Question about travel staffing and "shortage" - page 2
by ixchel, rn 4,061 Views | 19 Comments
As I understand it, the idea of the nursing "shortage" is a sham right now, especially with new grads. Right? That's a pretty clear theme all over AN. My local hospital (serves a community of maybe 40,000 people without any... Read More
- 0May 27, '12 by chrissypsychRN09Hell, I know they're filling holes on my old unit with PRN staff or pulling staff from other units rather than allowing staffing from other units to use their PTO time. It's all about cutting costs. I asked about coming back on, knowing full well there are holes but my old NM has those holes covered by staff that aren't hers.
- 0May 28, '12 by NedRNActually the first reply (#1) was right on the mark. Estimates of the cost to recruit a nurse (or train a new grad) are 40K and up. Travelers are actually cheaper in this phase of the economic recovery. Businesses are unsure if increased business will continue and hire contingent staff. Translated into nursing lingo, travelers are hired when the census increases until the hospital is certain it will stay up. It can take considerable time before a hospital considers hiring more permanent staff during a recovery.
This always happens in economic swings and holds true in this one. Travelers were first to go (down a touch over 50 percent), and are the first to be hired when things get better (now). Simple answer, you do have a shortage of nurses in your area and the need is being met by travelers despite the ready supply of new grads (who need an expensive orientation period).
Your story of importing foreign nurses was pre-2007/8 when the nursing shortage was acute. That will eventually be the case again. Look for a real crunch in 2014 when the healthcare act takes full effect - if not voted back out.
Travelers cost more than staff in every respect otherwise. Familiarity with local conditions and culture, experience in a particular hospital, continuity of staff and morale, control over practice are all better for the hospital with permanent staff. Not to mention actual cost of travelers is higher.
That said, there are a number of conditions where hiring travelers is beneficial to a healthcare system. Upswings of census until hospital is sure there is no downswing. Seasonal shortages where hiring a year round employee costs more than a temp. Covering vacations, pregnancies, and leave. Finally acute regional or national shortages.
Staffing real shortages does cost more, but that is the nature of business - supply and demand. Real shortages bring about real increases in pay (what we've been seeing in nursing over the last 20 years as well as a steady rise in the number of travelers) which leads to more people becoming interested in nursing as a career, which leads to more nursing schools and graduates. The recent downturn is cutting waiting lists, and schools are closing. Wages and hiring is stagnant. And the cycle continues. However, all estimates are that nurses will be in short supply when full employment resumes and will be for the next several decades. Unfortunate for the new grads today though.
I graduated nursing school in California during a mild downturn in 1992 and was unable to land a hospital job in the state. I found a good one in Baltimore after many interviews nationwide, 9 months after graduating. California was a little behind the curve in that downturn, and other state economies were improving earlier. This "jobless" recovery of the last two years has been brutal for new grads but things will be getting better.Last edit by NedRN on May 28, '12
- 0May 28, '12 by NedRN2014 is when the healthcare act takes full effect. But nothing is certain. The Supreme Court could invalidate it, or Congress could vote to reverse it if the Republicans take control of Congress and the Presidency this fall. There are lots of reasons why our economy could also crash in the near future, many of them out of our control overseas. But probably things will be good for new grads in 2014.
You should understand that when viewed from above, travel nursing is a zero sum game. Every travel nurse position means one staff position cannot be filled. Travel nursing and registries do supply a vital safety valve role in the industry, but only to a point. I like to make a hubcap analogy. Back in the 80s, stealing hubcaps was popular and created a large new and used hubcap industry. Travelers also self-create jobs by leaving staff positions. This only happens in good times, when nurses are confident that travel jobs will exist. In bad times, they take staff positions. And that is exactly what happened in 2008, and travelers themselves helped to knock the travel industry back on its heels by 50 percent. Right now, future and former travelers are also insecure about what the future holds, just like hospitals, and are reluctant to travel and give up their for-sure job. Despite there being no where near as many travelers as in 2007, these dynamics have created a situation where hospitals don't want to hire permanent staff and are looking for travelers, but there are not enough. So you have a demand supply imbalance and travel (albeit on a smaller scale) that is good for travelers right now. Agencies have more openings than nurses.
There are other large dynamics that take place in nursing. Nursing is a tough job. There are around 2.7 million licensed RNs currently but historically about 400,000 RNs do not work as nurses. But in a downturn, many of those non-working RNs re-enter the workplace. Husband loses job, or has the potential, and economic uncertainty abounds. In economic downturns, people lose their jobs, causing a loss of insurance, and less healthcare is consumed. Even those who keep their jobs are afraid to do even necessary surgery much less elective surgery. You should be able to picture how these elements come together in perfect storms in nursing and in every industry nationally. Jobs create more jobs. Fewer jobs destroy jobs. Vicious or virtuous circles.
But the underlying trends look really good. Even if universal healthcare insurance is invalidated, portions of the law such as preexisting conditions should go on. If the healthcare act doesn't work, Congress could just widen Medicare to cover the entire population and raise premiums (FICA) - the Supreme Court could not stop that. The economy is getting better. And unions are putting pressure nationwide to pass staffing ratio laws. All of that should increase needs for nurses. And there is still a fundamental shortage that will become apparent as full employment eventually returns to the nation. So probably things will be good by 2014 for you to find a good staff position (recommend large teaching hospital with long internship), and then travel in 2016.
