About a month before the world turned upside down in 2020, Baylie Panzarello took a career step that proved happy.
Tired of waiting for more experienced nurses to advance in her career, Panzarello gave up her job as a staff nurse in Baton Rouge to try her hand at traveling. Travel nurses, also known as agency or contract nurses, are registered nurses who can travel throughout the country to meet the needs of the workforce. They usually earn higher rates than employees.
Two years later – even after overcoming the COVID-19 pandemic in the intensive care units from Baton Rouge to Boston – Panzarello does not see that she has returned to work. The salary is too high for us to refuse.
From what Panzarello has seen, she is not alone.
“Most of the nurses I go to now all travel,” said Panzarello, a 26-year-old nurse for a staffing agency called Aya Healthcare. She has worked in intensive care units at Tulane Medical Center, Ochsner University Hospitals and Clinics in Lafayette, Woman’s Hospital and even the Boston facility.
“This is exactly the case with the women’s hospital at their JIS,” she said. “I know this is almost the case of the Baton Rouge General at this point.”
The pandemic has created a conundrum for the nursing workforce in Louisiana. Healthcare executives said there was a shortage of nurses before the coronavirus and hospitals turned to nurses in record numbers as the patient population grew sharply.
Demand has driven up hourly rates for travel nurses through the roof. As a result, a lucrative salary persuaded some nurses to turn to agency life, exacerbating the problem.
Healthcare executives said they do not expect the use of travel nurses to remain so bloated, but in some cases they are still needed, which increases costs. They said long-term solutions were needed to address gaps in the workforce, such as investment in training programs and the salaries of nursing school faculties.
But in the near future, hospitals and nurses will be left to the daunting question: say yes or no to nursing?
“We didn’t have enough nurses to handle all the hospitalizations that took place and the critical state we were in at the beginning of the pandemic,” said Karen Lyon, general manager of the Louisiana State Board of Nursing. “We had to bring in a lot of travel nurses – and they came.”
Money, money, money, money
Determining the average wage for travel nurses is challenging. It may vary depending on market forces and private hospitals are not required to disclose cost details.
However, some Louisiana hospitals have given The Advocate a proverbial look behind the curtain.
Ed Halphen, vice president of human resources for the women’s hospital, said that before the pandemic, the typical rate was between $ 75 and $ 80 per hour for nurses. The Bureau of Labor Statistics estimates that the hourly rate for nurses nationwide was $ 39.78 in 2021.
For some units, such as the JIS, the agency’s rate has “almost doubled” in the last two years, Halphen said.
“At the time they are most needed, their prices are the highest,” he said.
Warner Thomas, president and CEO of Ochsner Health System, said rates were as high as $ 200 an hour. He also said that Ochsner’s temporary work costs – which include travel nurses – increased from $ 19 million in 2019 to about $ 160 million in 2021.
Baton Rouge General Health System paid $ 22 million for the workforce in 2021, 16% more than in 2020. Approximately $ 6.3 million of that was for contract work, the system said.
Edgardo Tenreiro, president and CEO of Baton Rouge General, said some experienced travel nurses across the country earn up to $ 250 an hour. This is in addition to the incentives paid to encourage nurses to make further changes.
“This is a nationwide problem. You’re just robbing Peter to pay Paul,” Tenreiro said.
Franciscan missionaries from the Virgin Mary’s health system and LCMC Health refused to provide specific numbers for The Advocate.
As part of the fight against scarcity and costs, the Ministry of Health commissioned the Federal Emergency Management Agency to overpay three agencies for staff nurses – SnapMedTech, AMI Expeditionary Healthcare and Safety Management – which provided extra work.
According to the Ministry of Health SnapMedTech, the state charged almost $ 428 million for its travel care services in two years. Meanwhile, AMI and Safety Management sent invoices for $ 49.4 million and $ 7.6 million, respectively.
Dr. Joseph Kanter, a state health officer, said the FEMA program had saved Louisiana hospitals from crisis management, which would force providers to choose who gets the bed.
“We got close,” he said. “We got too close.”
‘It’s hard to refuse’
Although the number of COVID-19 hospitalizations is the lowest here since the beginning of the pandemic, the ripple effect can still be felt in health care in Louisiana.
