Burnout and high turnover have been taking a toll on nurse clinicians, resulting in a staffing deficit that will only worsen. According to McKinsey & Company, the U.S. will be short 200,000 to 450,00 registered nurses for direct patient care by 2025. Research from NCSBN further reports almost 900,000 RNs intend to leave the workforce by 2027.
With this in mind, leaders from our company wanted to examine what could be done to mitigate this growing crisis, one already impacting nearly every healthcare facility daily. So, we surveyed our traveling clinicians to find out what motivates and keeps them in the industry. Analysis of the data revealed the benefits that matter, what they appreciate in a facility, and perhaps more importantly, why they continue taking travel assignments and remain in the profession. Here are a few of the highlights.
Control Leads to Satisfaction
Over three-quarters of respondents surveyed said they were satisfied with their most recent travel job, whereas only half felt the same about their last permanent staff post. Burnout was a significant factor for staff clinicians due to problematic patient-to-staff ratios, lengthy shifts, and hospital politics. These issues were major influences in prompting clinicians to pursue traveling opportunities.
Not surprisingly, higher compensation and the ability to meet financial goals were the foremost reasons nurses seek traveling opportunities, cited by 84% of respondents. Other motivators included freedom and flexibility at 71%, followed by a sense of adventure (39%), work-life balance (28%), and an “ability to focus on the patient, not hospital politics” at 22%.
Top 5 Motivators for Seeking a Travel Position
Having experienced the freedom and flexibility afforded by traveling, 41% of respondents said they would never return to a staff position. Additionally, after completing their first assignment, data showed work-life balance increased in value by 4%, as did the chance to focus more on patients, not politics.
Traveling Nurses: The Value of Pay, Place, and Perks
Pay was the top motivator when selecting a travel assignment at 26%, followed closely by location at 20%. This is supported by what we see internally as many clinicians begin their searches filtering by city and state. Shift structures and the facility came in at 11%, with contract length (10%) and start date (8%).
Travel clinicians are particularly adept at negotiating monetary benefits. That said, we asked them to rank the compensation package features they find most important. The top responses were: Pay rate guarantees (18%), housing stipends (14%), travel reimbursement (12%), paid time off between assignments (8%), licensing and certification reimbursement (7%), affordable healthcare (7%), retirement contributions/401k matching (5%), support while on assignment (5%), scrubs reimbursement (4%), housing coordination and support (4%), and continuing education unit (CEU) reimbursement (3%).
As the data shows, pay, place, and perks are a few of the best ways to retain and attract these talented nurses.
Flexibility and Safety
Every healthcare facility has its processes and systems, ranging from unique float parameters to the type of electronic medical records (EMR) software it uses. When evaluating offers from a specific facility, traveling clinicians cared most about flexible scheduling (14%) and staff-to-patient ratios (13%).
Yet, while patient safety and support are critical, other factors have an impact, including facility reputation (9%), floating frequency (8%), charting systems (7%), opportunity for overtime shifts (7%), ability to request time off (RTO – 7%), thorough onboarding (7%), parking (7%), float parameters (6%), number of unit clinicians (6%), and lunch breaks (5%).
Interestingly, after completing their first assignment, responses showed some changes in value. “Work-life balance” grew by another four points, as did the ability to focus on the patient, “not the politics.” While still overwhelmingly important, money became somewhat less of a motivator for repeat travelers, dropping eight points.
Top 5 Motivators for Seeing a Travel Position
We also included a body of allied health professionals in our survey, those providing various diagnostic, technical, therapeutic, and support services. Topping their list of essential factors is thorough onboarding (12%), followed closely by the number of clinicians per unit. These healthcare professionals, on the whole, tend to be newer to traveling, likely explaining why they emphasize onboarding and ratios at a facility when considering offers. On a related note, Staffing Industry Analysts project continued growth in this space, with allied health travel jobs increasing by 5% in 2023 and 2024.
Satisfaction Guarantees?
The NCSBN study noted that more than 60% of nurses experienced workload increases during the pandemic. This left many feeling exhausted, emotionally drained, and disillusioned. With healthcare workforce shortages showing no signs of stopping and every indication they will continue to climb, the nursing profession must focus on rebuilding, or tragic consequences may follow.
