Al­ways on the move

Ag­ing boomers, pri­mary-care doc short­age keep trav­el­ing nurses in de­mand

Modern Healthcare - - THE WEEK IN HEALTHCARE - Rita Pyril­lis

When reg­is­tered nurse Pa­tri­cia Pitts gets called to fill in at a hos­pi­tal far from her Ge­or­gia home, she makes sure to pack the es­sen­tials first—a fry­ing pan, a rice cooker, a slow cooker and two ball gowns.

“I never go any­where with­out them,” said Pitts, 53, an ob­stet­rics nurse born and raised in Guyana on the north­ern coast of South Amer­ica. “I need to have my stews and cur­ries. They are a touch of home.”

As for the ball gowns, Pitts, a for­mer com­pet­i­tive ball­room dancer who likes to keep her moves sharp, said that she never knows when an op­por­tu­nity to fox trot might present it­self. “You want to be ready,” she said.

For the past 20 years, Pitts has been load­ing up her car and head­ing across the coun­try to work in hos­pi­tals in need of skilled, short-term nurs­ing help. She’s worked in New York, Texas, Michi­gan, Penn­syl­va­nia, Min­nesota and Wash­ing­ton, D.C., and is of­ten gone for months at a time.

“I’m hav­ing so much fun,” said Pitts, cur­rently do­ing a three-month stint at Nan­tucket (Mass.) Cot­tage Hos­pi­tal. “My job is a work­ing va­ca­tion. I pick a lo­ca­tion, and some­times I may not even know where it is. I told my agent that I was go­ing to drive all the way to Nan­tucket, and she said, ‘No, Pat, you can’t. It’s an is­land.’ ”

Pitts is one of thou­sands of reg­is­tered nurses, li­censed prac­ti­cal nurses and nurse prac­ti­tion­ers in the U.S. who travel around the coun­try and some­times the world, fill­ing in at hos­pi­tals, nurs­ing homes, dial­y­sis clin­ics and other health­care fa­cil­i­ties look­ing for ex­pe­ri­enced tem­po­rary nurses.

They are known as trav­el­ing nurses, and the de­mand for their ser­vices is grow­ing, said Gene Scott, spokesman for the National As­so­ci­a­tion of Trav­el­ing Health­care Or­ga­ni­za­tions. Rea­sons for that growth in­clude the num­ber of ag­ing baby boomers, the short­age of pri­mary-care doc­tors and the in­creas­ing need for preven­tive care, he said. Also fu­el­ing the de­mand is the new fed­eral re­quire­ment that nearly all Amer­i­cans have health in­sur­ance start­ing in 2014, he said. Ex­perts pre­dict a huge in­flux of newly in­sured pa­tients, many with chronic con­di­tions.

A grow­ing num­ber of hos­pi­tals are tap­ping trav­el­ing nurses to fill in while staff nurses train on new elec­tronic health-record sys­tems, said Scott, who also is CEO of Travel Nurse Across Amer­ica, a staffing agency in Lit­tle Rock, Ark.

In ad­di­tion, some health­care fa­cil­i­ties hire trav­el­ing nurses to fill in dur­ing la­bor dis­putes with staff nurses. That may lead staff nurses to eye travel nurses with sus­pi­cion. “Our per­spec­tive is the pa­tients don’t go on strike,” said Joe Gira, di­rec­tor of mar­ket­ing at Fastaff Travel Nurs­ing, an agency in Green­wood Vil­lage, Colo. “We’re there to help while hos­pi­tals work out their la­bor is­sues.”

Lor­raine Sei­del, CEO of the National Fed­er­a­tion of Nurses in Wash­ing­ton, said bring­ing in travel nurses dur­ing a strike only stokes re­sent­ment and an­i­mos­ity to­ward them.

“Some­times the hos­pi­tal sets us up against each other,” she said. “A lot of strike-break­ing nurses are money ori­ented. They get top wages, food al­lowances and they come in and say they want to work six days in a row, and the hos­pi­tals say they must com­ply un­der their con­tract. It be­comes a pull and tug.”

But Sei­del noted that not all trav­el­ing nurses are will­ing to work dur­ing la­bor dis­putes, and that most trav­el­ing nurses are skilled and ded­i­cated to their pro­fes­sion and to their pa­tients.

