Luke Kelly was a registered nurse in Mercy Hospital’s cardiovascular intensive care unit when he decided in December it was time to become a travel nurse.
Stretched thin at Mercy, unhappy with the results from a lengthy hospital strike and wooed by the chance to more than triple his hourly pay, he filed his two weeks’ notice and soon embarked on a two-day, 1,300-mile drive to Miami for his first assignment: a 13-week contract at the University of Miami Health System that paid him $130 an hour.
“I find it hard to go back to making a third to do the same job,” said Kelly, a 30-year-old Town of Tonawanda resident.
Many nurses, fed up by working conditions that worsened during the pandemic, reached the same conclusion. They’ve seen colleagues retire early, pivot into medical office jobs or switch fields entirely. They waded through multiple waves of a pandemic that drained them emotionally, worked constant overtime that overwhelmed them physically and, especially early on, felt the stomach-churning worry that they could bring Covid-19 home from the hospital and infect their families. Then Covid vaccine mandates depleted their ranks further.
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And there’s concern more could depart: More than one-third of 2,500 nurses who participated in a recent national survey said it was very likely they would quit their job by the end of 2022.
Amid this supply-starved nursing market – one survey of upstate New York hospitals found a 25% registered nurse vacancy rate as of Jan. 1, up from about 18% a year earlier – rates for travel nurses skyrocketed at one time to as high as $200 an hour. By comparison, the average hourly wage for a registered nurse in a U.S. hospital is about $41 an hour, federal data show.
Perhaps no issue looms larger for Western New York’s hospitals, paying huge costs to agencies and desperately searching for permanent employees to lessen their reliance on travelers. Hospital executives, seeing their bottom lines squeezed, are pressuring politicians and regulators to rein in what they view as price gouging by some staffing firms.
Nurses say hospitals need to improve working conditions if they want travel nurses to return to permanent posts.
Those staffing concerns, no doubt, are taking center stage right now as Western New York’s largest health system, Kaleida Health, negotiates a new labor contract with the two unions representing nearly two-thirds of its workforce.
And sure, rejuvenating a tired health care workforce is the major driver behind the state’s multiyear, $20 billion plan for the industry, including $1.2 billion to pay certain health care workers bonuses of up to $3,000. A traveler, however, can make $3,000 in a week – or in just a couple days in some of the larger contracts.
But as Covid hospitalizations remain low, even the travel workers wonder: This booming market can’t last forever, can it?
Kelly, for one, has seen rates drop recently, though jobs within his specialty continue to pay more than $100 an hour. He extended his contract in Miami for four weeks, at $105 an hour, through May 4. After that, he’ll start a new contract May 10 in an outpatient lab at Strong Memorial Hospital in Rochester, also at $105 an hour.
And while some local hospitals report a slight easing in travel nurse rates and usage, it’s unlikely they can stop employing agency workers anytime soon – especially in preparation of a state safe staffing legislation that mandates specific plans be implemented by Jan. 1.
Maybe the rates are the product of a nurse staffing crunch years in the making that can’t be solved overnight.
“You need a nurse as soon as possible that needs absolutely no training, that can jump into whatever role you throw at them,” Kelly reasoned. “You’re going to have to pay for it.”
‘Pandemic just lit it on fire’
Let’s rewind a little bit – back before Kelly was a nurse, before he worked in construction while attending nursing school or before he was even born, for that matter.
It’s 1989, and newspapers are reporting increasing nursing vacancy rates instigated by heightened workload and frustration. A story in The Buffalo News quotes local nurses turned entrepreneurs, busy advising attorneys on malpractice cases or starting their own businesses – including their own travel nursing firms.
The groundwork for the nursing predicament today may have been laid many years earlier.
AMERICA’S NURSES are trading in bedpans for briefcases. Because of dramatic changes in the health care system, nurses are going on strike, negotiating four-day work weeks and extra weekend pay. And many are even saying goodbye to hospitals and hello to corporate settings. Consider this: A recent survey by the Hay Group, a Washington, D.C., management firm, shows that
Cori Gambini, a nurse of 37 years and a local union president negotiating with Kaleida, said unions spoke to hospital administrators 15 years ago about a nursing shortage that was likely to pop up around 2022 as an aging workforce neared retirement age. Meanwhile, nursing schools have struggled to expand capacity to enroll more students.
A biannual national nursing workforce survey backed that up: While the number of active registered nurses hit about 4.2 million at the end of 2019, up 6% from 2017, the median age of a nurse was 52 years old. Further, nearly one-fifth of the nurse workforce was at least 65 in 2019, up from 15% in 2017 and 4% in 2013.
And pre-pandemic, hospitals increasingly managed the workload by matching staff to the number of occupied beds, employing travelers for short-term moments of peak demand. Some frustrated unions call this “just-in-time” staffing.
“So that growth had always been there,” said Barry Asin, president of Staffing Industry Analysts. “Then the pandemic just lit it on fire in just all sorts of different ways.”
In fact, Staffing Industry Analysts forecast the U.S. travel nursing market hit $11.8 billion in 2021, up a whopping 40% from 2020 and more than double the 2018 figure.
Asin, a Western New York native, said the market has remained strong so far in 2022, though his firm expects it to slow later this year – assuming the pandemic continues to ease.
“The pandemic just accelerated and exposed the trends and the flaws that were already there,” he said. “That’s really what’s happened. I think nursing in hospitals will never be the same. I think it will be decades probably before this all sort of straightens itself out.”
