are travel nursing jobs going away

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Travel nurses raced to help during Covid. Now they're facing abrupt cuts.

Tiffanie Jones was a few tanks of gas into her drive from Tampa, Florida, to Cheyenne, Wyoming, when she found out her travel nurse contract had been canceled.

Jones, who has been a nurse for 17 years, caught up with a Facebook group for travel nurses and saw she wasn’t alone. Nurses had reported abruptly losing jobs and seeing their rates slashed as much as 50 percent midcontract.

“One lady packed up her whole family and was canceled during orientation,” she said.

Many career nurses like Jones turned to travel gigs during the pandemic, when hospitals crowded with Covid-19 patients urgently needed the help. Some travelers — who made double, sometimes triple, what staff registered nurses earned — gathered on TikTok and other social media platforms to celebrate payday , share tips on how to calculate net income from contracts , and boast about how much they were taking home weekly . So great was their good fortune that federal and state lawmakers considered capping their pay , mobilizing nurses in protest.

The tide has swiftly turned. As Covid hospitalization rates stabilize, at least for now , and federal and state Covid relief funding dries up, travel nurse contracts that were plentiful and lucrative are vanishing. And after the pressure cooker of the past two-plus years led to staff turnover and a rash of early retirements, hospitals nationwide are focused on recruiting full-time nurses.

Nationally, demand for registered nurse travelers dropped by a third in the month leading up to April 10, according to data from staffing agency Aya Healthcare, although openings have rebounded slightly in recent weeks.

When Oregon’s governor declared the pandemic emergency over April 1, state-level Covid relief money evaporated. Oregon Health & Science University Hospital in Portland lost funding for close to 100 travel nurses. That, along with lower Covid rates and more full-time hires, has led to “a bursting of the bubble,” said Dr. John Hunter, CEO of OHSU Health.

The health system had about 50 contractors of all kinds before the pandemic, compared with 450 at its height, when patients, many in need of close monitoring, flooded in and turned the hospital’s recovery room into an intensive care unit.

“It has been very expensive,” Hunter said. But things are turning around, he said, and in recent weeks the hospital has negotiated contract rates with its travel nurse agency down as much as 50 percent.

Staff nurses make far less than their traveling counterparts. Rates for a new staff nurse at Northeastern Vermont Regional Hospital in St. Johnsbury, for example, start at $30 an hour — plus benefits and extra for night shifts. At the pandemic peak, the hospital paid staffing agencies about $175 an hour for each travel nurse. The rate remains well over $100 an hour, but the hospital is trying to negotiate it down. Because the hospital pays the agency directly, how much nurses pocket is unclear, said CEO Shawn Tester.

For some travel nurses, the abrupt drop in pay has been a shock. Since December, registered nurse Jessica Campbell had extended her 13-week contract at an Illinois hospital without any hiccups. In early April, a week into Campbell’s latest contract, her recruiter said that her rate would drop by $10 an hour and that she could take it or leave it.

“I ended up accepting it because I felt like I had no other option,” Campbell said.

The situation for some travel nurses has gotten so bad that a law firm in Kansas City, Missouri, said it is considering legal action against more than 35 staffing agencies. Austin Moore, an attorney at Stueve Siegel Hanson, said some agencies are “breaching their contracts” and in other cases “committing outright fraud” through bait-and-switch maneuvers on travel nursing contracts.

The firm opened an investigation in March, drawing comments from hundreds of nurses, Moore said. “Our phones are ringing off the hook,” he said. “Nobody has experienced it like this — historically, contracts have been honored.”

How much is a nurse worth?

Stephen Dwyer, senior vice president and chief legal and operating officer of the American Staffing Association, the trade group that represents the travel nurse staffing industry, said in an emailed statement that “as market conditions change, hospitals and other healthcare facilities may change the terms of travel nurse contracts.”

“For rate reductions or contract cancellations that take place mid-assignment, staffing companies often recommend advance notice,” he said.

Moore said that the fine print can vary but that when a staffing agency cancels a contract at the last minute or gives a nurse one or two days to consider a lower rate, the agency is often breaching a contract. According to the contracts, the loss should fall to the agency, not the nurses, when a hospital requests a lower rate, Moore added.

Pay rates have always fluctuated seasonally as the demand for nurses to plug staffing holes at hospitals changes, said XueXia Bruton, an ICU nurse based in Houston. She has traveled since 2018, drawn to the flexibility and financial freedom, and has no plans to return to staff nursing. Along the way, Bruton has cataloged her experiences on TikTok and Instagram, telling her more than 91,000 followers that, for instance, “it may make more sense to wait to take a contract until rates go back up.”

“It was very hard across the board during Covid when cases were really high,” Bruton said. “We were all burned out and exhausted, so it was important to be able to take as much time off as needed.”

Bruton saw crisis rates as high as $10,000 a week. Travel nurse rates now average about $3,100, according to online hiring marketplace Vivian Health . Still that’s higher than before the pandemic, and well above what a typical staff nurse makes.

Last year was particularly profitable for staffing agencies. Cross Country Healthcare, one of the few publicly traded companies that staff travel nurses and other health care workers, posted a profit of $132 million in 2021 , compared with a loss of $13 million the previous year and even bigger losses in 2019. Then-CEO Kevin Clark called the company’s 2021 financial results a “historic milestone for both revenue and profitability.”