Retaining talented, tenured RNs and attracting new talent are essential. The traveling nurses in our study have provided vital feedback related to job satisfaction. While there are no guarantees, their insights are important to consider across the industry as we work together to position healthcare for a healthier future.
According to Vivian Health’s Future of Healthcare Work Report findings, clinicians on long- and short-term travel contracts are more willing to explore permanent employment in 2023 than in previous years. During the height of the COVID-19 pandemic, Vivian saw clinicians prioritizing safer and more respectful work environments. This year’s results continue this trend, with other priorities rising to join them: focusing on flexibility, work-life balance, and commute times when considering new positions.
The findings cover employment settings, wages and benefits, workload, clinician mental health, desired work environment characteristics, and insights into attracting clinicians to permanent employment. This year’s report emphasizes a rising demand for permanent employment by travel clinicians, which could be a saving grace to an industry that staffing shortages have rattled. Over half of the respondents are over 45, and 28% are over 55. These findings suggest there is also an opportunity to retain experienced professionals as the industry hurtles toward a retirement cliff brought on by the hardships of working during a global pandemic.
“Staffing challenges in the healthcare industry predate and were exacerbated by the pandemic, presenting many difficulties and rapidly evolving conditions for the professionals that have continued to work over the past three years,” says Parth Bhakta, co-founder and CEO of Vivian Health. “The increased demand for more permanent, stable, long-term positions serves as a light at the end of the tunnel for those who have carried the weight of these shortages during the COVID-19 pandemic.”
Switching to Permanent Employment
Vivian Health found 1,663 clinical and clinical-support staff from across the country using a combination of emails to their proprietary healthcare talent marketplace, online communities, and social media tools. Of the respondents, 65% were registered nurses. Of all respondents, 36% were employed in travel positions, with 44% employed in permanent positions. Vivian’s methodological goal was to achieve a diversified, representative sample of the non-physician clinical workforce.
Eighty-six percent of travel clinicians surveyed said they are open to switching to permanent work, with nearly half (46%) planning to work permanently in 2023. That number has grown significantly since 2022 when only 55% considered switching to permanent positions. While these statistics are promising for understaffed hospital systems reeling from the aftermath of the global pandemic, employers must make significant investments to create better, safer work environments to attract healthcare professionals.
“Healthcare professionals indicated an even greater need for work-life balance and workplace safety when searching for jobs than in previous years,” says Bhakta. “The respondents ranked feeling safe at work and their commute time as important in their job search, marking a shift from last year, when the most important factors in new job searches included respect from leadership, workload, and support for mental health and well-being.”
Heavy workloads and the inability to take time off can often lead to burnout, exhaustion, and stress for healthcare clinicians. Fifty-six percent of respondents (n=935) were asked every week to work overtime, and half of the employed clinicians surveyed took just 5 to 10 days of PTO in 2022. The call for additional staff was a common theme in this report, with 57% of respondents indicating their unit was adequately staffed less than 75% of the time.
Vivian asked respondents, “what could your employer do to increase your overall job satisfaction?” Excluding increases to wages and bonuses, the top five responses were:
Increase the number of support staff
Increase the number of nurses
Allow adequate time for meals and breaks
Offer more PTO
Offer flex scheduling
When making the switch to a permanent role this year, clinicians stated that their top five considerations are:
Hourly Wage
Benefits
Workload (Staffing)
Commute Time
Flexible Schedules
“Vivian actively participates in conversations with nurses and has seen an increase in appetite for permanent positions,” says Vivian Health User Research Manager Rachel Norton, BSN, RN. “Healthcare professionals are looking for the additional stability that permanence offers. Employers hoping to hire and retain permanent talent will have to offer a well-rounded experience and environment to meet their needs.”
Nursing is in a state of crisis. Overwhelmed by the critical need for more nurses, nursing is at a crossroads, and according to the president of the largest school of nursing in the U.S., it’s time to adopt a new professional model.
Daily Nurse chatted with Chamberlain University President Karen Cox, Ph.D., RN, FACHE, FAAN, about the state of nursing in our country and what we must do to help fill critical nursing shortages.
What is the state of nursing today?