The Amer­i­can Hos­pi­tal As­so­ci­a­tion de­clined to comment for this ar­ti­cle.

De­mand for trav­el­ing nurses dipped sig­nif­i­cantly dur­ing the Great Re­ces­sion. But Joe Boshart, CEO at Cross Coun­try Health­care, said the in­dus­try has been slowly re­bound­ing. In 2012, an­nual rev­enue for the travel nurse mar­ket was es­ti­mated at $1.5 bil­lion, ac­cord­ing to an anal­y­sis by Staffing In­dus­try An­a­lysts, a re­search firm owned by Crain Com­mu­ni­ca­tions, the pub­lisher of Mod­ern Health­care. The three largest firms—AMN Health­care, Cross Coun­try Health­care and Aureus Med­i­cal Group—rep­re­sent about half of the mar­ket.

While the num­ber of trav­el­ing nurses is hard to pin down, Gira es­ti­mated that there are 25,000 ac­tively work­ing to­day, but he ex­pects that num­ber to grow.

The most com­mon rea­son why health­care fa­cil­i­ties turn to trav­el­ing nurses is sea­sonal de­mand, ac­cord­ing to the 2011 U.S. Hos­pi­tal Nurs­ing La­bor Costs Study by ac­count­ing firm KPMG. About 45% of hos­pi­tals sur­veyed said sea­sonal in­fluxes in places such as Arizona or Florida, where large num­bers of re­tirees flock ev­ery win­ter, led them to hire trav­el­ing nurses. About 41% cited nurs­ing short­ages, and 28% pointed to fa­cil­ity ex­pan­sion. Trav­el­ing nurses also have been called in to help af­ter dis­as­ters.

In a dif­fer­ent type of emer­gency, the Aug. 1 open­ing of a new free-stand­ing emer­gency depart­ment at the Univer­sity of Florida Shands Hos­pi­tal in Gainesville prompted hos­pi­tal of­fi­cials to hire trav­el­ing nurses this sum­mer, said Gayla Beach, di­rec­tor of em­ploy­ment and re­cruit­ing at Shands. The hos­pi­tal cur­rently em­ploys 21 travel nurses.

“We’re mov­ing our ex­pe­ri­enced staff nurses to that fa­cil­ity and bring­ing in trav­el­ers to help staff our ex­ist­ing ER,” Beach said.

Work­ing in new sur­round­ings with dif­fer­ent op­er­a­tions ev­ery few months means that trav­el­ing nurses must be quick stud­ies, Gira said. The level of train­ing that fa­cil­i­ties of­fer varies, he added. “Some hos­pi­tals will sim­ply ori­ent the travel nurse dur­ing their first shift,” he said. “Other hos­pi­tals will have a three-day ori­en­ta­tion that cov­ers hos­pi­tal pol­icy and pro­ce­dures, test­ing and unit train­ing.”

The chal­lenges don’t seem to de­ter new re­cruits, he said. Many are lured by the prom­ise of ad­ven­ture and big pay­checks. Gira said that some of his top nurses make more than $150,000 a year. As staff em­ploy­ees, Fastaff nurses also get med­i­cal, den­tal and vi­sion ben­e­fits and a 401(k) with a com­pany match, al­though those of­fer­ings are fairly stan­dard in the in­dus­try, he said.

The aver­age pay for a trav­el­ing R.N. is $25 to $50 an hour, com­pared with $35 an hour for a staff R.N., ac­cord­ing to the KPMG study. Trav­el­ing nurses in high-de­mand spe­cial­ties, such as ICU or la­bor and de­liv­ery, can make more.

But Scott said the num­bers over­state ac­tual take-home pay. The wages touted by many staffing agen­cies fac­tor in tax breaks on hous­ing and meals, and monthly stipends pro­vided by the agency to help nurses cover rent or mort­gage pay­ments while they travel, he said.

Some­times a trav­el­ing nurse de­cides to stay on per­ma­nently, some­thing that most staffing agen­cies say they are fine with. A few, such as Cross Coun­try, charge fa­cil­i­ties a small fee for hir­ing a trav­el­ing nurse per­ma­nently. It’s likely that more per­ma­nent nurses will de­cide to hit the high­way as the de­mand for trav­el­ing nurses grows, Boshart said. “The higher the level of un­met de­mand, the more likely a nurse is to be will­ing to give up the se­cu­rity of a staff po­si­tion.”

