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Many hospitals with shortages of nurses are tapping into a new labor source — workers who move from city to city every few months.
“Travelers,” as the new medical migrants are called, are in high demand — and are demanding high wages. Nearly 60 percent of all U.S. hospitals and health-care networks fill vacant nursing positions with travelers, according to the American Hospital Association (AHA).
“We would prefer to have our own staff nurses,” said Maureen McCausland, chief nursing executive at the University of Pennsylvania Health System in Philadelphia, which started using travelers two years ago. “But we are in the middle of a nursing shortage, and we can't always fill our positions.”
The phenomenon emerged in the 1980s, when a few temporary-staffing companies discovered there was money to be made in the nursing shortage. The demand then was limited to a few states with seasonally fluctuating populations, such as California, Florida and Texas.
But the situation changed rapidly as the nursing shortage spread across the nation. Today, at least 50 companies broker nursing services to hospitals across the country. “We have become a mainstay for many hospitals, large and small, urban and rural,” said Rosellen Sullivan, vice president of sales at Cross Country TravCorps, in Boca Raton, Fla.
The brokers help travelers determine where they want to work, what types of facilities interest them and which assignments are available. They also facilitate job interviews, which are often conducted over the telephone.
Many nurses say the financial aspect of the traveling-nurse life is hard to beat. Staffing companies set the rates at which their itinerant clients are paid — usually significantly higher than what hospitals pay their staff nurses. In addition, most companies set their clients up with other valuable services, such as free housing, health insurance and travel expenses.
“I get a housing allowance; I get a free rental car; I get free air fare,” said Ronan Umali, 27, who gets his assignments through Across America, a San Francisco firm. “They pay for everything.”
Other travelers value the opportunity for change and adventure. Christi Strawley, 25, has worked in hospitals from coast to coast since graduating from the University of Pennsylvania School of Nursing in 1999. She especially enjoyed a three-month assignment in Seattle.
“I'd walk right outside my apartment six blocks from the hospital and [there] is Mount Rainier,” Strawley said. “It's 100 miles off, but it's all you can see. The air is so clean and fresh, the city is friendly and incredibly interesting. And you can work six days in a row and have eight days off and visit Alaska.”
But there are downsides to the itinerant life. Many travelers don't receive paid sick leave or vacation time, and they are often assigned the toughest patients and the least desirable shifts. Likewise, some just get tired of packing up and moving every few months.
“I've had my fill,” said Sue Schaffer, 26, who traveled for three years. “There is a lot of stuff that goes with moving so frequently. I honestly don't think I can change my address one more time.”
Hospital executives typically have few qualms about using travelers as a stopgap measure, aside from their higher cost. McCausland says they generally are responsible and highly skilled and perform their duties in a professional manner.
“We would prefer to [hire] permanent staff,” said Lynn Bracci, director of patient-care support at Providence St. Joseph Medical Center, in Burbank, Calif. “But if you can't get that, the travelers are just about the next best thing. It would be hard [to carry on] without them.”
But Hedy Dumple, director of nursing practice at the California Nurses Association, a labor union, argues that travelers are eroding the profession's standards, undermining patient care and placing a greater burden on full-time staff nurses. “Travelers come and go,” Dumple said. “The majority take the money and run. There is no commitment to patient advocacy or to improving standards of care.”
Still others say that although travelers receive higher pay than regular staff nurses, being able to hire temporaries serves as an “escape valve” so that hospital administrators “don't have to solve the underlying problems,” such as mandatory overtime and low wages, says Cindy Price, a spokeswoman for the American Nurses Association. “So, in the long run, it contributes to the problem of depressed wages and thus to the nurse shortage.”
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