Big profits across the nurse staffing industry have drawn the attention of lawmakers, including U.S. Rep. Peter Welch (D-Vt.), who said he feared that private equity firms that were buying up staffing agencies were charging exorbitant fees during the pandemic, a pattern reported on by Stat . In January, Welch and U.S. Rep. Morgan Griffith (R-Va.) wrote the White House a letter requesting an investigation of possible “anticompetitive activity” by staffing agencies after receiving reports that they were “vastly inflating price, by two, three or more times pre-pandemic rates.”

Some travel nurses are returning to full-time gigs, drawn by hefty incentives and stability. Jones, whose contract in Wyoming was canceled in early March, considered a staff nurse position in Montana — swayed in part by a $10,000 starting bonus. But she ended up in a travel nurse contract in rural Kansas, where the pay is better than a staff job’s would be but not quite what she’d gotten used to during the pandemic.

Jones said her traveling stint raised a big question: How much is a nurse worth?

On the road, Jones said, she “could breathe financially for the first time in years,” at times making almost double what she made as a staff nurse.

“It’s a tough profession,” she said. “We love doing it, but we have bills to pay, too.”

Hannah Norman is a digital producer for Kaiser Health News. 

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The Future of Work Issue

‘Nurses Have Finally Learned What They’re Worth’

As the coronavirus spread, demand for nurses came from every corner. Some jobs for travelers paid more than $10,000 a week. Will the boom last?

Chris Detten earned enough as a traveling nurse to make a down payment on a home in Lubbock, Texas. Credit... George Etheredge for The New York Times

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By Lauren Hilgers

• Published Feb. 15, 2022 Updated June 15, 2023

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In the early morning on Mother’s Day in 2020, Solomon Barraza walked into an intensive-care unit in Amarillo, Texas, and, with the fluorescent lights clicking on above him after the night shift, flipped through the stack of papers attached to a gray clipboard — his roster of patients and nurses for the day. Barraza, who was 30 at the time, had only recently become a charge nurse at Northwest Texas Healthcare System hospital. He was technically still a “baby nurse”: Just over a year earlier, he started working his first shifts in the I.C.U. Now he was responsible for overseeing the care of everyone there, making sure his nurses and patients had whatever they needed, answering questions and directing care in case of an emergency. As he looked through his roster, he saw that there were 11 patients on his floor; eight had Covid-19, and five of those were intubated. Then he looked at the other sheet of paper. There would be four nurses working for the next 12 hours. He needed at least six.

He could see the day play out: a cascade of emergencies, a cacophony of beeping alarms and running feet, disasters that ended with overwhelmed nurses and patients crashing alone. And so for the first time, Barraza made the decision to call for “safe harbor” under a Texas law that can be invoked to protect nurses’ licenses while working in conditions that are potentially unsafe for patients. Barraza grabbed a form from the nurses’ station, and one by one, they all signed it.

Almost immediately, the emergencies began. “You need to get over to 18!” someone shouted. Barraza grabbed his mask and ran. He started hand-pumping air into the patient’s lungs with a ventilation bag while two other nurses hooked the bag up to oxygen. They stabilized that patient, and Barraza jogged down the hallways to check on the other seven. One person’s blood pressure was dropping precipitously, and Barraza was preparing to go inside the room when he thought to check on another patient, one door down. That patient’s blood-oxygen level had dropped into the 40s, far below the normal range of 95 to 100. “So what do I do?” Barraza said. “Who do I help first? There are multiple people’s lives at stake at the same time. What if I pick wrong and someone dies?”

A year and a half later, Barraza was sitting on the desk in the middle of the cardiac-intensive-care unit, or C.I.C.U. — which handles both coronary and Covid patients — looking around the group of nurses, remembering those first months of an ongoing crisis. “There were some funky things going on with staffing back then,” he told the group. Nurses were leaving the hospital to take traveling jobs in New York. The rest of the hospital was shut down, so the I.C.U. floor was the chaotic heart of a ghost town. The hospital had yet to hire traveling nurses to pad its local staff, and Mother’s Day felt like a turning point. It was the day Barraza recognized that the pandemic would be defined by twin emergencies, two figures that he would watch anxiously as they rose and fell: the waves of patients on ventilators in his I.C.U., and the number of nurses available to take care of them.

In 2020 alone, Northwest lost 185 nurses — nearly 20 percent of its nursing staff. In the I.C.U., that number was closer to 80 percent. Many of those nurses left to take jobs with travel-nursing agencies, which placed them, on a temporary and highly lucrative basis, in hospitals throughout the country. When the nurses at Northwest quit, the hospital eventually hired its own travelers, who flowed onto Barraza’s floor to work for weeks or months at a time. There have been days when the unit was barely staffed and days when 20 travelers showed up unexpectedly. Barraza has watched friends burn out and retire. He has watched nurses leave for better pay or less stressful jobs. He has welcomed the strangers who have come to take their place — befriending them, folding them into his I.C.U. team and then watching them leave all over again.

Bedside nursing has always been, as one hospital chief executive put it, a “burnout profession.” The work is hard. It is physical and emotional. And hospitals have built shortages into their business model, keeping their staffs lean and their labor costs down. When the pandemic hit, shortages only increased, pushing hospitals to the breaking point. Nationwide, the tally of nurses with both the skills and the willingness to endure the punishing routines of Covid nursing — the isolation rooms, the angry families and the unceasing drumbeat of death — is dwindling. In a survey of critical-care nurses last year, 66 percent of respondents said they were considering retirement.

