March 2020, there were approximately 12,000 job opportunities for travel nurses, a figure double what was available in 2019; by December 2020, the number of job opportunities for travel nurses was up to 30,000 (NYT 2022).
While travel nurses have historically earned more than their core staff counterparts, to compensate for reduced job security, the astronomical wage discrepancies seen during the pandemic were a sign of serious and systemic underlying problems with nurse staffing.
“Even pre-Covid, nurses were short-staffed and understaffed, always running a little tight,” Norton says. “Over the years, we’ve been asked to do more things and take on more responsibilities without any additional compensation. A lot of nurses just burned out. They were sick of not having the proper resources.”
Health systems are deep in the financial red for 2022, and many are looking to recoup costs by once again leaning on their already stretched-thin nursing staff. But cuts to non-medical support staff and technology budgets only make the problem worse. Some nurses are turning to travel jobs not just for the higher pay, but for fresh work environments.
Even as the pandemic recedes, wage discrepancies are inordinately high. There are some barbed questions as to why health systems and hospitals would continue to overpay for temporary fixes rather than invest in long-term solutions that effectively support all nurses.
“Just because a health system or hospital is in the red doesn’t mean they’re on the brink of bankruptcy,” Dr. Boston-Leary says. “There is room to maneuver, to restructure, and to redistribute resources.”
Why Nurse Shortages Are Persisting Post-Covid
While the urgency of the pandemic is receding, nurse shortages are persisting due to several factors. The Baby Boomer generation heading into old age is creating its own complex healthcare crunch; pent-up demand from people who held off seeking healthcare services during the pandemic is now trickling in; and nurses are reporting high levels of stress and an increased desire to leave the healthcare workforce.
“When nurses aren’t properly valued, there are consequences,” Dr. Boston-Leary says. “Recently, we’ve seen large numbers of nurses leave the workforce, we’ve seen nurses state their intention to retire early, and we’ve also seen strikes.”
Vivian Health’s 2022 report on the state of the healthcare workforce found 63 percent of survey respondents were considering leaving the workforce in the next five years; only 43 percent said the same a year ago. Notably, that increase comes despite 73.5 percent of respondents reporting an increase in compensation over the same time period.
“Part of the issue has to do with pay,” Norton says. “But a lot of it also has to do with the burnout and moral injury nurses felt before the pandemic. So while there are some travel nurses who are looking to move back into permanent staff positions, they’re looking for hospitals that are going to show them that they are valued.”
Many health systems build nursing shortages into their business model to reduce costs. (Better to ask nurses to overperform situationally than to have them underperform expensively, perhaps the thinking goes).
This is a dangerous and unsustainable practice. Nurse shortages lead to worse patient outcomes, while appropriate staffing reduces mortality rates, reduces the average length of stay, and reduces hospital readmissions.
“More staff at the bedside equals better care,” Norton says. “There’s no way around that.”
How to Effectively Support Staff Nurses & Travel Nurses
In January 2022, a collaboration of five professional organizations, the Partners for Nurse Staffing, launched the Nurse Staffing Think Tank. (Dr. Boston-Leary was one of the representatives from the American Nurses Association.) In tackling a multi-variable problem, the think tank proposed a multi-pronged set of solutions, of which total compensation was only one part.
Key areas of focus in the think tank’s report included:
- Promoting a healthy work environment
- Supporting diversity, equity, and inclusion
- Building a flexible workforce with flexible scheduling
- Addressing stress and including nurse well-being as an organizational value
- Implementing innovative care models (e.g., a tribrid approach that balances on-site care, IT integration of patient monitoring, and virtual or remote care)
- Instituting a formalized total compensation program
“Health systems and hospitals need to show nurses that they value them,” Dr. Boston-Leary says. “If you can provide nurses with dignity and respect, you will boost retention, you will attract new talent, and you will see improved outcomes.”
Vivian Health has also researched how healthcare workers look for and assess job opportunities. Their research team talks to nurses weekly to learn more about what they want from their jobs, and what they don’t. For nurses, traits such as mental well-being, staff ratios, and respect continue to rank higher than ‘benefits’ when selecting what’s important to them. Offering flexible schedules and making nurse-centric decisions can help health systems retain veteran nurse staff members; prioritizing retention bonuses over sign-up bonuses can make a difference, too.
Nurses are the lifeblood of the American healthcare system. It does not work without them. An increased focus on the retention of core staff nurses is critical, especially for low-wage and rural areas. Nurses who remain at the same healthcare facility can more quickly grow into nursing leaders, who, in turn, foster attractive work environments.
Part of this is a data problem: if more healthcare administrators had a dashboard clearly displaying the cost of an understaffed nursing unit, versus the value of an appropriately staffed one, wage discrepancies might return to a more healthy balance more quickly. But both Norton and Dr. Boston-Leary are hopeful that health systems will value all nurses more accurately instead of simply reducing compensation for one group of nurses.
“Nurses are humans taking care of humans,” Norton says. “This volatility in pay isn’t something we’re used to. The pandemic was the first time that some nurses really felt like they were being paid how they deserved to be paid. We were highlighted as heroes. There was all this clapping. Then, as soon as it’s over, it’s back to dropping wages and cutting rates, and it’s just really disappointing. I’d love to see a way for us to be able to elevate nurses, close the wage gap, and show all nurses that we value them.”