Why do hospitals hire travellers?

Editorial Team / Admin · Jul 28, 2013

No one wants to work for them. Some places have an incredibly toxic environment where the word has spread or other clues exist. For example, when I was applying for my first job, all the local hospitals but one paid slightly over $20. The outlier was offering over $30. Now why on earth would one hospital be offering over $10 more? Their reputation for treatment of nurses and patient ratios was absolutely horrendous- no one wanted to work there. Other reasons may include the requirements of the job. Whenever the cardiac OR team has an opening, it takes forever to fill it or the person who took the position doesn't last. Of the last 6 people who left, the reason they cited leaving was the amount of call we have to take. It is a lot, and for those who are unfamiliar with having to take call, it can be quite a culture shock when they realize how time-consuming it ends up being. We ended up hiring several travelers to cover our vacancies during the extended time it took to hire someone.

NedRN · Jul 28, 2013

Start by thinking about seasonal needs. South Florida, for example, just about doubles in the winter. Paying a nurse year round doesn't make sense. Next think about regional shortages, and rural shortages. The first is cyclical, the second need is chronic. Next think about vacation season, and pregnancy leaves. Finally, think about the underlying nursing shortage. It is real, you just might not recognize it if you are living in Mississippi.

California has a unique legal situation with their staffing ratio laws - by law they have to be well staffed. Here is where the underlying nursing shortage is really apparent despite excellent staff pay - they just cannot get enough permanent staff. Most nurses in regions where there is no nursing shortage, mostly in the South, don't want to leave home and relocate. Thus you have a need for staff however you can get it. The nature of hospital business is that you may not be able to afford raising pay and improving working conditions enough to attract new staff, but you can afford 1 to 5 percent higher cost contingent staff.

umcRN, BSN, RN · Jul 28, 2013

At our hospital we moved two of our ICU's to much larger units, nearly doubling our occupancy. Management didn't think though that because we had more beds we would instantly have more patients...but they were so so wrong. Both units exploded and we barely kept afloat. They started hiring travelers AND permanent staff like crazy, however those coming on as staff needed a much more in depth orientation (4-6 months depending on experience) where as travelers could come work instantly. So we used travelers to bridge us in gaining adequate staff. It's taken almost a year but our use of travelers is now dying down as we have enough trained staff.

llg, PhD, RN · Jul 28, 2013

Also, traveler's are competent to provide safe care almost immediately upon hire. They don't need or expect any real orientation, benefits, committment to a good schedule, etc.. They come in as "hired guns," fill a temporary need with no long-term committment toa relationship ... and leave when they are no longer needed.

mlbluvr · Jul 28, 2013

No one wants to work for them."

I would never have guessed that as a reason, fascinating!

mlbluvr · Jul 28, 2013

Start by thinking about seasonal needs. South Florida, for example, just about doubles in the winter. Paying a nurse year round doesn't make sense. Next think about regional shortages, and rural shortages. The first is cyclical, the second need is chronic. Next think about vacation season, and pregnancy leaves. Finally, think about the underlying nursing shortage. It is real, you just might not recognize it if you are living in Mississippi. California has a unique legal situation with their staffing ratio laws - by law they have to be well staffed. Here is where the underlying nursing shortage is really apparent despite excellent staff pay - they just cannot get enough permanent staff. Most nurses in regions where there is no nursing shortage, mostly in the South, don't want to leave home and relocate. Thus you have a need for staff however you can get it. The nature of hospital business is that you may not be able to afford raising pay and improving working conditions enough to attract new staff, but you can afford 1 to 5 percent higher cost contingent staff.

I mentioned having a pool in my post- that would give them nurses on call for whatever the reason. Isn't the the nature of a pool of nurses? But thanks for the other information (the small cost of having a few expensive replacements on hand, especially)- but I'm sure the 'nurse shortage' message will get the gang going wild in here. Seems like there's a constant disconnect in perception. As Judi Dench so eloquently said in Notes on a Scandal: "Takes courage to recognize the real, as opposed to the imagined."

mlbluvr · Jul 28, 2013

Also, traveler's are competent to provide safe care almost immediately upon hire. They don't need or expect any real orientation, benefits, committment to a good schedule, etc.. They come in as "hired guns," fill a temporary need with no long-term committment toa relationship ... and leave when they are no longer needed.