Sitting on the desk that day, Barraza didn’t know why he kept reflecting on May 2020. He had stabilized those two patients that morning, but that would not always be the case. For the most part, he said, the days bleed together in his mind. Sometimes it felt as if he had spent the last two years running the world’s longest marathon, his adrenaline pushing him from patient to patient, watching people die and trying his best to pause for a moment, just enough time to recognize each as an individual without being overwhelmed by emotion.

“That was the first time we called for safe harbor,” said Matt Melvyn, a veteran nurse who has stayed with Barraza throughout the pandemic. “But it was definitely not the last.”

In the flood of resignations, retirements and shortages that have redefined workplaces across industries these past two years, nothing has been as dramatic or as consequential as the shifts taking place in nursing. The scramble for bedside nurses is tied to everything from how we run our hospitals to the way we value the work of caring for others to our understanding of public health and medicine. And if our health care system has faltered under the weight of the pandemic, it will need hundreds of thousands more nurses to build itself back up.

For at least three decades, hospitals across the United States have followed a model that aims to match nurses precisely to the number of occupied beds. It’s a guessing game that has charge nurses performing daily tallies and hospital administrators anticipating the seasonal movements of illness and people — winter flus and migrating retirees. Many hospitals don’t offer nurses clear paths toward career advancement or pay increases. Depending on demand, they may trade nurses between units. When there are shortages throughout the hospital, they will send out emails and text messages asking nurses to come in and take an extra 12-hour shift. And when the shortages are too great, hospitals turn to travelers.

Even before the pandemic, there were many reasons to hire travelers. Nurses would be brought in for a season, a maternity leave or the opening of a new department. This kind of gig work grew increasingly common, and from 2009 to 2019, according to data from Staffing Industry Analysts, revenue in the travel industry tripled, reflecting a work force that was already in flux. There are hundreds of staffing agencies in the United States — national agencies, regional agencies, agencies that specialize in bringing in nurses from other countries, agencies that send American nurses abroad. In mid-March 2020, there were over 12,000 job opportunities for traveling nurses, more than twice the number in 2019.

Then, as the coronavirus spread, demand came from every corner. By December 2020, there were more than 30,000 open positions for travelers. And with the help of federal dollars — from the CARES Act Provider-Relief Funds and the American Rescue Plan — their salaries started climbing. Job listings in Fargo, N.D., advertised positions for $8,000 a week. In New York, travelers could make $10,000 or more. The average salary of a staff nurse in Texas is about $75,000; a traveler could make that in months.

Nurses often refer to their jobs as a calling — a vocation that is not, at its core, about money. At the same time, nurses have spent years protesting their long hours and nurse-to-patient ratios. In 2018 alone, there were protests in California, Michigan, New York, Pennsylvania and several other states. When the pandemic hit and travel positions opened up in hospitals all over the country, nurses suddenly had more options than ever. They could continue serving patients, continue working grueling hours in frantic conditions, but they would be paid well for it. Travelers were valued. Their work was in demand. The money would be enough that after a few weeks or months on the job, they could go home and recover.

Hospital associations were already beginning to see the steep costs of these workers, but they had little choice in the matter. The shortages were too severe, and they would only get worse. In July 2020, Texas established a statewide emergency staffing system, coordinated by select regional advisory councils. The state has put $7 billion in relief funds toward supplementing staffing, which has allowed hospitals like Northwest to attract travel nurses without shouldering the full cost. “The problem is that their salaries were so much higher than our employee salaries,” said Brian Weis, the chief medical officer at Northwest. “Our employed nurses were doing the same job, but they’re saying, ‘Why are we getting paid a fraction of what these nurses are?’”

The following year, the demand for travel nursing broke loose from Covid. In April and May 2021, as case counts dipped, hospital requests for travel nurses only grew exponentially. “They now know what pent-up demand does to a health care system, and it’s not healthy,” said April Hansen, the group president at Aya Healthcare, one of the largest providers of travel nurses in the country. “If you look at our demand today, it looks like our demand pre-Covid in terms of specialties: med surge, telemetry, I.C.U., emergency room, surgical. It’s just the volume that is being asked for in every specialty.”

It isn’t the traveling-nurse boom alone that has transformed the market. There are also more job opportunities beyond the bedside than ever. Nurse practitioners treat patients in doctors’ offices; insurance companies employ thousands of nurses; Microsoft and Amazon have hundreds of open nursing jobs. Today, only 54 percent of the country’s registered nurses work in hospitals. “There was competition for talent before the pandemic,” Hansen said. “But the pandemic took a small crack and made it as wide as the Grand Canyon.”

To make things worse, the nursing shortage is part of a worker shortfall that spans the entire health care industry. “This is labor across the hospital,” said Rose O. Sherman, an emeritus professor of nursing at Florida Atlantic University. “This is respiratory therapy. This is lab. This is dietary, environmental services. They have not been immune to having an Amazon warehouse open up and losing a significant chunk of their staff.” If labs are backed up, patients have to wait for a diagnosis. If rooms aren’t cleaned, nurses step in to do the work themselves. Barraza has been known to empty bedpans when the housekeeper is too busy.

