As Financial Pressures Rise, Hospitals Cut Traveling Nurses

As Financial Pressures Rise, Hospitals Cut Traveling Nurses

From VTD

USA – In April, nurse Courtney Peters was working a six-week Covid stint as a traveling nurse when she got a call from her local hospital. It was a job offer.

At the time, Peters, who’s in her 30s, was working long days at her Massachusetts hospital, as Covid cases surged.

The offer from Brattleboro Memorial Hospital, where she had worked off and on for more than a decade, was appealing. Her hefty traveler’s salary didn’t make up for the grueling work schedule, she said. National reports of shortages of personal protective equipment made her nervous.

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“You want to be part of a safe team,” Peters said. She accepted a 13-week gig at Brattleboro, and then extended it. Six months later, she’s still there.

For hospital officials, the phone call to Peters marked part of a two-year effort to cut down on pricey contract nurses and instead turn to former staff members and local help to fill gaps in staffing.

“The nursing shortage is huge, so you have to put in this effort,” said Jodi Stack, the hospital’s chief nursing officer.

In the spring of 2018, the 61-bed hospital had roughly a dozen traveling nurses, about 10% of its overall nursing staff.

On July 19, 2020, the hospital hit the milestone it was aiming for: Bidding goodbye to the last traveling nurse, Stack said.

Brattleboro Memorial’s success is part of a widespread effort among Vermont hospitals to cut down on expensive temporary staff.

As Covid increases financial pressure and exacerbates workforce shortages, health officials are doubling down on their efforts to reduce dependence on traveling nurses and replace them with full-time staff. They’re partnering with nursing schools, increasing wages and providing education reimbursements to bring nurses to Vermont, and then keep them here.

Some hospital officials say they’ve made strides. Whether they can continue to keep staff nurses will have implications both for the health care system and for Vermonters in nursing school hoping to get jobs in-state.

Hospitals “are doing some really creative things,” said Jeff Tieman, CEO of the Vermont Association of Hospitals and Health Systems. But as patient numbers change or staffing evolves, success may not be permanent. “One can stem the tide, but to do so permanently, it’s still a tall order,” he said.

The Legislature passed bills this session creating $1.6 million in scholarships for nursing and other medical students and making it easier for nurses from other states to receive licensure in Vermont.

“The nursing shortage is huge,” said Sen. Ginny Lyons, D-Chittenden, chair of the Senate Health and Welfare Committee. “Anything that hospitals are doing to attract nurses is a good thing. We need to continue to support folks who are going into the nursing field, and we need to think about how we can pay them better once they get there.”

Growing demand
Vermont government and health care officials have long warned of a looming nursing shortage.

“If we don’t begin planning now, Vermont will face a critical shortage of nurses in the near future,” said U.S. Rep. Peter Welch, D-Vt. at a press conference in 2008. The demand would be especially acute in rural areas, he said.

For years, hospital officials have complained to regulators that staffing shortages contribute to their financial challenges.

“Financial stability is directly linked to workforce, and our workforce challenges are driving cost inflation in our system that we feel helpless to [rein in],” said Shawn Tester, CEO of Northeastern Vermont Regional Hospital at a public forum late last year.

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A nurse bandages a patient at Central Vermont Medical Center.
A 2018 Vermont Talent Pipeline study estimated that Vermont would have job openings for 3,900 nurses by April 2020. The demand likely isn’t that high yet, Tieman said, though the exact number isn’t known. As of 2017, about 8,500 registered nurses were practicing in Vermont, as well as about 1,300 licensed practical nurses, and 3,400 licensed nursing assistants.

The pinch is growing nationally as well. More than 500,000 registered nurses are expected to retire by 2022, according to the U.S. Bureau of Labor Statistics. If that plays out, there will be more RN jobs available than any other profession.

“We’re not alone, but we do have an acute shortage,” Tieman said, noting that recruiting can be even more difficult in rural areas.

Hospitals have historically filled staffing gaps with travel nurses. Facilities recruit through nursing agencies, which post job listings for health care workers around the country. They offer short-term stints, usually 13 weeks, typically in specialty areas such as the operating room or emergency department, where it’s harder to find and train nurses.

Travel nurses come at an extravagant cost — about double the price of a full-time staffer. Hospitals pay fees to the nursing agency, as well as the salary and housing for the nurse. There are additional hidden costs in the frequent turnover, of more training and a lack of consistency within the hospital, Stack said, of Brattleboro Memorial Hospital.

The Covid-19 pandemic has increased both price and demand for the travelers. Hospitals in coronavirus hotbeds around the country have ramped up recruitment of traveling nurses to meet the skyrocketing demand. Pay for those nurses has spiked as well, rising to as much as six times higher than typical traveler nurse salary. Some were promised as much as $10,000 a week during the height of the pandemic.

In comparison, an RN in Vermont makes about $34 an hour on average, or $69,000 a year, according to national nursing salary data. That’s slightly below the national average.

The true cost is more than just the salary; hospitals must also cover the costs of training, onboarding, and turnover, according to Stack. “It’s a strain on our resources,” she said.

In 2018, the hospital increased pay and benefits, as part of its negotiation with the nurses’ union. Brattleboro also hired more staff, so nurses didn’t feel overburdened.

The challenge is “not just to get nurses in the door, but to retain the nurses we have,” Stack said.

The following year, the Brattleboro hospital launched a graduate RN residency program to recruit recent grads and help them transition into hospital jobs. Nurses chosen for the program participate in several months of classes and work under an instructor, and then apply for an open job in their chosen department.

Interest appears to be increasing in the program, Stack said. Last year, the hospital had 12 applicants for six slots. This year, it had 28.

