Copyright © 2021 Albuquerque Journal
If you’re a patient at a New Mexico hospital, the odds are better than usual that your nurse or caregiver is working at the hospital on a temporary basis.
To meet patient needs and keep staffing levels high during the latest uptick in COVID-19 cases, hospitals across the state have over the past several months become increasingly reliant on traveling nurses – nurses from around the country who take temporary positions at hospitals and other medical facilities to help address staffing shortages.
Hospital and medical association leaders are concerned that relying on these nurses, who help fill gaps in care, but cost hospitals several times more than a staff nurse, will leave hospitals in an untenable situation as the pandemic drags on.
“We’re all competing for the same pool of nurses,” said Tim Johnsen, senior vice president and chief operating officer at Presbyterian Healthcare Services. “It is an unsustainable model, with rates just too high for us to continue.”
A combination of higher wages for travel nurses and burnout in staff positions have driven some New Mexico nurses to take jobs as traveling nurses, allowing them to take temporary, typically 13-week, positions at health care facilities across the country.
A survey conducted by the New Mexico Hospital Association in September showed that 12% of New Mexico’s nursing workforce is traveling nurses, which association president and CEO Troy Clark characterized as the highest the organization has seen. Officials from Presbyterian, University of New Mexico Hospital and Lovelace Health System have each confirmed that they have significantly more traveling nurses on staff than they did prior to the pandemic and at earlier points.
“Almost every hospital that I talk to is at an all-time high,” Clark said.
How did we get here?
Sources from various hospitals said the number of traveling nurses on staff varies, but the overall total has risen significantly since the pandemic reached New Mexico in March.
Speaking during a Bernalillo County Commission meeting last month, UNMH CEO Kate Becker said the hospital had about 500 traveling nurses working in the state. A hospital spokesman declined to comment for the story, but provided data showing that the figure had increased 593% from February 2020.
Johnsen said Presbyterian had 417 “travelers” – 96% of whom were nurses – on staff as of last week, up from around 120 across the hospital system before the pandemic began. Vesta Sandoval, chief medical officer at Lovelace, said earlier this month that the hospital had 255 traveling nurses on staff at the end of October, and had added at least 20 more since the month ended. Sandoval said she believed that total was a record high for the hospital.
Clark said New Mexico had been short on nurses and other health care professionals for decades before COVID-19 reached the state. Clark cited a 2020 study from the Legislative Finance Committee showing that New Mexico was short about 6,200 nurses in 2019.
“If anything, we think that might be understated,” Clark said.
Deborah Walker, executive director of the New Mexico Nurses Association, added that the pandemic shone a light on existing shortages. Walker said that more than a year and a half of treating patients during a pandemic has taken an emotional toll on a lot of hospital nurses. She said stress and burnout are increasingly common, and that a number of nurses have reported verbal and physical abuse from family members of patients.
“This is not normal, and it feeds into the burnout,” Walker said.
The survey conducted by the hospital association showed that 17% of nursing positions were considered vacant as of September. Some nurses have left the industry entirely, while others have transitioned into becoming traveling nurses for higher wages and a change of scenery. The survey showed that 30 New Mexico facilities have had at least one staffer leave to work as a traveling worker.
Sandoval said this can create a cycle that leaves hospitals more reliant on traveling nurses as staff nurses leave.
“It has really taken a lot of nurses away from New Mexico, unfortunately,” Sandoval said.
The spike in COVID-19 cases associated with the delta variant during the summer and fall has led to a greater need for hospital nurses. Johnsen said Presbyterian’s traveling nurse staffing levels have corresponded roughly with spikes in COVID-19 hospitalizations. With each of the three hospital systems recently activating crisis standards of care, the need for traveling nurses is higher than ever, Johnsen said.
“When such high volumes of patients come in, it’s a way for us to level-load across the system,” he said.
‘It does affect their sustainability’
Various hospital leaders said cost is the biggest factor in why traveling nurses aren’t a sustainable model for their systems. Hospitals have always paid a premium to bring in nurses on a temporary basis, but Clark said high demand and limited supply has driven costs up since the pandemic began.
Since the latest spike in COVID-19 cases began, Clark said a staffing agency may charge hospitals up to six times more than what staff nurses were making before the pandemic began, in some cases upwards of $200 per hour. While hospitals have offered raises and other bonuses to nurses on staff, they haven’t kept up with pay increases for travelers, Clark said.
“It is a financial drain (and) it does affect their sustainability,” Clark said.
Clark said having a large number of traveling nurses on staff can cause cultural challenges, as well. He noted that some travelers may not be as familiar with the cultural idiosyncrasies of their communities, or may take time to learn the layout of their new facilities. Clark added that the pay disparity between traveling and staff nurses can frustrate workers.
Another challenge is the bidding process itself. Hospitals bid against facilities all over the country and, when local COVID-19 case spikes happen in such populous states as Texas and Florida, Johnsen said it can be challenging for New Mexico hospitals to bring in the nurses they need.
“You do compete on a national landscape for travelers,” Johnsen said. “It’s not a local thing, it’s always on the national level.”
He added that Presbyterian’s workplace environment and Albuquerque’s location has made the company’s urban facilities attractive to travelers, but acknowledged that it can be a challenge to bring nurses to New Mexico’s rural communities.
Johnsen and Walker agreed that the best way to keep nurses in rural communities is to focus on programs that train workers already living there rather than bringing in newcomers.
“We believe that nursing, in many regards, is an economic development issue,” Walker said. “If we can recruit and retain nurses from the areas they started out in, then we have a greater chance of retaining them.”
The path forward?
The pandemic not only made life harder for current nurses, but also affected the pipeline of talent entering the industry.
Diane Evans-Prior, associate dean for Central New Mexico Community College’s nursing program, said shutdowns related to the pandemic caused some nursing students to lose clinical rotations, where nursing students visit hospitals and interact with patients under supervision at local hospitals. The most impacted cohort had just over half the typical rotation experience of a typical class, Evans Prior said. She said hospitals opted to close their facilities early in the pandemic and lacked excess capacity to help teach nursing students, even when students were able to return.
“We’re guests in those facilities,” Evans-Prior said. “And you can have the most wonderful guest in your house, but, after a certain amount of time, you’re kind of wishing they would go home.”
Local leaders are looking for state and federal support to bolster New Mexico’s depleted corps of nurses. The hospital association is seeking a $15 million allocation to the state Department of Higher Education to increase capacity for nursing programs during the upcoming legislative session. That money could be used to bring in additional faculty and adjunct professors, and for student travel stipends and other factors.
The hospital association has also asked for an infusion of state funding directly to hospitals. Clark said New Mexico hospitals have received more than $360 million in federal funding from the American Rescue Plan Act and other stimulus packages, but added that the association estimates that hospitals have lost around $650 million in revenue and increased expenses since the pandemic began.
“Although $360 million sounds like a huge number, recognize that it represents about half of the lost revenue or increased costs in this state,” Clark said.
In the short term, Clark said the hospital association has written a letter to Xavier Becerra, secretary for the U.S. Department of Health and Human Services, asking for a temporary cap on the prices that staffing agencies can charge hospitals.
Walker said she’d like to see hospitals take a hard look at the amount of money they’re spending on traveling nurses, and consider reallocating that funding to staff nurses in a bid to keep them around. Finally, she asked that patients and their families be kinder and more compassionate to the nurses they’re working with, noting that their own support systems have been eroded by the pandemic, as well.
“It’s great to say how resilient nurses are, but they are running on fumes,” Walker said.