Even as hospitals have scrambled to hire travel nurses, many have been chafing at the rising price tag. A number of states are exploring the option to cap travel-nursing pay, and the American Hospital Association is pushing for a congressional inquiry into the pricing practices of travel-nursing agencies. Sherman, however, believes that the problem will not be solved until hospitals start considering how to make bedside jobs more desirable.

After two years, nurses have borne witness to hundreds of thousands of deaths. They have found themselves in the middle of a politicized illness and faced countless angry, grieving family members. Many, now, are moving on. They are looking for jobs outside the hospital. Others are simply uprooting themselves — leaving their homes and their families and continuing to do their jobs for a higher salary. “Nurses have finally learned what they’re worth,” Nora Shadix, one I.C.U. nurse, told me. “I don’t think they’re going to go back to the way it was before. I don’t think they’re going to settle.”

One of the nurses who has cycled through Barraza’s staff is Kulule Kenea, who was furloughed from her job as a nurse practitioner in Minneapolis in March 2020 as part of the city’s initial lockdown. She spent her early years working in I.C.U.s and trauma wards. Her uncle was a registered nurse, as was her cousin. It was something she had always wanted to do. Kenea, who is 33, liked her job. She never had that itch to travel or move. Even before starting her furlough, she got text messages from travel agencies looking for nurses willing to fly to New York. She wasn’t sure how the agencies got her number, but the offers kept coming. “I saw and heard other nurses too,” she said, “just getting mass texts out of nowhere.”

Many nurses like Kenea started traveling in the early months of the pandemic. They were nurses who had also been furloughed, nurses whose personal circumstances allowed them to travel, nurses who felt the call to help people in an emergency and nurses who were drawn by the salaries. Ivette Palomeque, who lives in Texas, traveled to Florida during her divorce. Shadix, who was working at BSA Health System in Amarillo, the hospital across the street from Northwest, decided to travel for six months starting in the summer of 2020 after her boyfriend at the time gave her the number for a staffing agency. Susie Scott, a charge nurse in Abilene, Texas, left her job in the fall of 2020, after 19 years at the same hospital; it had become so short-staffed that Scott was doing the jobs of two or three people. Traveling was an escape. “Now, what I do,” Scott told me, “I go in, I take care of my patients and that is it.”

“People were so desperate for this particular skill,” Kenea told me. “My only responsibility at home is to water my plants. I don’t have kids. I don’t have any other responsibilities. It felt wrong. It felt unfair to be able to just sit at home in the comfort of my house when other people are suffering.” Kenea took a contract to travel to New York and was on an airplane within days — there were only a handful of other people on her flight. She spent a night in a hotel, woke up the next morning and boarded a bus heading to a hospital in Harlem. She was assigned to a medical surgical unit and, on her first shift, was given 11 patients, compared with the typical four or five. It was, Kenea said, unreal. “It did not feel like America.” She worked 14 days in a row, 12-hour shifts, compared with the three-day-a-week standard before the pandemic. She did chest compressions on one patient while another was in the room, watching her, terrified.

Kenea’s father sent her text messages daily, asking her to come home and to stop risking her health. “He would send me all these statistics,” she said. “And I would be like: ‘I’m in the hospital. I know.’” A few months later, in July 2020, Kenea contracted with a traveling agency called Krucial Staffing, which specializes in emergency disaster response. She knew her assignment would be in Texas but had to call in to learn which city — the agency was working primarily with nurses who were willing to go anywhere at a moment’s notice. Kenea would have about a day to get her bearings, taking quick tours of I.C.U.s, notebook in hand. The alarms in each I.C.U. have their own sounds. The charting systems change from place to place. “You need to know the pins for certain doors and a telephone number or email for a manager or somebody who can make stuff happen for you quickly,” Kenea said. “You need to get those things down pat first within the first couple of hours: eyes wide open, ears listening sharp, constantly aware of things.”

Kenea was sent to Corpus Christi and assigned to an older part of the hospital that had been reopened to help accommodate the influx of Covid patients. Not long afterward, she was transferred to another ward, where many of the nurses were younger than she was. Kenea worked a relatively manageable five days each week, although the job was still grueling. “I am not afraid of running toward the fire,” she told me. And the staff nurses were welcoming. Some stopped to ask Kenea for advice on how to start traveling themselves.

Barraza’s unit sits on the fourth floor of a tower on the north side of Northwest. It is brightly lit and wide, and most doors have a yellow sign alerting everyone to the need for personal protective equipment. The medical intensive-care unit, or M.I.C.U., where Shadix has been working as a staff nurse after her stint as a traveler, is separated from the C.I.C.U. by a bank of elevators. There, the lights are dim, and most of the patients have been medically paralyzed so the ventilators can work without resistance. Alarms beep, and monitors are facing the glass, the oxygen levels of each patient blinking toward the hallways.

I.C.U. nursing demands a particular set of skills. Nurses here monitor life-support equipment, track patients’ reactions to medications and respond quickly in an emergency. It can be physical work — it takes multiple people, for example, to turn a patient without unhooking any equipment. I.C.U. nurses are trained to titrate several medications and drips. Good nurses can anticipate when a patient is about to crash. They’re expected to handle situations that are unpredictable and patients who are unstable. “If you don’t use those skills,” Kenea said, “you lose it.”

