Amid staffing shortages and rising hospitalization rates during the pandemic, many hospitals have relied on travel nurses to keep up with patient volumes—and while this practice is straining many hospitals' budgets, it's a trend experts believe will last beyond Covid-19.

The nursing shortage, discussed: A conversation with Advisory Board's top nursing experts

Hospitals are increasingly relying on travel nurses

Currently, there are more than 5 million nurses in the United States, including about 4.2 million RNs, according to the National Council of State Boards of Nursing. However, exhaustion, burnout, and other issues have led many to leave their full-time staff jobs to pursue less stressful careers during the pandemic. In addition, many have transitioned from full-time staff positions to travel nursing because of the increased pay and scheduling flexibility. 

How organizations can compete for nurses in the travel nursing era

Notably, the United States has enough nurses to fill the necessary full-time positions, according to Linda Aiken, a nursing and psychology professor at the University of Pennsylvania who researches workforce issues, but the issue stems from the harsh working conditions and inadequate pay that existed in full-time nursing since before the Covid-19 pandemic.

"This is not a failure of our supply of nursing," said Aiken. "It's really a failure of hospitals to invest enough of their resources, to have enough nurses working for them."

However, data from Indeed shows that interest in travel nursing continues to climb, with job searches now at more than five times the levels of pre-pandemic searches.

Zachary Shepherd, a 36-year-old ICU nurse, has worked as a travel nurse for the past four years. He has worked in ICUs in Covid-19 hot spots, including Newark, N.J. and Long Beach, Calif. Shepherd said he doesn't mind the uncertainty surrounding his work since he enjoys the flexibility associated with working as a travel nurse.

"I like the empowerment that I feel from being a traveler and having a lot more control over the direction of my career," said Shepherd.  

Meanwhile, hiring for staff nurses declined 3.2% in February 2022 compared with a year earlier, according to the U.S. Department of Labor.

"Everybody is searching for more staff, asking your staff to take on longer shifts," said Troy Clark, CEO of the New Mexico Hospital Association. "That encourages them to go, 'If I'm going to do all this work, I might as well go become a traveler and get paid a heck of a lot more.'"  

The rise of travel nursing brings budget concerns and wage gaps

In 2021, travel nursing revenue tripled to an estimated $11.8 billion, up from $3.9 billion in 2015, according to Staffing Industry Analysts. As a result, hospitals and health systems around the country have taken a financial hit from having to rely on highly paid travel nurses—with no clear fix in sight.  

The nursing shortage, discussed: A conversation with Advisory Board's top nursing experts

According to ZipRecruiter, during the Covid-19 pandemic, wages for travel nurses surged as high as 3.4 times the wages of regular full-time nurses in January 2021.

In addition, ZipRecruiter in January reported a 15% increase in average monthly postings for open travel nursing jobs. According to Sinem Buber, ZipRecruiter's lead economist, the increase will likely continue as the backlog of patients who need elective procedures return to hospitals and the population continues to age.

"I don't see the trend going down or getting flat anytime soon, even if the pandemic wanes," Buber said. 

Before the Covid-19 pandemic, the University of New Mexico Sandoval Regional Medical Center (SRMC) never had to rely on travel nurses. Now, their monthly payroll ranges up to roughly $1.5 million for around 60 travel nurses—almost half as much as the payroll for its full-time staff of 580, who receive around $3.3 million.

During the pandemic, SRMC lost almost a third of its 200 nurses to traveling positions, forcing them to increase staffing levels further to meet the increased demand of Covid-19 patients, said CEO Jamie Silva-Steele. With potential travel nursing costs of $18 million in 2023, Silva-Steele plans to replace 40% of the center's travel nurses with full-time staff by the end of June.

"We are not budgeted for another $18 million in compensation, so we have to have those strategies to gradually reduce those types of staff in the organization," Silva-Steele said. 

To reduce the financial strain brought on by travel nursing, many hospital administrators are making efforts to reduce the number of travelers—and some are considering not renewing travel contracts, Bloomberg reports.

Ultimately, "[w]e want our nurses and all of our clinical staff to be paid fairly, but we have to be able to keep the doors open," Clark said. (Gooch, Becker's Hospital Review, 3/16; Adegbesan, Bloomberg, 3/15)