I would have to describe it as that we’re in a crisis. And it’s a crisis of nurses being willing and physically able to work in acute care. We have four million nurses. And of those, if you needed to work in acute care in hospitals, direct care, and other home care roles, we would be okay, but the current environment is not satisfying to them for several reasons. And so, we’re at a crossroads where we need to consider a new professional model.
What do you envision a new nursing model will include?
First, let’s talk about how we got here. The pandemic certainly was an accelerant to having a crisis develop. But it wasn’t. It was predictable. It just got moved up and made more real by COVID.
Nursing is the only profession that doesn’t quantify its financial contribution. Nurses are seen as part of the bed charge, so their value is different than a physician who bills for visits. Physicians bill either by minutes or by the procedure. So the reality is nurses must be better and more capable of demonstrating their value to positive patient care outcomes. Because we are valuable, and there’s evidence of this when we’re engaged in the right numbers and skill sets. The outcomes are better when we have the things we need. So that’s one big piece.
The other piece is because nurses are hourly, that sets us up to be commoditized. When I need you, I need you. When I don’t, I don’t. If I need you really bad, I’ll pay you a lot more. And then we wonder why nurses go after these travel contracts that are so lucrative. But if you treat somebody like a commodity, that’s how they’re usually going to act. Some CEOs understand this and are trying to get past anything we can do to change that mindset on both sides of health leadership and nursing.
Has the bubble burst for travel nurses?
I’ve had a lot of discussions about the bubble being burst with travel nurses. During COVID, they were responding and getting paid a lot of money. Now the value they showed and their dedication it’s not needed anymore.
So would you say that’s adding to the problem in nursing?
I absolutely agree. It’s supply and demand, as opposed to treating somebody as a valued professional. Why don’t healthcare leaders around the country understand that the pay scale isn’t high enough? Why wouldn’t nurses take those jobs when the pay was so high? The answer is somewhere in the middle. Nurses have yet to have an increase, taking into account inflation in many years. And then the role is so much harder than it has ever been. When I was doing direct care, it just changed. The expectations are demanding. It’s a hard job.
I always tell people this: if you’re not in healthcare, you don’t think about it. We’re asking people to work 12 hours a day, for the most part, and to be physically present, and they’re expected to lift patients. The other thing that no one wants to say out loud is 60% of the population is overweight or obese. Twenty years ago, lifting somebody with a knee replacement and helping them get to the bathroom wasn’t a problem. It’s different now if they weigh 100 pounds more! Then it’s the mental and emotional part of dealing with people who are vulnerable. And on top of this, nurses must use critical thinking and make critical decisions. Making clinical judgments and doing all the left-brain things make a difference in how people experience their illness in their care, which impacts outcomes.
What are ways that you recommend nurses demonstrate their value?
The pandemic has accelerated the move to value-based care and getting paid for the outcomes, not procedures. Nurses make a difference in hospitalized patients’ outcomes. If patients don’t get an infection, if they don’t experience anything imposed by poor care, any of the outcomes getting patients out within so many days, no readmissions within 30 days, that’s nursing and nursing care. Others participate in it, but it’s heavily influenced by nurses who are there 24/7. And so it is changing the discussion. And it’s not just about employee or patient satisfaction. It’s about real-world outcomes.
And that’s how the health systems will get paid in the future — they will get paid more when they do well, as opposed to more when they do more. And that’s a different relationship. So there’s an opportunity to change the relationship and the governance. We need to change the mindset of leadership and nursing. COVID, if anything, has shown nurses that if they stay in acute care, they want to be at the table for more decisions that impact them and their patients.
Is the biggest challenge facing nursing today the loss of nurses?
That’s a piece of it. And then the second part is, how are we trying to resolve it? One of the things that’s important for people to know is unless we get people back to the acute care setting who have left or haven’t been there for a while, we aren’t going to have enough nurses for at least five-10 years to deliver care the way we have for the last 20 years. And we need to be able to do it the way research supports us. But the answer is not to throw in more patients and nurses having more to delegate to. We need fundamental shifts in the role and supplement with new roles. And the one role that is the future is the virtual nurse.
What is the role of the virtual nurse?
This role does a lot of different things. For example, if you have an inpatient unit and a nurse with seven or eight patients, they usually have less than two years of experience. People would be surprised to know the need for more experience in acute care settings. So you would have a virtual nurse who can be down the hall in a room or even at home, and they’re there with the knowledge and experience to answer patient/family questions.
