How a Bidding War for Covid-19 Nurses Hurts the Pandemic Response
BY MARKIAN HAWRYLUK & RAE ELLEN BICHELL, KHN
She remembers her
employers telling her and her colleagues to “suck it up” as they struggled to care
for six patients each and patched their protective gear with tape until it
fully fell apart. The $800 or so a week she took home no longer felt worth it.
“I was not sleeping
and having the most anxiety in my life,” said Tripeny. “I’m like, ‘I’m gonna go
where my skills are needed and I can be guaranteed that I have the protection I
need.’”
In April, she packed
her bags for a two-month contract in then-Covid hot spot New Jersey, as part of
what she called a “mass exodus” of nurses leaving the suburban Denver hospital
to become traveling nurses. Her new pay? About $5,200 a week, and with a
contract that required adequate protective gear.
Months later, the
offerings — and the stakes — are even higher for nurses willing to move. In
Sioux Falls, South Dakota, nurses can make more than $6,200 a week. A recent
posting for a job in Fargo, North Dakota, offered more than $8,000 a week. Some
can get as much as $10,000.
Early in the pandemic,
hospitals were competing for ventilators, Covid tests and personal protective
equipment. Now, sites across the country are competing for nurses. The fall
surge in Covid cases has turned hospital staffing into a sort of national
bidding war, with hospitals willing to pay exorbitant wages to secure the
nurses they need. That threatens to shift the supply of nurses toward more
affluent areas, leaving rural and urban public hospitals short-staffed as the
pandemic worsens, and some hospitals unable to care for critically ill
patients.
“That is a huge threat,” said Angelina Salazar, CEO of the Western Healthcare Alliance, a consortium of 29 small hospitals in rural Colorado and Utah. “There’s no way rural hospitals can afford to pay that kind of salary.”
Hospitals have long
relied on traveling nurses to fill gaps in staffing without committing to
long-term hiring. Early in the pandemic, doctors and nurses traveled from
unaffected areas to hot spots like California, Washington state and New York to
help with regional surges. But now, with virtually every part of the country
experiencing a surge — infecting medical professionals in the process — the
competition for the finite number of available nurses is becoming more intense.
“We all thought,
‘Well, when it’s Colorado’s turn, we’ll draw on the same resources; we’ll call
our surrounding states and they’ll send help,’” said Julie Lonborg, a
spokesperson for the Colorado Hospital Association. “Now it’s a national
outbreak. It’s not just one or two spots, as it was in the spring. It’s really
significant across the country, which means everybody is looking for those
resources.”
In North Dakota, Tessa
Johnson said she’s getting multiple messages a day on LinkedIn from
headhunters. Johnson, president of the North Dakota
Nurses Association, said the pandemic appears to be hastening a
brain drain of nurses there. She suspects more nurses may choose to leave or retire early after
North Dakota Gov. Doug Burgum told health care workers they could stay
on the job even if they’ve tested positive for Covid-19.
All four of Utah’s
major health care systems have seen nurses leave for traveling nurse positions,
said Jordan Sorenson, a project manager for the Utah Hospital Association.
“Nurses quit, join
traveling nursing companies and go work for a different hospital down the
street, making two to three times the rate,” he said. “So, it’s really a kind
of a rob-Peter-to-pay-Paul staffing situation.”
Hospitals not only pay
the higher salaries offered to traveling nurses but also pay a commission to
the traveling nurse agency, Sorenson said. Utah hospitals are trying to avoid
hiring away nurses from other hospitals within the state. Hiring from a
neighboring state like Colorado, though, could mean Colorado hospitals would
poach from Utah.
“In the wake of the
current spike in Covid hospitalizations, calling the labor market for
registered nurses ‘cutthroat’ is an understatement,” said Adam Seth Litwin, an associate professor of
industrial and labor relations at Cornell University. “Even if the health care
sector can somehow find more beds, it cannot just go out and buy more
front-line caregivers.”
Litwin said he’s glad
to see the labor market rewarding essential workers — disproportionately women
and people of color — with higher wages. Under normal circumstances, allowing
markets to determine where people will work and for what pay is ideal.