True enough, though- but why use not a local agency, unless it IS that the locals know the place suks, and won't go there, and travellers don't have the inside scoop on what places might suk? I'm loving the input, still, I can't get a handle on the fact that some places have to 'import' nurses, when the masses are crying foul- we have no jobs, etc. It's like a hospital I know of in the SW that imported a boatful of Phillipino nurses, because of the 'nursing shortage' (even though I know of FIVE local nurses that cannot find a job, anywhere?).

aTOMicTom · Jul 28, 2013

[h=1]Why do hospitals hire travellers? [/h]

Thanks for asking this - and for all the fascinating answers. I have been hanging back since joining AN recently and wondering what the rationale for travelling nurses is. Now I know!

Gotta admit I thought it was purely from hospital greed, glad to see I was (partially) wrong! :)

meanmaryjean, DNP, RN · Jul 28, 2013

There are millions of unemployed nurses, everywhere. And the pay of nurses is plummeting in many places. They could hire some of those milions, even to just have a pool of staff on call. Yet they pay huge $ for the travellers (salary, big housing allowances from the agency, food, etc., plus I'm sure the agency gets a big fat slice of the cash pie). I don't get it. Not in this economy anyway. The 80's, that makes more sense.

Well, there are not 'millions' of unemployed nurses 'everywhere'. There are pockets of unemployment which affect mostly new graduates. And pay is not 'plummeting'. Yes, there are some workplaces which have eliminated differentials/ weekend option / bonus pay, and even fewer workplaces have decreased wages by as much as 5%. Hardly 'plummeting'.

The travel nurse option has contracted substantially to reflect these realities. But there is, and probably always will be, a mismatch between the number of experienced nurses needed in some locations and the number of experienced nurses living in those areas. The reason there are still travel nurses? Simple supply and demand. Economics 101, Week One.

Esme12, ASN, BSN, RN · Jul 28, 2013

True enough, though- but why use not a local agency, unless it IS that the locals know the place suks, and won't go there, and travellers don't have the inside scoop on what places might suk? I'm loving the input, still, I can't get a handle on the fact that some places have to 'import' nurses, when the masses are crying foul- we have no jobs, etc. It's like a hospital I know of in the SW that imported a boatful of Phillipino nurses, because of the 'nursing shortage' (even though I know of FIVE local nurses that cannot find a job, anywhere?).

Money the short answer is money.....it is cheaper in some instances to hire travelers than have permanent staff. Seasonal employment is a big reason like FL with tourists and the snow birds. Those "boatload" of Filipino nurse are very inexpensive to hire through the agency. Local agencies on a day by day basis are more expensive than traveler contracts AND the locals know if a facility really stinks and has a toxic environment.

NedRN · Jul 28, 2013

So why travelers versus local agency has been posed as a question. That is a valid question only in fairly large urban areas that can support a local agency or even several. Large regions of the country have no local agencies. If you cannot support a local agency, you can also not support a hospital pool - except possibly in nurse saturated places like the South.

Next, why do hospitals have permanent staff at all? Control, and continuity of a good healthcare culture is the answer. Even when local registry is available, travelers with a contract provide much better continuity of care than a new random nurse every day. Ask your manager which sort of nurse she would prefer and her answer would be staff first, then traveler, then registry. A regular registry or pool nurse is very acceptable of course, but by their very nature, usually not dependable. They seek part time work for a reason.

Imported nurses are the next best thing to staff as their contracts are typically one year or more. They are not inexpensive - pretty darn close to a regular travel nurse bill rate, a bit lower because they are usually new grads. High cost is largely the urban myth that also says travelers make $100 an hour. It takes a long time to import nurses and train them, and it takes a very long term view from the hospital management perspective to go that route. Communication skills (English) also add to the real cost of using imported nurses. I can promise you that if American staff nurses were an option, management would go that route.