Some nurses are physically challenged, and it is too much to do the 12-hour shifts. The virtual nurse can do many things that nurses want to do and need to do but don’t have time or experience. It’s about more than tasks. It’s about the social determinants of health. For nurses to impact and improve health disparities, we must be less transactional and more relational with patients and families.
I can do many things if I’m a virtual nurse sitting in a room. I can notice if somebody is in trouble. I can answer their questions. But more importantly, I can start working on how they go home and not end up in a diabetic coma in a month, talking to their family, talking to their caregivers, understanding what got them in the hospital in the first place, and what they need. Those are, again, things that nurses want to do. But they need the wherewithal, and they need the experience. That’s why you make that role how we get both out of this staffing crisis and working on health disparities, which is what the National Academy of Medicine The Future of Nursing 2020-2030 report recommends.
What other things should we be doing to attract more people into nursing?
It goes back to what are we? Are we valued professionals? A commodity? Somewhere in between? How nurses choose to be and how they’re valued does make a difference. And it goes back to how involved nurses are in decisions, much like physicians. Physicians control their practice within limits and have a governance structure that some argue could be more robust in some places.
Nonetheless, it exists. And it puts nurses in place to advocate and influence patient care. They can do it in other settings, not only at the bedside. And that’s an opportunity.
The other thing we have to do is increase diversity. If you follow Chamberlain University, you know we’re diverse, much more than anybody else’s student nursing population. But it means that we have to do it. Students who’ve been in low-resource high schools or have not attended another nursing program will not get into the big traditional schools because their GPA isn’t 3.8 or 3.9. But at 3.0, they’re also incredible nurses, and it’s about their life experiences. So that’s on the education side. We must use a holistic process to admit students to the nursing program.
Talk about the growth of online nursing programs and their impact on nursing. What kind of infrastructure is needed to make online nursing programs more appealing?
We’re doing a high flex or a hybrid model at Chamberlain University. When the pandemic began, I can’t tell you how many students were adamant about returning to campus full-time. And now, they learned to adjust their classes to their family life and are enjoying this model. So there’s a lot to be said for having that flexibility.
We’re finding that with faculty too. At first, they thought online classes were horrible. I’ve never done this before, that sort of thing. And now they’re thinking, maybe these online classes are okay, and they’re identifying some courses that academic leaders say should be in person, and here’s why. But a lot of it doesn’t have to be. And what we’re trying to develop at Chamberlain is a way for students to do it the way that makes sense for them. That’s one of the reasons we have an evening & weekend program. I didn’t think people would flock to that. And I was wrong.
You can sit there and try to be traditional all day long, the way we were before, but nothing will be the way it was before. It’s not just education. It’s everything. That’s all changed.
Chamberlain has a BSN Online Option. It’s not entirely online, but it’s close. It’s our same curriculum, but we administer it differently. And that’s going to be the wave of the future. We will need to offer different options for people. If we’re to solve the nursing crisis in terms of the numbers and the diversity, and trying to get people who are mid-career that have 20 good years plus, they can’t necessarily just quit work altogether.
The online BSN program just started, and we’re up to 350 students, which sounds small because we’re Chamberlain. But that’s the size of some schools of nursing. We’re working out the kinks in the system, learning from that, and doubling down on this across the country. Every state board will be different about what they view as okay. Sp everything has to be geared toward that in terms of our priorities.
While you may have heard about what it’s like to work as a travel nurse, have you ever thought about travel nurses who work in the ICU?
Daisy Award-winner Deji “DJ” Folami, RN is an ICU registered nurse from Oklahoma with Cross Country Healthcare, who specializes in critical care nursing and travel nursing. He told us what it’s like to work as a travel ICU nurse—and why he loves doing it. What follows is our interview, edited for length and clarity.
“I was just simply blown away by their [ICU travel nurses] level of confidence, their can-do and go-getter attitude, and their all-around knowledge, that the motivation to explore travel nursing came easily.
DailyNurse: How did you get interested in being a travel nurse—especially one working in ICU?
