Ally and Zane Ferguson of Conway are travel nurses who met on their first assignment seven years ago for Travel Nurses Across America. The past two years of the pandemic have greatly increased the need for travel nurses and put unprecedented pressures on many different types of health care professionals.
“I wouldn’t say that being a travel nurse has been harder during the pandemic, but I’ve seen more death and suffering over the past two years than I have my entire career,” said Ally Ferguson, who most recently has been on assignment in Olympia, Wash. “Before the pandemic, I could count on one hand the number of times I performed chest compressions during a code.
“Since the pandemic, it’s tripled. I never dreamed that I would be in the middle of comfort care holding a patient’s hand as they pass and look out a window and see people protesting vaccine mandates.”
Ally said the job has been much more demanding during the pandemic, not just with patients, but also trying to provide education to families as well, with so much misinformation coming from the media.
Zane said he has seen more deaths in the last two years than in his entire career, mainly because previously, most people got better and left the unit.
“The past two years, the majority of people have died on our unit, and that’s not because we weren’t trying,” he said. “In fact, we were doing everything we knew how and then some just to see what might work, and they were still dying.”
Zane said not only do travel nurses leave their families and homes, but they also work in unfamiliar environments, help treat sick people and deal with combative/aggressive patients and families. And sometimes they do it with little to no support from either companies or hospitals.
“I’m fortunate enough to work for a company that always has my back,” he said. “But I know of several nurses who have been treated unfairly in certain situations with no one there to help them. Nurses in general don’t get paid enough, and we saw that with the surge of travel nurses that occurred during the pandemic.
“The value of a nurse to help your loved ones or yourself through what could potentially be the most critical time of their life is invaluable. When a hospital has to restrict visitors, and no one can be with their loved ones when they’re dying, the travel nurse or any nurse becomes the family to be the only one present as the patient passes away. You can’t put a price on a good compassionate nurse.”
Paid too much?
Action has been discussed on the state and federal levels to cap the salaries of travel nurses. But Tim McKenzie, president and CEO of Travel Nurse Across America (TNAA), based in North Little Rock, said it should be noted that a traditional traveler’s pay package includes the hourly pay rate plus subsidies for temporary housing while on their assignment, plus meals and incidentals.
What often gets published is the combination of all three of those amounts. McKenzie said when the combination of all three of those amounts is compared to the hourly pay rates of permanent staff, it can appear exaggerated.
“A traveler is typically operating under a short-term contract — 13 weeks is the industry average,” McKenzie said. “They most often are required to find short-term housing, in many cases in a very tight housing market, which is often expensive. Housing subsidies and meals and incidentals are regulated by geography. Rates are ultimately set by the hospitals and vary from market to market.
“A travel nurse is requested when the census in the hospital is such that additional staffing is needed to appropriately staff the unit. Travelers are requested by specialties — ER, ICU, NICU, etc. — based on the needs of each unit in that health care facility. Oftentimes, they are required to have at least two years of experience in acute care settings consistent with the type of hospital unit they apply with. They’ll also need to have nurse licensing requirements consistent with each state where they may choose to work.”
McKenzie said pay packages for travel nurses vary by specialty and have varied significantly during various phases of the pandemic. Currently, with hospitalizations due to COVID-19 falling across the country, pay packages are declining significantly from their peaks during the omicron variant. And it is not unusual that travel nurse assignments will be canceled due to lower patient levels or contracts renegotiated.
“Pay rates for travel nurses have been studied in the past (pre-pandemic), and when compared to the total cost of employment of permanent staff, were found to be reasonably in-line, although any study can be debated,” he said. “However, during the pandemic, due to the extreme shortage in nurse staffing, pay packages for travelers far outpaced the average pay for permanent nursing staff. Where those pay packages land in the future for both permanent and travel nursing, given the systemic shortage of nurses nationwide, is yet to be fully determined and will vary by market geography.”
Jean Cook, chief operating officer for TNAA, said one reason travelers generally are paid more has to do with the requirements of being a travel nurse.
“They generally have received a higher wage due to their high skill level, the ability to hit the ground running, and that many times they are put in the toughest situations at the hospital — the place the help is most desperately needed,” Cook said. “In addition, travelers who are having to pay for lodging while away from home are reimbursed for that expense related to the business travel, the same as most businesses cover the expense of out-of-town travel for their employees.”
McKenzie said both permanent and travel nurses are the real heroes of the pandemic.
“For most of us, we have no idea the stress and challenges that nurses have endured during these past few years, in particular,” McKenzie said. “It was a difficult job to begin with. For travel nurses, they are moving into a new area of the country and a new hospital setting/unit that has requested them because of need. They are in temporary housing away from family and friends in a high-stress environment. All nurses are trained clinicians, and we should be grateful for their skills and how many nurses were willing to move to the places of need to support and care for our communities across the country.”
Cook said travel nurses face all the same challenges as staff nurses, and in addition, as experienced nurses, they are expected to “hit the ground running,” placed in units that need help fast. Travel nurses are also away from home, which means no nearby family or friends, and they are living in some sort of temporary lodging such as an apartment, Airbnb or VRBO-type lodging, or even an extended-stay hotel.
And the nurses have had to deal with an unprecedented level of patient death.
“This is for all nurses, staff and travelers,” Cook said. “For many nurses, they became a health care professional to help people, to be a part of their patients recovering from illness. The impact of this level of loss has caused them a great deal of stress and pain. Nurses have been leaving acute-care bedside jobs due to this, which has added to the shortage of nurses that existed before the pandemic even began.”
Cook said all nurses — staff and travelers — should speak up and advocate for reasonable patient ratios. They can and should speak to leadership at their workplace or reach out to the clinical support team at their staffing agency.
The pandemic has exposed several weaknesses in the delivery of health care. Nonetheless, McKenzie said that the industry should be applauded for its response to a worldwide pandemic that impacted communities, large and small.
“One of those weaknesses is the importance and the need for nursing professionals, and everyone is hopeful that the pandemic will open up opportunities for many to pursue a nursing career, certainly for permanent staffing. But some may include some travel along their journey.
“Because of a nationwide shortage of nursing staff, all clinicians are hopeful that pay packages will reflect both their professional skills and the overall availability of trained staff. Well over 90 percent of acute-care nurses are permanent staff, so we should all be grateful for their work. And, for that smaller percent that were willing to quickly travel to places of need, we should be grateful for their work as well.”
Cook noted several reasons why nurses like being a traveler — different reasons for different people, she said. Among the reasons she hears most often are the opportunities to go where they know their skills are most needed, build their resume by gaining experiences and skills faster than by staying at a single job and see different parts of the country.
For the Fergusons, each of those reasons resonate.
“I love the freedom of being a travel nurse,” Ally Ferguson said. “I enjoy being able to take a break between assignments and going on international trips. I enjoy being a peon, but also being a resource to staff at the hospital I’m working at. The hardest part is being away from home. Being away from your support system and your comfort zone is always hard. Another hard part is finding affordable housing.”
There has been some criticism of the high salaries being paid to travel nurses during the pandemic. Ferguson disagrees.
“The jobs that were paying crazy amounts… those nurses were working five to six 12-hour shifts a week,” she said. “What bothers me is people criticize nurses for either wanting better pay or for what they’re being paid, but don’t take a second glance at administrators’ pay or other high-paying jobs. What is so terrible about paying those who are in the trenches saving lives every day?”