- 0Jun 2, '12 by ixchel, rnI would be a happy girl if I had a large hospital with internships here. It's a little bit small town where I live. It's intimidating to consider spreading my wings immediately after graduation to fly as a "competent" RN. I know now I'll be a nervous new grad. I'd love to feel like I had a tiny bit of a safety net, so to speak, by continuing my education through internship.
Thank you for your thoughts. I like hearing peoples' ideas about where nursing and medical care in general might go in 2014.
- 1Aug 9, '12 by theopenroad54It's been my experience that it is still much cheaper to hire travel nurses than it is to maintain full-time employees over the long term. The cost of orientation alone is much more cost-effective with a traveller. It's the difference between 1-2 days of orientation (if even that), and a minimum of 4-6weeks with a new hire, which really ties up 2 employees (the preceptor and the preceptee) and in most cases limits the amount of patients that this team can take on any given shift. And, as someone said above, if they don't like a given traveller, they can always just get rid of them, for whatever reason. This is all before the long-term needs of a given employee (insurance, PTO, etc). From what I've come to understand, when a hospital commits to a contract with a traveller, they present a base-line amount they will pay for the course of the assignment. This will cover all of the needs for both the traveller and the agency. Although this may seem like a high amount in the immediate situation, it is still much cheaper than maintaining an employee in the long run. Today, most hospitals are run on a corperate structure, not a non-profit structure, and the bottom line is everything.
As for the "nursing shortage", I don't believe this exists any more. It is merely a ploy used by the corporations to promote the lack of adequate staffing rampant in most hospitals. I came into this profession in the early/mid 90's, and can remember what the true nursing shortage was like, and it was seen most in the fact that for every 5 jobs applied for, you would get at the minmum 4 interviews and probably 4 offers. Now, it's more like 1-2 interviews for every 10 postions applied for. In the past 10 years, I've been on interviews and in managers offices where there are literally stacks of potential candidates, the majority of which are never even considered. Why should they hire 2 employees when they can push 1 to do the same amount of work? But this is a double edged sword in that it increases the possiibility for work-related injuries and patient care mistakes. It's a vicious cycle based on the need to improve that bottom line. And guess who suffers for it....the patients! As well as the staff who are given to injuries and reprimands that affect their ability to do there job properly.
The trend to hire mostly new grads is reflected in this. From my experience, hospitals hire new grads primarily for 2 reasons. 1) they can pay them a lot less than an experienced nurse, and 2) they can literally get the new grad to do things that an experienced nurse would balk at. This isn't to belittle any new grads or to short-change their general knowledge, but 5, 10, or 15 years or more experience, either on a particular floor or in the profession in general, can't and should never be replaced for the sake of some need for control or the bottom line. I presently work on a floor where the old-timers have only been on the floor for 5 years or less, and have seen new grads being oriented by nurses who have less than 1 year experience, and who are basically just out of orientation themselves. This is all related to the cost effectiveness issue, and is in its essence a managerial issue. There are bosses and there are leaders, and the trend these days seems to be pushing for "bosses" who, for all intents and purposes, have the ability to push others to do the very things that they can't do. This " little tin god" attitude doesn't like experience, because experience will question the safety and veracity of these demands. A true leader leads by example, not demands and flow charts or supposed acuity levels. This is Health Care, not business school. This is not a situation where if you miss a shipment of paper or something, things get slowed up a little. In this profession, when a mistake is made, peoples lives are affected. This should be the bottom line here, not some form of cost-effectiveness. Just my opinion.
- 1Aug 9, '12 by NedRNQuote from theopenroad54Nice, but I doubt that you could find a single hospital that would agree with you in principle. They are the experts since it is their money and they believe travelers cost them money and continuity. The only exception would be hospitals who need seasonal employees.It's been my experience that it is still much cheaper to hire travel nurses than it is to maintain full-time employees over the long term.
As for the nursing shortage, it is very real indeed. It is just being obscured by a number of factors. Census is down nationwide, thus needing fewer nurses. This is directly related to the economy as jobs still have not recovered, thus fewer people have insurance. Even those with insurance may not be willing to chance their jobs and be out for a needed procedure.
One hidden factor few people know about are the substantial investments and income that most hospitals relied on. Those are typically greater than operating income. That income dropped by more than half when the investments went south in 2008. So hospitals stopped hiring and made do with less, a situation that is still happening today.
This is evident in the increased workload of nurses. This is not optimal care and represents a functional nursing shortage. In the meantime, there is a ton of deferred care needs out there and when the ACA is in full effect in 2014, the need for nurses will explode. Right now, the travel nurse situation is almost back to where it was in 2007 in terms of open assignments versus available nurses.
Contingent staffing is a leading indicator of the state of the economy. Per diem registry and travel were the first to go in 2008, and they are the first to come back. New grads is a trailing indicator. Hospitals are not going to pay the significant expense of orienting new grads until they are certain that the census has recovered permanently.
So back full circle to the first theme of this post. In the near term travelers will be seen as cheaper in the short term than new grads until hospital administration is sure of the direction of their finances. Short term nurses versus long term nurses. So there are elements of truth in your analysis, but perhaps for different underlying reasons. In the long term, hospitals will again be stuck with hiring a lot of travelers because they need the staffing.
There is another economic circle here. Travelers fled in 2008 for the security of staff positions. When they feel secure that they can again travel, they will (and so will many nurses that have never traveled before). When a nurse becomes a traveler, there is a hole that must be filled in their former position. So travel will grow just because it grows!