In December 2020, Kenea arrived in Amarillo for an assignment on Barraza’s team. By that time, the hospital had already seen waves of travelers come and go. Before the pandemic, potential travel nurses were carefully vetted by agencies for expertise and good standing. They were required to have clocked at least a year in their specialty, sometimes two or three. Kenea, for her part, had eight years of nursing experience under her belt. During the early days of the pandemic, however, with hospital staffs suffering from shortages and looking for immediate relief, many local nurses and administrators had doubts about the level of experience of some of the travelers who were landing in their I.C.U.s.

When groups of travel nurses started arriving in Amarillo, Barraza barely had time to connect with them before they disappeared. Their contracts didn’t stipulate how long they needed to stay in any particular hospital, and some would be gone within weeks. Barraza worked shifts in which he was the only member of the core staff, unsure of who had the experience to handle an emergency. “There were some travelers that came, and they were amazing,” he told me. “They were some of the best nurses I’ve worked with. But then there were the ones who shouldn’t have been there.”

If the challenge for travelers, before and during the pandemic, has been to do their job in an unfamiliar environment, the challenge for the nurses who stayed was to offer consistency amid the chaos. Barraza knew early in the pandemic that he would stay. He took on the job of keeping up morale and arrived at his shifts with the energy of a favorite aunt. He started taking in baskets of candy and snacks. He knew the moods of his nurses and which patients were feeling scared and in need of company. He knew who needed a break and who could keep going.

As time went on, the work of boosting morale became more difficult as nurses found themselves facing an unprecedented level of hostility from the outside world. A majority of Covid patients now in the I.C.U. at Northwest are unvaccinated — the region hovers below a 50 percent vaccination rate — and restaurants and malls are filled with unmasked people. Melvyn, the veteran on Barraza’s team, said that one of the most difficult parts of the job is walking outside the hospital into a world where it seems that the pandemic is already over. “You are here and it’s a war zone, and you walk outside and there’s no war,” he said. “My whole life we’ve been preparing for a pandemic, but in none of those meetings, in none of those drills, did anyone say, ‘What if there’s a pandemic, and nobody believes it’s a pandemic?’”

Families of patients now yell at staff daily, asking for unproven treatments or accusing nurses of doing harm. They oppose intubation or refuse to wear masks. Shadix still remembers the time a family blamed her for the death of their loved one. “I will always have compassion for my patients,” she said. “But I’m running out of compassion for the families.”

Nurses have compassion fatigue, fatigue fatigue and alarm fatigue, becoming desensitized to the beeps of monitors. Nurses at Northwest have nightmares about crashing patients, nightmares that they’re being intubated themselves, nightmares that wake them up doing chest compressions on their mattresses. Shadix turns on cartoons while she falls asleep to drown out the soundtrack of alarms that plays in her head. A lot of nurses are stoic, she said. They hold it in. They make jokes. “Surely the Lord is going to bless me for putting up with all of this crap,” one nurse told me.

On bad days, Barraza holds the nurses’ hands while they cry. “We have a pretty well versed nurse that has been a nurse for a long time,” he told me. “But there was a day when her patient was going to be intubated, and she was in the hallway crying, saying that this isn’t fair and she couldn’t do it. I hugged her, and I said: ‘It sucks that it is this hard, but you’re here for a reason. I am here for you, and you’re here for me, and we’re here for these people.’” He went on: “I’m still trying to keep holding on to that aspect of my personality and who I am. If I start losing that part of me, then I need to get out.”

When Shadix was traveling, she left her daughter in the care of her mother and ex-husband and struggled to leave her work at work, she said. For months she took it back to her hotel rooms and Airbnbs — the faces of the patients she lost, the feeling of doing chest compressions, the fear in people’s eyes when they came in. Now when she loses someone, she counts to 10 and allows herself to feel all her emotions. Then she takes a breath and does her best to put them aside.

But for many other travelers, the exhaustion and the hostility they regularly face is blunted by their ability to do something staff nurses can’t: leave. Kenea thinks that moving around has helped her navigate the emotional toll of the pandemic without losing hope — she has witnessed death firsthand, but in episodes, each hospital providing a change of scenery. And when she “decommissions” from an assignment, she allows herself a break before she takes a new job. She feels overwhelmed at times but never burned out. At the end of each shift, she assesses her day, and if she feels she has done everything she can, she lets go of it as soon as she leaves the parking lot.

Then, of course, there’s the pay. Kenea has made enough money to help cover the tuition to become a nurse anesthetist. Shadix’s six-month stint as a traveler allowed her to put a down payment on a house. Chris Detten, a traveler at Northwest, was also able to afford a down payment. Adrian Chavira, Detten’s friend and another traveler at Northwest, said the money has made it possible for his partner to stay at home with their new baby. “Money is a very good motivator,” Detten said. There’s a sense that all the hard work is being rewarded. “You don’t have to worry about the politics of the hospital you’re in.” The power plays, the interoffice dramas, the personalities you can’t escape — the travelers are insulated from it all.

“I appreciate that they’re here,” said Karen Hammett, a longtime charge nurse at Northwest. “Am I a little salty that they’re making more than me? Yes.” Hammett was a veteran of the hospital. She had made it through every wave of the pandemic. But last year was her hardest. “It’s having to deal with the secondary stuff that gets to me — the hate is what sucks. And it’s the worst it’s ever been.” She had her last shift at Northwest on Nov. 21. After nearly 20 years at the hospital, she quit.

