Question about travel staffing and "shortage"

MN-Nurse, ASN, RN · May 26, 2012

And if there are so many people scrambling for jobs, why are hospitals still relying so heavily on travel staffing? It is so much more expensive, unless I'm missing something.

They can use the travelers whenever they need them, and get rid of them when they don't.

The same thing happens in many other industries; companies hire temporary workers until demand is so high they are more profitable hiring regular staff.

ixchel · May 26, 2012

I would agree if the trend weren't to keep them on so long. It was honestly rare that these nurses would stay on for only one or two 13-week contracts. They typically were staying for 3 or longer. Considering they're probably spending at least $30 more per hour on them, it seems crazy. Our community had at any given time, 6-12 apartments with this staffing agency, each with one nurse, sometimes also the nurse's family/significant others. Wouldn't it make more sense to hire a half dozen per diem nurses?

ETA: I should also mention that this wasn't the only staffing agency used regularly with this hospital. There were two agencies that this hospital used. The second agency didn't seem to hold onto nurses as long, though.

canesdukegirl, BSN, RN · May 26, 2012

I don't understand either. Travel nurses are frighteningly expensive, and your description of what travel nurses are paid is pretty accurate. When I traveled, I was paid $42/hr, had all of my utilities (except for cable/internet) paid for, had a relocation allowance of $1,000, a weekly meal allowance of $400, weekly travel/gas allowance of $200 and a $500 bonus if I renewed my contract. I got a $1500 referral bonus for every nurse that I recruited to the company. It was a very nice set-up!

I suspect that the HR department is not doing a good job recruiting new nurses. It seems like they just keep putting a band-aid on staffing shortages by continuing to employ travel nurses, which would seem like a poor way to do business. I agree with you-why don't they put resources/money into training new grads? Is the pay rate really low at your hospital? When I traveled, the hospital offered me a permanent position...at $21/hr. When I told them that I made more than that as a new grad 13 years ago, the best offer they came back with was $23/hr. Although it was a nice hospital and I loved working there, it was located in a resort area with a very high cost of living. The closest hospital was 75 miles away, so there was no competition; thus the low pay rate. Perhaps this is the same scenario with your hospital.

ixchel · May 26, 2012

I'm not sure what the pay rate is actually, but I do believe it is low. I've just heard their CNAs make as little as $8.50/hr. I've heard numbers as low as $23, but they were just rumored. It seems to me it would make more sense to stop paying traveling companies and hire twice as many new grads at $30/hr and treat them well enough to want to stay.

Stephalump · May 26, 2012

Are they currently relying on travel staff? I saw you mentioned you noticed this years ago...

Years ago, there WAS a shortage. When my mother graduated NS in 2002, she had hospitals lining up, throwing sign on bonuses at her. Travel nursing was booming and lucrative. Hospitals she worked at were wooing nurses from the Philippines to come work their floors.

Around 2009 it all slowed down and has been going downhill ever since. My state has a relatively strong economy/job market, but there's no desperation out there anymore - for new, grads, at least

If your local hospitals are STILL in extreme need, I'm sure there are hundreds of AN new grads who wouldn't mind relocating.

pinkiepie_RN · May 26, 2012

i think it could also have to do with the fact that travel nurses don't go through as intensive orientation as new staff. That might be cost-saving.

Meriwhen, ASN, BSN, MSN, RN · May 26, 2012

i think it could also have to do with the fact that travel nurses don't go through as intensive orientation as new staff. That might be cost-saving.

In addition, hospitals don't have to provide benefits (medical, retirement, etc.) or PTO for travelers. That's a very big cost-saver right there.

ixchel · May 27, 2012

The 3 of you right above me make very valid points. That could be the case. Although I still think I'd rather train my own employees the way I want things done rather than hope the traveler can do it in a way I find acceptable.

ImKosher · May 27, 2012

Travelers are much cheaper then hiring full time employees with benefits. It may seem $55 an hour is a lot. Think about the full time employee. They have Insurances, annual training, paid time off, and other stuff. It has nothing to do with new grads. Like another person said, it's flexible. Once the traveler's contract is done, they can wish to sign on another term, but the hospital can turn them down. It's a cost saving method.

pinkiepie_RN · May 27, 2012

Hell, 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.

NedRN · May 28, 2012

Actually 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.