“On the other hand, we
are not operating under normal circumstances,” he said. “In the midst of a
severe public health crisis, I worry that the individual incentives facing
hospitals on the one side and individual RNs on the other conflict sharply with
the needs of society as whole.”
Some hospitals are
exploring ways to overcome staffing challenges without blowing the budget. That
could include changing nurse-to-patient ratios, although that would likely
affect patient care. In Utah, the hospital association has talked with the
state nursing board about allowing nursing students in their final year of
training to be certified early.
Meanwhile business is
booming for companies centered on health care staffing such as Wanderly and
Krucial Staffing.
“When Covid first
started and New York was an epicenter, we at Wanderly kind of looked at it and
said, ‘OK, this is our time to shine,’” said David Deane, senior vice president
of Wanderly,
a website that allows health care professionals to compare offers from various
agencies. “‘This is our time to help nurses get to these destinations as fast
as possible. And help recruiters get those nurses.’”
Deane said the company
has doubled its staff since the pandemic started. Demand is surging — with
Rocky Mountain states appearing in up to 20 times as many job postings on the
site as in January. And more people are meeting that demand.
In 2018, according to
data from a national survey, about 31,000 traveling
nurses worked nationwide. Now, Deane estimated, there are at least 50,000
travel nurses. Deane, who calls travel nurses “superheroes,” suspects a lot of
them are postoperative nurses who were laid off when their hospitals stopped doing
elective surgeries during the first lockdowns.
Competition for
nurses, especially those with ICU experience, is stiff. After all, a hospital
in South Dakota isn’t competing just with facilities in other states.
“We’ve sent nurses to
Aruba, the Bahamas and Curacao because they’ve needed help with Covid,” said
Deane. “You’re going down there, you’re making $5,000 a week and all your
expenses are paid, right? Who’s not gonna say yes?”
Krucial
Staffing specializes in sending health care workers to disaster
locations, using military-style logistics. It filled hotels and rented dozens
of buses to get nurses to hot spots in New York and Texas. CEO Brian Cleary
said that, since the pandemic started, the company has grown its administrative
staff from 12 to more than 200.
“Right now we’re at
our highest volume we’ve been,” said Cleary, who added that over Halloween
weekend alone about 1,000 nurses joined the roster of “reservists.”
With a base rate of
$95 an hour, he said, some nurses working overtime end up coming away with
$10,000 a week, though there are downsides, like the fact that the
gig doesn’t come with health insurance and it’s an unstable, boom-and-bust
market.
Amber Hazard, who
lives in Texas, started as a traveling ICU nurse before the pandemic and said
eye-catching sums like that come with a hidden fee, paid in sanity.
“How your soul is
affected by this is nothing you can put a price on,” she said.
At a high-paying job
caring for Covid patients during New York’s first wave, she remembers walking
into the break room in a hospital in the Bronx and seeing a sign on the wall
about how the usual staff nurses were on strike.
“It said, you know,
‘We’re not doing this. This is not safe,’” said Hazard. “And it wasn’t safe.
But somebody had to do it.”
The highlight of her
stint there was placing a wedding ring back on the finger of a recovered
patient. But Hazard said she secured far more body bags than rings on patients.
Tripeny, the traveling
nurse who left Colorado, is now working in Kentucky with heart surgery patients.
When that contract wraps up, she said, she might dive back into Covid care.
Earlier, in New
Jersey, she was scarred by the times she couldn’t give people the care they
needed, not to mention the times she would take a deceased patient off a
ventilator, staring down the damage the virus can do as she removed tubes
filled with blackened blood from the lungs.
She has to pay for
mental health therapy out-of-pocket now, unlike when she was on staff at a
hospital. But as a so-called traveler, she knows each gig will be over in a
matter of weeks.
At the end of each
week in New Jersey, she said, “I would just look at my paycheck and be like,
‘OK. This is OK. I can do this.’”
Markian Hawryluk and
Rae Ellen Bichell report for Kaiser Health News.
This article was
originally published by Kaiser Health News and
is republished here under a Creative Commons license.