Thanks to so­cial me­dia, trav­el­ing nurses have formed a tight-knit com­mu­nity. Candy Treft, 43, launched her web­site, th­e­gyp­synurse.com, last year to pro­vide prac­ti­cal in­for­ma­tion to new and as­pir­ing trav­el­ing nurses, such as how to travel with pets. Three months ago, she also launched the Gypsy Nurse Face­book page.

Treft, a reg­is­tered nurse, is home­less by choice. A di­vorced empty nester with two chil­dren, she gave up her of­fi­cial res­i­dence in In­di­ana nine years ago. When she’s not work­ing, she stays with friends and fam­ily. She said that given the amount of time she spends trav­el­ing, keep­ing her old three-bed­room house didn’t make fi­nan­cial sense. Now ev­ery­thing she owns, aside from the pho­to­graphs and me­men­tos she stores at her fa­ther’s farm­house, fits into six Rub­ber­maid tote boxes that she takes with her.

It is not a line of work for the emo­tion­ally needy. “It takes some­one with a sense of hu­mor who can take the worst sit­u­a­tion and turn it into an ad­ven­ture,” Treft said. “There’s go­ing to be hard times.”

In ad­di­tion to spend­ing a lot of time alone and driv­ing long dis­tances to un­fa­mil­iar places, trav­el­ing nurses some­times en­counter hos­til­ity from staff nurses who fear los­ing their jobs, or have a low opin­ion of their itin­er­ant cousins.

“I’ve worked at hos­pi­tals where staff nurses were absolutely thrilled to have me on­board, while at oth­ers, it was an­i­mos­ity,” Treft said. “They think that you’re mak­ing the big bucks, so they make you do the hard work. Sev­eral years ago, travel nurses had a very bad name. We were viewed as nurses who couldn’t hold down a job or were drug­gies. You have to prove your­self.”

Oc­ca­sional re­ports about mis­con­duct and pa­tient care prob­lems in­volv­ing trav­el­ing nurses haven’t helped their im­age. In June, four trav­el­ing nurses at a hos­pi­tal in Water­town, N.Y., were ar­rested on al­le­ga­tions of il­le­gally dis­pens­ing drugs. In 2011, a trav­el­ing nurse in Cal­i­for­nia was ac­cused of caus­ing a pa­tient’s death through a med­i­ca­tion er­ror.

But Linda Aiken, an R.N. and a pro­fes­sor at the Univer­sity of Penn­syl­va­nia School of Nurs­ing, said the idea that trav­el­ing nurses are less qual­i­fied than those on staff is wrong. Her 2012 study showed no link be­tween trav­el­ing nurses and pa­tient mor­tal­ity. “We find that if any­thing, they are more qual­i­fied,” she said. “They’re more likely to have a spe­cialty, they tend to be younger, which is a pos­i­tive be­cause they are closer to their ed­u­ca­tion, and they tend to be more di­verse.”

An­gela Os­borne, 50, be­came an R.N. more than 20 years ago af­ter a di­vorce left her to raise two young chil­dren alone. She re­mar­ried in 2000, but her hus­band died eight years later. “My son was in col­lege and I was alone,” said Os­borne, who hails from In­di­ana. “I had al­ways wanted to travel, and my son’s girl­friend saw a sign ad­ver­tis­ing for trav­el­ing nurses. So I called it.” That was in 2011.

A few weeks later, she was fly­ing to Hawaii. “I was so ex­cited,” she said. “I knew that this was go­ing to be some­thing I loved. My grandma had been to Hawaii five times in her life, but I hadn’t been any­where. When we landed, I went to Waikiki beach and I thought of her.”

It was her first time on an air­plane. Since then, she’s been to 37 states and is shoot­ing for all 50, she said. The best part, she said, is load­ing up her red Ford pickup, pop­ping in a CD and hit­ting the high­way. “As soon as I start driv­ing, it’s like woo-hoo! I’m on my way.”

“I’m hav­ing so much fun,” Pa­tri­cia Pitts said. “My job is a work­ing va­ca­tion.”

An­gela Os­borne al­ways wanted to travel. She has been to 37 states as a trav­el­ing nurse and is shoot­ing for all 50.

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