Some nurses, especially those of retirement age, have retired due to burnout. Others have chosen the lucrative life of travel nursing.
“Can you imagine being offered a $ 200 an hour and a $ 5,000 sign-up bonus? Lyon said. “It’s hard to refuse, no matter what happens.”
Panzarello, a travel nurse, said her contracts offer flexibility that staff work cannot. Her term of office can last from four weeks to 12 weeks and can be extended – or terminated – if she wants.
“You can just go. You can just get up and leave,” she said. “You don’t have to stay.” You don’t have that luxury with nursing staff.
But the concert is not just the sun and roses.
The introduction of travel nurses can cause friction in the hospital unit, Lyon said, because they are paid more and are less familiar with the culture, principles and procedures of the ward.
“Bringing a foreigner, whether he earns $ 25 more (per hour) than you, or whether he earns the same salary, can be very difficult to integrate quickly into this culture because they are outsiders,” she said. .
The pandemic also had another unintended effect: the “boomerang sisters,” as described by Missy Sparks, Ochsner’s vice president of talent management. These are nurses who went on a trip but returned to work.
“We welcome them back home,” Sparks said. “Some said, ‘Hey, I’m going to do this for six months, because if I can earn what I could earn in a year or two, and I can use it to pay for college.’ tuition, it seems like a good choice for me and my family. “
But the return of these nurses can “cause a lot of emotional suffering to the nurses who stayed and who felt loyal to their hospitals and their organizations,” Lyon said.
Panzarello acknowledged the tension. She said the sisters knew how to be “terrible.”
However, the benefits of travel nursing still outweigh the disadvantages, Panzarello said. Contracts are usually short enough to withstand stress.
She would still be in the game if she could. She and her husband are expecting a baby in July, which is why she has a break in travel.
“It simply came to our notice then. It hardly reflects the way hospitals operate at this point, “she said.” Why don’t you decide to do what you can earn in a year at Baton Rouge General and earn somewhere else in six months? “
Long term view
Louisiana’s health care leaders expect travel nurses’ use to plummet as pandemic hospitalizations hopefully remain low. However, labor shortages still persist.
According to the latest annual report of the Louisiana State Board of Nursing, at the end of 2020, 17% of RNs working and living in Louisiana – 9,331 – planned to leave their current position. The two biggest reasons for retirement were retirement and salary.
“I understand that we will continue to have at least a short-term shortage of about five years,” said Tina Schaffer, vice president of human resources for the Virgin Mary Regional Health Center at the lake. “I think organizations are doing things to get together so they can take care of their patients.”
Hospital officials said they were participating in staff recruitment training and scholarship programs. Kanter, a state health officer, said the nurses “deserved to earn more than their basic salary” and vouched for loan repayment programs to compensate for student debt.
But all hospitals are facing hard struggles to drive more graduates out of state nursing schools.
Although nursing schools in Louisiana have produced an average of 1,996 graduates per year over the past five years, according to the State Council’s annual report, they rejected an average of 1,400 qualified applicants each year within the same timeframe. The main reason is the shortage of skilled workers, which is mainly due to salaries that lag behind the national average.
The average salary of a professor of nursing in Louisiana in 2020 was $ 86,958. Meanwhile, the American Association of Nursing Colleges says the nationwide average of medical professors was $ 118,967.
Tenreiro of Baton Rouge General called the problem of the faculty and the applicant “a problem with bureaucracy.”
He said nurses needed a master’s degree to teach, but said nurses did not need a master’s degree to succeed in a clinical setting. He also called on the State Nursing Council to relax its rules so that licensed nurses who provide more routine patient care can take on more responsibility.
“The system is not able to respond to reality – it is not able and perhaps not even willing to respond accordingly,” Tenreiro said. “It’s a huge problem.”
However, Lyon argued that patients in 2022 were ill and needed a higher level of care, driven by “critical thinking and intellectual capital,” which came with a degree in registered nursing.
She added that it is more practical for nurses to study at an advanced level of practice to become a nurse, which offers more money and opportunities than teaching.
“You need to find ways and methods to improve faculty salaries to make nursing education as attractive as clinical practice,” Lyon said.