DJ Folani: I joined ICU nursing after one year of being a Med-Surg nurse because I was fascinated by the skills and organization of the code team. Same degree, just higher levels of training and knowledge. After one year in ICU, I met a few travel nurses. I was just simply blown away by their level of confidence, their can-do and go-getter attitude, and their all-around knowledge, that the motivation to explore travel nursing came easily. In 2016, I started my journey as a travel or contract nurse, and I have never looked back since.
Explain to me briefly what a travel nurse specializing in ICU does? How long do you tend to work in any one facility?
A travel nurse must be an experienced and adaptable person. However, a travel nurse who specializes in ICU is expected to be dynamic and ready to meet challenges when circumstances change.
For example, most ICU travel nurses specialize in medical-surgical ICU but may be asked to float to a cardiovascular or neuro ICU to take care of patients within their scope. Simply put—same skill set, different unit or different protocols.
Typically, a travel nurse works as a contract employee at a facility. Each contract can be a period of 8 to 26 weeks, renewable up to one year. After that one year is up, a break is required up to 30 days, depending on state laws. If the facility wants to continue with the nurse, they will offer to renew the contract.
How and why did you get into becoming a travel nurse? Did you have to sign up with one specific business that places travel nurses? Are ICU travel nurses in high demand?
I was satisfied being an ICU nurse, but I was not content with the knowledge I had acquired. I wanted to impact the world beyond my residential city. I love meeting people. Therefore, I pushed myself to follow up on a referral made by another experienced travel nurse I had spoken with. The recruiter asked questions about my interests, specialty, etc. While awaiting offers, I called and spoke with other travel agencies to compare my preferred assignment, convenience, and of course salary rates.
Yes! Travel nurses are in high demand. An ICU travel nurse with experience in complex critical interventions such as continuous renal replacement therapy (CRRT), hypothermia protocol (Arctic Sun), and certifications such as critical care registered nurse (CCRN), etc., are in high demand.
What do you like most about working as a travel nurse?
Every facility has its own unique way of carrying out nursing processes. I love learning new ways of doing the same thing. These new experiences add to my wealth of knowledge.
What are the biggest challenges you face in travel nursing?
Finding a suitable accommodation. A comfortable and affordable place to live while on a travel assignment is vital to my overall well-being. I love to find a place that is close to a gym, a grocery store, and at closest proximity to the hospital.
What are your greatest rewards as one?
New friendships and networking.
Is there anything else that is important for our readers to know?
The key here is to add value to their team and strive to make an impact such that you become an asset and not a liability. I always ask the nurse manager or leaders what ways I could be more useful to their team. Have a positive attitude, rid yourself of trivial complaints. Be a part of the solution you are there to be and have fun while doing it. Blend in quickly and be an important team player. Do this, and you’ll be surprised at how fast the facility will ask you to stay longer with them.
In parts of the country where covid-19 continues to fill hospitals, a rotating cast of traveling nurses helps keep intensive care units fully staffed. Hospitals have to pay handsomely to get that temporary help, and those higher wages are tempting some staff nurses to hit the road, too.
Nearly two years into the pandemic, there’s some truth in a joke circulating among frustrated ICU nurses: They ask their hospitals for appropriate compensation for the hazards they’ve endured. And the nurses are rewarded with a pizza party instead.
Theresa Adams said that’s what happened at the Ohio hospital where she worked. The facility across town was offering bonuses to keep its nurses from leaving. But not hers. They got a pizza party.
“I heard a lot of noise about ‘Well, this is what you signed up for.’ No, I did not sign up for this,” she said of the unparalleled stress brought on by the pandemic.
Adams is an ICU nurse who helped build and staff covid units in one of Ohio’s largest hospitals. She recently left for a lucrative stint as a travel nurse in California.
Travel nurses take on temporary assignments in hospitals or other health care facilities that have staffing shortages. The contracts typically last a few months and usually pay more than staff positions.
Adams hopes to return to her home hospital eventually, though she’s irritated at management at the moment.
“I did not sign up for the facility taking advantage of the fact that I have a calling,” she said. “There is a difference between knowing my calling and knowing my worth.”
Hospitals – and Staff – Reckon with Costs of Hiring Travel Nurses
A reckoning may be on its way as hospitals try to stabilize a worn-out workforce.
The use of traveling nurses took off in the 1980s in response to nursing shortages. Although they’ve always been paid more for their flexibility, some traveling ICU nurses can now pull in as much as $10,000 a week, which can be several times more than staff nurses earn.
