Corona Daily 231: Travel Nurses

Laura Liffiton, a 32-year-old nurse, worked in an overrun ICU in a crowded New York city hospital in April. In July, she flew to Arizona, where she lost four patients on her first day. In October, she travelled to Green Bay, Wisconsin. She has been sleeping only four hours a night. In different cities, she has seen overwhelmed doctors and nurses, lines of intubated and dying patients, with no end in sight to the misery of the situation.  

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Laura is one of the fifty thousand or so travel nurses in the USA. They work on temporary contracts, and move from city to city. For some, travelling is the motivation, for others money. Early-career nurses want to work in different places to gain experience. Those nearing the end of their careers, with little family burdens, want to use their last few years of work to increase their retirement savings. In normal times ICU and medical surgical nurses are the highest in demand.

Specialised agencies bill the hospitals and provide the “travelers”, who stay in hotels, Airbnbs or rented apartments. They usually stay in one place for three months. The three months were historically granted as a maternity leave, during which a travel nurse would replace the one on maternity leave.

When natural disasters such as hurricanes or tornadoes strike, travel nurses serve a useful function. They reach the hot spot, work in the disaster zone, and then leave.

What is happening this year is unprecedented. In November, the demand for travel nurses went up by 44%. California, Texas, New York, Florida and Minnesota are the five states with the worst shortages.

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Now, more than 100,000 Covid patients are hospitalized every day in the USA. Ordinarily a nurse, particularly in ICU, serves a maximum of two patients. Now, nurses are looking after eight. The governor of North Dakota has allowed covid-positive doctors and nurses to continue working, as long as they are asymptomatic. The University of Utah hospital has been using 36-hour shifts for nurses and the state of Iowa has run out of staff beds.

In summer, travel nurses were mainly needed to help in operating rooms on postponed cases and backlogs from the spring wave. In normal times, hospitals scrutinized the resumes to carefully select the best candidates. Now they specify only the number. Like the rush to get the vaccines, there is a rush to get the travel nurses.

The dynamic between the staff nurses and travel nurses is complicated. In a Sacramento hospital, only staff nurses were given higher quality equipment such as air-purifying respirators. With travel nurses earning substantially more, staff nurses are bound to feel upset. Some of them have left their permanent staff positions to become travelers.

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The prices for travel nurses are skyrocketing. Before the pandemic, hospitals would pay $75 an hour, now it is three times more. A traveler can earn anywhere from $5000 to $10000 a week. On top of that, now hospitals are asking for travelers for vaccination. Joe Biden wants America to give 100 million shots every month. Rural hospitals are struggling to find money to pay the high rates for travelers.

The never-ending work is risky. One organization has identified 922 frontline health workers who died of covid after helping the patients.

High pay has drawn more supply, but because this profession requires training and qualifications, there is a limit to the supply. There just aren’t enough nurses. The agencies are shuffling nurses in what they call robbing Peter to pay Paul.

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In my view, the USA needs to take the extraordinary step of expanding the travel nurse concept to nurses from overseas. Countries like India and the Philippines, with relatively fewer cases now, would be able to provide a few thousand nurses on an emergency basis.

Ravi