‘That’s when I decided to put my two weeks in’
Registered nurse Cassidy Rae Payne worked her last shift at Buffalo General Medical Center on Jan. 14 – and what led to that moment can be traced back to staffing issues that worsened in early fall when the Mercy strike began and redistributed patients across the region’s hospitals.
Before that, Payne would have no more than six patients to care for during a shift. But soon that became seven patients. Then she started caring for patients boarded in hallways.
A couple weeks before her final shift, she came in to find she was one of three nurses working in a 36-bed unit – 30 of them full.
As her responsibilities increased, so did the guilt. She was moving as fast as she could, but having more patients meant she was unable to spend as much time with each one. Some of the basic tasks, like giving a patient a bed bath, fell by the wayside. Fellow nurses were getting into travel work – something that, amid the pandemic-induced workforce reshuffling, becomes contagious.
“Each of us had 10 patients each,” said Payne, 25. “That’s when I decided to put my two weeks in and look into travel because it was very unsafe, and I was not getting my break.”
One month after the strike began, the Buffalo Niagara region’s other hospitals are grappling with more patients, patients are facing longer wait times for emergency services as volumes increase and others are seeing their elective surgeries postponed due to a lack of available beds.
The Niagara Falls resident is on her first travel assignment at Newark-Wayne Community Hospital, 30 miles east of Rochester, and recently extended the contract for 10 weeks, through July 2.
She’s making triple what she made at Buffalo General, and she’s caring for fewer patients – no more than five a day so far. She typically works three consecutive days while staying in a Rochester-area hotel, then spends her days off home in Niagara Falls.
“It’s actually 10 times better,” Payne said. “My patient ratio is very good compared to what I was dealing with in Buffalo.”
Kelly, the former Mercy nurse, said that while it was a no-brainer to travel because of the money, hitting the road to work in a new environment in a new place on short notice still isn’t easy – especially when you have to quickly find a place to live.
Heading to Miami meant being apart from Katie, his girlfriend of seven years, his two dogs and the home he owns in Tonawanda. He had flown home for a couple days in mid-February when he met with The Buffalo News – his dogs, Gary and Gwen, excitedly by his side, relaxing only when he caved and gave them peanut butter, their tongues lapping in the background while he spoke.
The very next week, when Kelly was back in Miami, 8-year-old Gary had to be put down after battling an aggressive cancer. Kelly wasn’t there to say goodbye.
“I know now why they’re paying what they do because, you know, you leave everything behind,” he said.
‘Not much they can do but pay it’
For hospitals, the cost of using travelers adds up – fast.
The Iroquois Healthcare Association surveyed its membership – more than 50 health systems across 32 upstate counties, east of Rochester – to find out just how much. Twenty-nine hospitals responded, reporting total spending on staffing agencies of $171 million last year, up 90% from $89.5 million in 2020. Further, many of those hospitals reported spending had not slowed through the first two months of 2022.
Buffalo’s Catholic Health System, meanwhile, spent $42 million on staffing agency costs last year – and that did not include tens of millions for strike-replacement workers at Mercy, Chief Financial Officer David Macholz said.
Said another way: A new full-time registered nurse working overtime would cost half of what a travel nurse would, he added.
Kaleida Health, engaged in labor negotiations, declined to comment for this story.
In mid-November, however, Kaleida CEO Robert Nesselbush said the system had about 100 agency personnel under contract, 70 through a state staffing agency contract referral. The cost of those 70 agency workers, who worked 50-hour weeks, was about $400,000 per week – meaning each worker, on average, cost Kaleida $5,714 a week, including agency fees, he said.
Health care employment across the country is down by 524,000 since February 2020, with nursing and residential care facilities making up about 80% of the loss, according to the U.S. Bureau of Labor Statistics.
Erie County Medical Center, meanwhile, paid nearly $2.8 million to its go-to staffing firm Supplemental Health Care in 2021, up from about $410,000 in 2020, according to its annual reports. Pre-pandemic, ECMC spent $75,380 with Supplemental Health Care in 2019, spokesperson Peter Cutler said.
“Nobody likes having to use agency nurses,” said Thomas J. Quatroche Jr., ECMC’s president and CEO. “Hospitals don’t like it. Unions don’t like it. The other nurses in the building don’t like it, but it became a necessity to make sure we could care for our patients.”
And while hospitals and trade groups have called on government regulators to take action on staffing agency prices, only a handful of states, including Massachusetts, have wage caps.
Gary Fitzgerald, president and CEO of Iroquois Healthcare Association, said he has one member hospital spending $750,000 a week on agency staff, dipping deep into their cash reserves for the unbudgeted expense.
“They kind of have the hospitals really in a tight spot because in order to keep their units open, their ERs open, they need those nurses,” he said, “so there’s not much they can do but pay it.”
Several staffing firms contacted for this story declined to comment or did not return messages. Staffing Industry Analysts, which does a bimonthly survey of travel nurse staffing firms, said the median agency has exceeded 100% year-over-year revenue growth since August 2021.
Seeking to lessen their reliance on agencies, local hospitals are racing to hire new nurses.
That means battling for a limited pool of new graduates and offering large incentive payments that trigger after set periods to improve retention, said Laura Cianflone, Catholic Health’s vice president of human resources services. In addition, Catholic Health even created its own internal staffing agency during the pandemic’s last major wave, giving health care workers the ability to work across many settings, including taking assignments at any of the health system’s hospitals.
“It’s not just business as usual anymore,” she said. “It’s really making sure that we are flexible, able to change where we need to and just make this a place that people want to work, and they don’t want to leave.”