While some hospitals have offered retention bonuses or increased pay for permanent staff members, nurses say it doesn’t compare to the financial bonanza of traveling. Hospital managers now find themselves trapped in a pricey hiring cycle — competing for, in particular, the most highly trained critical care nurses who can monitor covid patients on the advanced life-support devices known as ECMO (extracorporeal membrane oxygenation) machines.
“Our turnover for ECMO nurses is incredible because they’re the most seasoned nurses. And this is what all my colleagues are facing, too,” said Jonathan Emling, a nurse and the ECMO director at Ascension St. Thomas Hospital in Nashville.
The shortage of ECMO nurses has prevented the hospital from admitting additional covid patients who need their blood oxygenated outside their body, he said. No more staff nurses have enough experience to start the training.
“We will train these people and then six months later they will be gone and traveling,” Emling said. “So it’s hard to invest so much in them trainingwise and timewise to see them leave.”
And when they leave, hospitals are often forced to fill the spot with a traveler.
“It’s like a Band-Aid,” said Dr. Iman Abuzeid, co-founder of a San Francisco nurse recruiting company called Incredible Health. “We need it now, but it is temporary.”
Incredible Health helps to quickly place full-time staff nurses in some of the country’s largest health systems. The number of listings for full-time, permanent nurses on the company’s platform has shot up 200% in the past year.
To help hospitals, some states are chipping in to hire travel nurses. But for many hospitals, the higher costs are straining their budgets, which is especially difficult for those that have suspended elective surgeries — often a hospital’s biggest moneymaker — to accommodate covid patients.
“Every executive we interact with is under pressure to reduce the number of traveler nurses on their teams, not just from a cost standpoint but also from a quality-of-care standpoint,” Abuzeid said.
It’s hard on morale as well: Camaraderie suffers when newcomers need help finding syringes or other supplies but may be paid two or three times as much as the staff nurses showing them the ropes.
Some hospitals are trying to stop the turnover by offering big signing bonuses to permanent nurses, as well as loan forgiveness or tuition assistance to pursue additional education. Hospitals have also hiked pay for nurses as they earn certifications, especially in critical care.
Importing Foreign Nurses to Fill the Gap
Other medical centers are looking outside the U.S.
Henry Ford Health System in Michigan announced plans to bring in hundreds of nurses from the Philippines. Smaller community hospitals are looking abroad, too. City-owned Cookeville Regional Medical Center, in a Tennessee town of 35,000, is now recruiting its first foreign nurses.
“The cost for what we pay for a local recruiter to bring us one full-time staff member is more expensive than what we are going to be spending to bring one foreign nurse,” said Scott Lethi, chief nursing officer at Cookeville Regional.
Lethi hopes the staffers from overseas will decide to stay more than a year or two. He said even new nurses sometimes leave or burn out: Cookeville hired a few recent graduates of U.S. nursing programs who quit after just a few months.
Among ICU nurses of all ages, two-thirds have considered leaving the profession because of the pandemic, according to a survey published in September by the American Association of Critical-Care Nurses.
When a nurse leaves — whether to retire, become a travel nurse or work in another field — the remaining nurses can be stretched dangerously thin, caring for more patients at once. Covid patients are particularly demanding, especially those on ventilators or ECMO machines who may require one-on-one care round-the-clock. Covid patients may be hospitalized for weeks or months.
“My ability to care for people has suffered. I know that I have missed things otherwise I would not have missed had I had the time to spend,” said Kevin Cho Tipton, an advanced practice nurse in the South Florida public health system. “Many of us feel like we’re becoming worse at our jobs.”
The worry about providing substandard care weighs heavily on nurses. But in the end, Tipton said, it’s the patients who suffer.
This story is part of a partnership that includes WPLN, NPR and KHN.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
I was satisfied being an ICU nurse, but I was not content with the knowledge I had acquired. I wanted to impact the world beyond my residential city. I love meeting people. Therefore, I pushed myself to follow up on a referral made by another experienced travel nurse I had spoken with. The recruiter asked questions about my interests, specialty, etc. While awaiting offers, I called and spoke with other travel agencies to compare my preferred assignment, convenience, and of course salary rates.