As I.C.U. beds in city hospitals filled up and staff nurses started leaving in droves, another story of a precariously overextended health care system was unfolding in smaller hospitals across the country. Rural hospitals, which have long sent their most acute cases to larger hospitals, were left with patients they were ill equipped to handle. Many of these hospitals, with lower profits and wages, struggled to retain nurses and compete with the enormous salaries offered by travel agencies. With no padding, entire departments shut down. Only 40 percent of rural hospitals in Texas offer labor-and-delivery services, and with staffing shortages, many deliver babies only a few days a week. There are 71 counties in the state with no hospitals at all. Across the country, 22 rural hospitals have shuttered in the past two years. According to one 2020 study, 453 more are in danger of closing.

Hereford Regional Medical Center is roughly 50 miles southwest of Amarillo. Shortly before Christmas, hospital officials there declared an internal state of disaster — all the travelers had gone home for the holidays, leaving the remaining staff and administrators struggling to keep the doors open. Administrative staff took shifts over Christmas and New Year’s to avoid a complete shutdown. Nursing teachers from Amarillo drove in to help bridge the gap between the departing and arriving traveling nurses. The hospital had stopped performing surgeries and was sending its labor-and-delivery patients to other hospitals. It could no longer take referrals — serving only the people who showed up in the emergency room — and none of the larger hospitals nearby were able to take its acute cases.

Other rural hospitals are reeling from similar shortages. In Missouri, one rural hospital was unable to transfer a patient with acute pneumonia after contacting 19 different hospitals. A nurse saved the woman’s life by staying up all night, loosening the mucus in the patient’s lungs with a hand-held massager. Rural hospitals in New Mexico have reported calling 40 or 50 hospitals in order to find a bed for acute patients. Candice Smith, the chief nursing officer at Hereford Regional, said: “We need staff, we need supplies, we need medicines. We have spent multiple hours on the phone to try to get patients out of here. If they’ve had a stroke or a heart attack or a traumatic brain injury, we’ve been getting them to Dallas or Oklahoma.” Smith sent a request to its regional advisory council asking for more travelers, but she was unsure of when, or whether, they might show up. “As a rural hospital, we can’t pay for them forever,” she told me. “It will cripple the health care industry.”

“There has been an evolution in the travelers,” Smith continued. “Now they don’t come here or to any facility and say: ‘What can I do? I’m willing to work any day you tell me to.’ Now they say: ‘I’m only going to work Sunday, Monday, Tuesday. I’m going to take off for Christmas.’” When I asked Smith if there was anything else she wanted to share, she said simply, “Just tell people to pray for us.”

In light of the grim staffing numbers, both city and rural hospitals have tried to focus on retention efforts, in some cases mirroring the benefits of the travel-nursing industry. Northwest now offers higher overtime rates for nurses who take extra shifts, and BSA started offering better pay overall. In Florida, hospitals are hiring recent nursing graduates and placing them in nursing teams with more experienced personnel. UAMS Medical Center at the University of Arkansas for Medical Sciences is offering a signing bonus of $25,000 to qualified nurses willing to stay for three years. At Parkland Health and Hospital System in Dallas, doctors have been helping ease the burden on nurses by performing some of their duties.

Ronda Crow is the chief nursing officer at Moore County Hospital District, a nonprofit that serves Dumas, Texas, and the surrounding rural areas. She has spent nearly 10 years working on hiring and retaining nurses, including implementing scholarship programs to help local students through nursing school. Everyone was paid a full salary throughout the pandemic whether they were scheduled to work or not — an incentive, Crow hoped, to stay. “We’re lucky here in Dumas,” she told me. The hospital has the backing of a foundation that helps with funding. During the pandemic, Crow has managed to increase her staff and now has the ability to open every bed in the hospital. “By staffing up, it gives me the opportunity to grow nurse leaders,” Crow said. “Is it an expensive gamble? Yes. Will it pay off in the end? Yes.”

Other rural hospitals, however, will continue to struggle. Without state support, many can’t afford to pay the higher wages that nurses are commanding. Fewer patients are insured, and many are older, their illnesses more severe. And experienced nurses are continuing to leave for other, lower-stress jobs. There are around 153,000 new nurses being licensed every year, but based on projected demand, it will not be enough.

For Barraza, each new spike in Covid patients seems to happen overnight. He may know a surge is coming. He may worry about families gathering for the holidays, but the influx always feels sudden. In the fall, Covid cases in Amarillo dropped, and the hospital was assigned fewer state-subsidized nurses. But the moment the travelers started to leave, a wave of new Covid cases began to fill the hospital’s beds. Northwest scrambled to bring in travelers again. Then the Omicron variant arrived. The hospital’s exhausted nurses went into overdrive. In late December, Shadix texted me a GIF of an exploding house.

“It’s bad,” she said. “But it’s fine. We’re fine.” There were new nurses in the medical intensive-care unit, people who had just graduated, and Shadix was watching them flounder. “It’s a sink-or-swim situation,” she said. “And you learn to swim really quickly, because otherwise, people die.” She had taken on many of the hard conversations with families — telling them that their loved ones would probably not make it. “They started calling me the hospice queen,” she said grimly. Families were allowed to enter the I.C.U.s, and Shadix let them, hoping that once they saw how bad things were — how low the quality of life was for their family members — they would start to let them go. Early in the pandemic, Shadix told me, nurses in the M.I.C.U. tried to stay positive, to offer family members a ray of hope until the end. Now they are more realistic. They need to set expectations.