Fun factor has vanished
The hospital started allowing nurses to take short-term stints away, to work at other hospitals as travel nurses, then return to their positions in Vermont, as a way to allow for greater flexibility and training. They also started recruiting per-diem nurses to temporary slots.

That’s how Peters returned to Brattleboro. For her, it felt like a welcome home.

There was assurance in returning to a job where Covid was under control, she said. When she left for Massachusetts, she had packed her own personal protective equipment and masks, unsure of whether there’d be a sufficient supply at the hospital.

“I don’t really want to put myself into the middle of that,” she said.

Peters had pursued travel nursing to see different parts of the country, and eat out and explore the area in her free time. She worked in Hawaii last winter. Most of that has ended with the arrival of Covid.

“The fun of being a travel nurse has kind of been lost in the last six months,” Peters said. Now, she’s ready to settle down — at least for the time being.

A public health nurse from the Vermont Department of Health gathers a specimen from Tim Jermain of Essex Junction at a Covid-19 testing site in Winooski on Thursday, June 4, 2020. Photo by Glenn Russell/VTDigger
Other hospitals have also pursued alternative avenues to hire. Rutland Regional Medical Center and Southern Vermont Medical Center have hired students from Castleton University — nearly all the program’s students get jobs, said Angie Smith, assistant dean at Castleton’s school of nursing.

In 2017, Gifford Medical Center in Randolph launched an LPN-to-RN training program, which allows nurses to pursue education and transition seamlessly into a new job, said spokesperson Ashley Lincoln. Two people are currently enrolled in the program.

Unable to find staff last year, Gifford contracted with a Florida nursing agency to hire international nurses to work as long-term travelers.

Stymied by a virus
Covid increased demand for workers, especially in long-term-care facilities. Some health care workers, who couldn’t work at home, had to take time off to care for family members or children.

For some hospitals, that has slowed efforts to wean off travelers. Gifford, like Brattleboro, had aimed to halt use of traveling nurses this year. But the target date of September fell through, when several staff members resigned to help children with virtual learning, and provide for family needs, as well as to make career changes, Lincoln said. So Gifford extended the travelers, who make up about 4% of staff, she said.

Vermont’s success with the virus has also drawn nurses to the state’s largest hospital, said Peg Gagne, interim chief nursing officer at UVM Medical Center. Some want to leave New York or other metropolitan areas in the wake of Covid. Others are fleeing West Coast fires. “People are wanting to relocate to Vermont and we’re trying to capitalize on that,” she said.

That’s not to say they’ve eliminated travel nurses entirely.

UVM Medical Center has budgeted for 76 traveling nurses in the current fiscal year starting Oct. 1, down from 111 full-time equivalents in fiscal year 2020. Porter Medical Center and Central Vermont Medical Center, affiliates of UVM, both cut their numbers of contract nurses by about a third.

Early on in the pandemic, UVM Medical Center hired dozens of traveling nurses to meet an expected surge of Covid patients. The surge never came, as the hospital suspended unnecessary appointments. The medical center continued to pay traveling nurses, even as it offered remaining work to full-time employees, Gagne said.

Travel nurses will remain necessary to cover leaves of absence, to fill staff vacancies before a full-time candidate is found, and until new staff members complete their orientation, she said.

Home grown nurses?
In spite of the high demand, it’s not easy for Vermonters to seek nursing degrees. The Vermont colleges that offer nursing programs — Castleton, Vermont Tech, UVM, and Norwich — often have waiting lists.

It’s hard to find faculty, said Rosemary Dale, chair of the UVM nursing department. Nursing faculty are paid less than someone with similar credentials who gets a job in a hospital, she said.

“You’d get 60 applications for a job for an English professor. If we got two applications, we’d be lucky,” she said.

It can also be hard to find clinical placements for students in hospitals. Students aren’t experienced enough to be useful to the hospitals, who need extra staff to volunteer to work with them.

UVM has 600 nursing students — 450 undergraduates, 100 grad students and 50 who are taking courses, but aren’t totally enrolled. Just over half of those who graduate take a job in-state, Dale said.

Castleton’s program has grown slowly but steadily since 2014, said Smith, Castleton’s assistant dean. This year, Castleton launched a master of science in nursing.

“All of our graduates potentially have a job, you know, waiting for them in Vermont when they get out,” Smith said.

But it’s not just supply and demand that are challenging. Vermont State Colleges were threatened with closure earlier this year, and the financial instability makes it hard to plan, Smith said. When she recruits students, she wants to be sure they’ll be able to have access to the resources they need. Smith’s long term goal is to expand. Short term, “it’s wait and see,” she said.

This year, Northwestern Medical Center and Vermont Tech created a new campus for 18 students in St. Albans. Northwestern was providing scholarships for three students in exchange for a commitment to work for two years at the hospital, said spokesperson Jonathan Billings.

“The emphasis is on training local folks who already have a connection to Vermont and northwestern Vermont,” he said. “The grow-your-own nurses is really promising for us.”

Among those home-grown nurses is Clayton Sabine, a per-diem nurse at Brattleboro who works in critical care. He was born at the Brattleboro hospital, and has worked various staff jobs and departments. He signed on as a temporary staff member in March and, like Peters, stayed.

The effort to hire and keep staff creates a snowballing effect that leads to retention, he said. More staff members can ensure that nurses feel supported and don’t burn out. They have time to pursue education. Better qualified and better educated staff provide better care and create a better work environment, he said.

That’s why he stays at Brattleboro, he said. There’s “the sense that you can do your job — you have the time, you have the tools, you have the support,” he said.

That’s the goal, agreed Stack. “We want you to want to stay,” she said.