June 15, 2023
During the COVID-19 pandemic, our country’s nurses were pushed to the brink. They risked their lives, faced burnout, and were overworked caring for patients as each new wave of the pandemic hit. According to a study released by the National Council of State Boards of Nursing, roughly 100,000 nurses left the workforce during the pandemic. When staffing was tight, hospitals, clinics, and other health care facilities nationwide used federal and state relief funds to hire travel nurses from private staffing agencies to work in short-term contract roles.
Travel nursing became a profession in the late 1970s in New Orleans, when hospitals were overwhelmed caring for sick tourists during Mardi Gras. Over the next decades, it became a way for staff nurses to get coverage when on maternity leave. And in recent years, it has transformed into a profit-driven business that hospitals pay steep figures for. And a large percentage of these steep figures do not directly go towards nurse wages; they are pocketed by the companies. Given how unregulated the private healthcare system is in the United States, private equity investors (unsurprisingly) jumped into the medical staffing industry when they had the opportunity to reap public dollars by buying up and operating traveling nurse agencies. There were a record 27 private equity deals in the medical staffing space during 2021 which is up from 11 deals in 2020 and well above any year over the previous decade.
As the figures display, there was a substantial gap between the lucrative temporary contracts of travel nurses and the wages paid to full-time staff nurses throughout the pandemic. The nurse professions included in this analysis are registered nurses, advanced practice nurses (nurse anesthetists and nurse practitioners), and, finally, licensed practical and licensed vocational nurses. Travel nurses were often paid much higher wages than these staff nurses even though workers were doing the same work side by side. Travel nurses already had a slight wage advantage over their staff counterparts in late 2019–prior to the pandemic. Figure 1 shows how this advantage dramatically increased through 2020, 2021, and 2022. The two main peaks in January 2021 and January 2022 likely happened as Covid cases, hospitalizations, and deaths surged in the United States, and hospitals felt the cost. At the peak wage in January 2022, travel nurses’ weekly wages were 148.1% higher than staff nurses nationally and 103.3% higher over the year as a whole (Figure 2). Travel nurse pay began declining in February 2022, and today it is much lower than at its peak.
In New York City, the publicly run Health + Hospitals network paid a single company, Rightsourcing, $1.2 billion to contract temporary traveling nurses in fiscal year 2022. This brought outrage from the New York State Nurses Association that represents permanently employed nurses across the city. The union was pushing for higher pay in contract negotiations at the same time and argued even a small portion of the millions spent on traveling nurse contracts could be used to raise wages for public sector nurses to parity with private sector nurse pay. Many union drives across the country were made more challenging by the infusion of travel nurses, considering that travel nurses are a non-unionized labor force that holds temporary jobs in high-need areas instead of specific facilities.
Poor staffing and low wages are not new problems for nurses. Hospitals have ignored the crisis of overworked nurses and understaffed facilities for decades, which is a main reason why nurses left and right are leaving the profession. Others choose to switch to travel nurse agency employment because it offered better pay and more flexibility to accommodate their lives.
Travel nurses filled a much-needed gap in staffing that hospitals faced during the pandemic. However, the infusion of a temporary, contracted workforce employed by large private corporations (backed by private equity) has dramatically altered the existing nursing profession and displayed the stark difference in wages compared to permanent staff nurses.
Legislators and advocates across the country are pushing to crack down on illegal price gouging; the practice of travel nurse agencies raising prices to an unfair extent to take advantage of the health crisis. There are proposed regulations across 11 states right now that cap the amount that travel nurse companies can charge healthcare facilities. The American Hospital Association wrote to the chair of the Federal Trade Commission in 2021 urging the agency to investigate anti-competitive practices and 200 lawmakers from both sides wrote to the White House to do the same in 2022. No steps have been taken from these initiatives. Swift and substantial federal and state action must be taken to address the new role travel nurse agencies play in the healthcare workforce, especially when profit is the priority of many of these staffing agencies.
These data make clear that permanent staff nurses must be paid more. Hospitals are increasingly operating like financial institutions without regard to pay and conditions of their staff when the budgets get tight. The entire healthcare system depends greatly on registered nurses, advanced practice nurses, and licensed practical and licensed vocational nurses. They are the largest occupational group among patient-facing workers in hospitals and urgent care centers, which means they need to be properly compensated. Here is specific legislation that had support from the National Nurses United during their national lobbying week in May 2023 on Capitol Hill.
Note: It is important to note that there isn’t comprehensive data on travel nurse earnings in the United States at this point. For this reason, this data byte relies on data from Vivian Health, a national healthcare hiring marketplace, which provides average weekly pay data for full-time travel nurse contracts (the precise number of days worked and hours can vary by contract). The data is predominantly registered nurses, but also includes advanced practice nurses and licensed vocational nurses. Vivian’s job marketplace has about 140K jobs open at any one time, and over the last 12 months the company had approximately 1.4 million jobs on its platform. Jobs are available in all 50 states across all urbanicities.