By January, Northwest had made appeals to the regional advisory council and FEMA for more nurses. Covid patients were filling up the emergency room and surgical floor. At one point, Brian Weis, the chief medical officer, knew of 43 patients in rural hospitals waiting for a transfer. Around 75 staff members at Northwest were in quarantine. While travel and military nurses began arriving, core staff continued leaving. Dellani Spradling, a charge nurse in the M.I.C.U. who never anticipated leaving, abruptly resigned in early February. Another Northwest nurse took a traveling job that moved him to the hospital across the street.

Shadix hopes to be a traveler again. She loves the physicians she works with at Northwest — she knows what labs they need and what questions they’re going to ask. But staying doesn’t make sense. “Here you are, killing yourself for five days making pennies,” she said, “versus working four days or three days making three times what you’re making right now.” Once Shadix goes, some of the longest-serving nurses in the M.I.C.U. will be travelers.

Many nurses are hoping to move on from the I.C.U. entirely. Kenea is starting the nurse-anesthetist program in May. Shadix is taking classes toward her nurse practitioner’s license. “Maybe once this is all over and done with, I’ll come back to the I.C.U. and take my normal patients,” she told me. “But if I never have to see another N95 mask in my life, I will not be sad.”

Barraza is hanging on for now, providing as much continuity as he can. In December, he was working six days a week. The C.I.C.U. was so full of Covid patients that it couldn’t take transfers from the emergency room. “We have beds; we just don’t have the ability to staff them,” he told me. “If we do bring them in, we just overwhelm people even more and possibly push them out the door.”

Barraza has begun taking patients himself in addition to overseeing all the nurses in his unit. He tries to take his candy cart down to the nurses in the emergency room now — he knows they are tired, too. Emergency-department doctors are in such huge demand in smaller hospitals that Weis recalled at least one at Northwest who was contacted and told to name his price.

As the new year started, however, even Barraza was beginning to fray at the edges. He has been having trouble falling asleep. He passes out on his couch most nights. “I lay there, and I see the people that I saw all day and the people that I saw before. I try to keep myself centered and not dwell on it too long, because it puts me in a low place.” He thinks, instead, of his staff. He thinks of the nurses who have made it out. He thinks of a patient who recently recovered. He tries to relax, but sometimes his body won’t let him forget.

Lately, as he tries to fall asleep, he has been feeling the phantom pressure of a hand in his — the feeling of a patient about to be intubated, another frightened person on the edge of life and death. “You get all these sensations and feelings,” he told me. “Feeling them grasp you, and feeling their grasp letting go when the medication hits them.”

Lauren Hilgers is a writer based in New York. She is the author of “Patriot Number One: A Chinese Rebel Comes to America.” George Etheredge is a New York City based photographer raised in North Carolina. He was recognized as one of “The 30: New and Emerging Photographers to Watch in 2020.”

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More nurses are quitting their jobs to try a lucrative stint as a traveling nurse

Blake Farmer

In many hospitals, the only thing keeping ICUs fully staffed is a rotating cast of traveling nurses. Hospitals are having to pay them so much that their staff nurses are tempted to hit the road too.

Copyright © 2021 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Burned-out nurses are swapping their hospital jobs for travel shifts. They're paid around 50% more than staff nurses, but life on the road can be tough.

• Staff nurses are burned out and trading stability for the flexibility and pay of travel nursing. 
• Many enjoy the perks of travel nursing and feel they have more control over their mental health.
• But there are challenges, including finding affordable housing and navigating unfamiliar hospitals.

"It hasn't gotten better," Dr. Sun Jones, a doctor of nursing practice, a board-certified family nurse practitioner, and an associate professor with the University of Phoenix College of Nursing, said. "The nursing shortage is still continuing." 

According to Jones, traveling nurses were supposed to be a temporary solution to the nursing shortage in the 1970s and 1980s. However, the scarcity of full-time resident nurses has remained an issue — and one that's only grown over time. 

The pandemic has amplified the need for more healthcare workers. Traveling nurses have been in high demand since the beginning of 2020 due to a few factors. Some nurses have fallen ill while supporting COVID patients and have needed coverage as a result, others have experienced burnout and needed time off, and there has been an increasing need of overall coverage as patients deal with illnesses and health complications from COVID. 

Jones expanded on the intensity of the nursing shortage, saying hospitals "are trying all different ways to increase the number of nurses, but the demand is getting higher and higher."

There simply aren't enough nurses at healthcare facilities to meet current demands. Staff nurses have been working overtime, which has led to a burnout epidemic. They are exhausted physically, mentally, and emotionally, and travel nurses are helping hospitals keep up with patient needs while giving staff nurses much-needed breaks. 

Why nurses are leaving staff jobs to become travel nurses

Hannah Stone left her staff-nursing job five years ago to become a travel nurse and explore other areas around the country while figuring out where she might want to settle down. 

"I experienced a lot of burnout in my staff job before travel nursing. The desire for something new was definitely needed at the time," Stone said. "I've really enjoyed the lifestyle and freedom it has allowed for me to live." 

