When the coronavirus disease 2019 (COVID-19) pandemic first hit the US, surges in various parts of the country, such as New York, motivated nurses to travel across the country to help during a public health crisis. In fact, this was one of the ways that America battled the first wave of the pandemic.
As temperatures got colder in the past month, we are seeing COVID-19 cases rising nationwide, which is going to present a much more complicated problem – one that cannot be countered by reallocating healthcare personnel based on areas of greatest need.
Health economist Joshua Gottlieb, a professor at the University of Chicago Harris School of Public Policy, has studied the phenomenon of nurses traveling to COVID-19 hotspots and found that the short-term nursing labor market has been very malleable during this crisis. Salaries for nurses able to see COVID-19 patients quickly rose and compensation became a motivator, as healthcare workers accepted positions far away from home for higher pay.
Gottlieb found that during the pandemic's initial surges, larger numbers of COVID-19 cases corresponded with higher compensation for nurses in those states. And while job postings for temporary nurse positions tripled across the board, they were even higher in regions where the impact of the pandemic was greatest. For example, postings for nursing jobs increased eightfold in in New York State, where the salaries nearly doubled.
“Although we focus on compensation, there can certainly be other motivating factors at the same time," Gottlieb said via email. “High compensation sends a signal about where nurses are most needed, so a desire to go where they can be most helpful could be part of the reason we see so much responsiveness to pay. If you want to go work where you can make a difference, seeing a high compensation offer is a credible measure of how desperately you're needed."
Gottlieb and his team used this opportunity to study the economics of non-traditional workers like traveling nurses. Healthcare facilities routinely hire short-term staff, such as during the flu season or during regular staff shortages.
Now with cases surging across the country, working conditions and resources are no better since the early days of the pandemic. Gottlieb's work sheds light on how simultaneous demand in various markets will affect the healthcare workforce and allow us to respond to the surge.
Ultimately, to combat this health crisis (or any future crisis), we would need an increase in the total number of nurses, which is not possible to accomplish in the short term. Hence, the only solutions may be longer working hours for nurses and reallocation of healthcare staff from less acute departments, both of which are already occurring.
One of the main conclusions of the study was that supply in the nursing market is very flexible and nurses are willing to enter the market where they are most needed. This is because healthcare facilities often have short-term needs and the traveling nurse market exists to fill this need, making the market rather elastic. And salaries are generally good incentives for the reallocation of such short-term workers.
Other than higher compensation, Gottlieb suggests that hospitals can also motivate healthcare workers by providing better resources. “Given the challenges and risks of doing these jobs, I suspect many prospective nurses also want to know that they will be protected and well treated," he said. “Ensuring an adequate supply of PPE, and good procedures for keeping clinical staff safe, is likely to be an important factor beyond pay in nurses' decisions of which job to take."
Loosening regulatory and legal barriers may also be critical. For instance, many states removed restrictions of scope of practice for nurses during the pandemic. “States' licensing modifications to increase flexibility could certainly have helped nurses get to where they were most needed, and be able to work there," said Gottlieb.
Another approach may be to make it easier for nurses from overseas to get into the country. “In an emergency it's especially important to reduce administrative and legal barriers to taking on new tasks," said Gottlieb. “Loosening visa or immigration restrictions would make it easier for workers to come from overseas."
In the early days of the pandemic, many states also made it easier for retired nurses to rejoin the workforce and nursing students to finish up their degrees quickly with fewer requirements. According to Gottlieb these are all good strategies, and providing adequate training to be able to perform these jobs under these conditions would benefit the individual nurse and society in the long run. “If we were to offer training in the key skills needed to care for COVID-19 patients, healthcare workers could use those new skills in the short term to alleviate the staffing crunch, and they'd benefit in the long term from having those additional skills."
