Agency or travel nurses have long been used to fill sporadic staffing gaps but never in the numbers or at the cost seen during the COVID-19 pandemic, which transformed a long-simmering nursing shortage into a full-blown crisis.
The crushing and seemingly unending workload exacerbated by shortages of personal protective equipment and the psychological strain of so many deaths from COVID-19 led some nurses to quit the profession entirely. Others left their employers for positions with less stress, while some opted for more money. And nowhere was there more money to be made than in travel nursing.
Surveys conducted in 2021 measured significant uncertainty among nurses about remaining in their jobs. McKinsey & Company found that 22% of nurses nationally were thinking about leaving their current positions while 42% of nurses responding to a survey in Washington State said they had thought about or made plans to leave the profession.
According to the New York Times, Aya Healthcare, one of the larger staffing companies, was booking 3,500 RNs a week in the summer of 2021, double the number before the pandemic. Travel nurses during the pandemic were earning salaries ranging from $6,000 to $10,000 a week, up from a weekly average of $1,700 in 2019. Hospitals were in such dire need for nurses, they had to pay whatever rates the agencies demanded, often using COVID-19 relief money or funds from the Federal Emergency Management Agency to do so.
In a letter to the White House COVID-19 response coordinator, the American Hospital Association and the American Health Care Association/National Center for Assisted Living called for an investigation of staffing agencies, accusing them of exploiting the shortage of nurses by “charging uniformly high prices in a manner that suggests widespread coordination and abuse of market position.” The organizations asserted that the agencies had raised prices by two to three times the prepandemic rates while keeping up to 40% of the fees for themselves.
To counter the high pay offered by travel nursing agencies, hospitals made efforts to retain staff nurses, including offering bonuses that ranged in 2021 from $500 at a hospital in Dallas to $1,500 at a hospital in Ann Arbor, Michigan. Others offered sign-on or retention bonuses: $15,000 at Penn State Health in Hershey, Pennsylvania, $20,000 at Baptist Health System in San Antonio, Texas, and as high as $40,000 for experienced nurses at Monument Health in Rapid City, Michigan.
Hospital industry leaders say the rates charged for travel nurses during the height of the pandemic are unsustainable, especially as state and federal funding support ends. Demand for these nurses will also likely fall as the number of COVID-19 patients declines. The question is, how many nurses will return to hospital employment and how many will leave the profession because of trauma and exhaustion? The fallout from COVID-19 on top of preexisting staffing shortages is likely to present workforce challenges for hospitals long after the pandemic subsides.—Karen Roush, PhD, RN, FNP-BC, news director