Additionally, traveling nurses make about 50% more money, on average, due to the high demand. According to Indeed, an average weekly salary for a travel nurse is around $2,425, compared to a staff nurse's average weekly salary of about $1,600.

Stone isn't the only nurse who has recently made this switch. Julie Mikus, another traveling nurse, shared similar thoughts. Mikus said she "started experiencing burnout at my last job" before she began traveling. 

Related stories

Mikus went on to explain that despite her hospital administration providing support to staff, the emotional toll she experienced from the immense loss of patients was too significant to stay. She needed a change.

The perks of going on the road

According to Jones, traveling nurses have a little more control over their schedules, allowing them to rest between assignments and take more vacations, which, in turn, helps them maintain their mental health.

"The benefit to travel nursing is being able to take the necessary time off between assignments to recharge so that I can be my best for myself, my family, and my patients," Beth Hawkes, a registered nurse, said. 

Ivette Palomeque, who has been an ICU nurse for 11 years, shared that the amount of control and agency travel nurses have over their time is another big reason why she went into travel nursing. 

"As a travel nurse , I get to choose where I go and, usually, the shifts I work. It allows me to move about the country and experience different settings, all while still doing what I love, which is being an ICU nurse," she said.

There are some challenges, but for most, the pros outweight the cons

Traveling nurses may have increased pay, but hospitals often hand them more responsibility and harder cases as a result — they can also have higher housing costs from moving around so frequently.

"It is unethical, but we all know it occurs: Travelers are paid more. Travel nurses always get the most difficult patients, regardless of the degree of acuity, the aggression of the family members, or the patient's lack of respect for the medical team," Hawkes said.

Other traveling nurses spoke to Insider about the challenges they regularly face when it comes to learning new hospitals and policies. They deal with everything from learning where supplies are and figuring out the chain of command to navigating different expectations; many day-to-day variables change, and staff nurses often have a bit more stability. 

This is something Stone has learned to deal with on her travel-nursing journey. "The biggest challenge while traveling is seeing how different hospitals operate and how they manage a patient's treatment," she said. "You have to be really strong in your skills and your field to best advocate for your patients. Always stay up-to-date on best practices for the best patient outcome."

Figuring out where you're going to live can be another struggle. Some traveling nurses will work with agencies that provide housing, but others are required to find their own affordable-living accommodations. With inflation and the housing crisis touching almost every part of the nation, affordable housing in safe areas — especially for temporary workers — can be difficult to find.

Beyond housing scarcity, there's the added stress of having to go weeks — and sometimes months — away from friends and family to work. 

"I caught COVID this January while on assignment in Maryland, 1,500 miles away from my home base in Houston. I was quarantined in a hotel room for 10 days, and it was awful," Palomeque said. "The support system you normally have now becomes remote, and if you find yourself battling with a decline in your mental health, it may be hard to get the help you need at the time."

But even with these challenges, many are finding that the relief from burnout they experienced as staff nurses outweighs the cons, and — at least for now — they aren't looking back.

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Pay for travel nurses is down—and some are suing

As demand for travel nursing wanes, many nurses are reporting abrupt pay reductions—ranging from 25% to 75%—from staffing agencies. In response, many of these nurses are now suing staffing agencies for allegedly engaging in "bait-and-switch" practices when it comes to their pay, Valerie Bauman writes for Newsweek .

Travel nurses sue staffing companies for abrupt pay cuts

During the pandemic, the travel nursing industry saw significant growth as many hospitals and health systems struggled with staffing shortages amid Covid-19 surges. According to Staffing Industry Analysts , traveling nursing revenue tripled from $3.9 billion in 2015 to roughly $11.8 billion in 2021. And at the height of travel nursing demand, some nurses saw pay as high as $125 an hour.

However, as Covid-19 hospitalizations declined and many states ran out of pandemic relief funds, the demand for travel nurses dropped, leading to significant—and sometimes abrupt—pay reductions.

Hannah Bailey, a 49-year-old nurse who had contracted with Aya Healthcare , initially agreed to a contract with an $85.86 per hour rate with a weekly $1,000 stipend, from late March to late June. Then, five weeks later, her rate was suddenly reduced to $50.85 per hour. Weeks later, her rate was further reduced to $34.25 per hour, lower than what she was being paid at her old, non-travel job.

"I'm just breaking even, barely," Bailey said. "Sometimes I'm in the negative—like this week ... I wouldn't have taken the job at this pay rate."

According to Bauman, hundreds of travel nurses have reported similar instances of seeing their pay rates significantly cut after being initially offered a much higher rate. Currently, several staffing companies are facing lawsuits that allege they engaged in fraudulent "bait-and-switch" practices of hiring a nurse at one rate while planning to reduce it after they relocate.

Austin Moore, an attorney at Stueve Siegel Hanson , said he has filed lawsuits against four staffing companies so far, including Aya Healthcare, Maxim Healthcare , NuWest Group , and Cross Country Healthcare .

"We're hearing from nurses all over the country who just felt absolutely taken advantage of, and who felt like the rug had been pulled out from under them," Moore said. "It's fraud because they're knowingly participating in a bait-and-switch."

While Aya and other providers said they wouldn't comment on specific litigation, an Aya spokesperson denied overall wrongdoing, saying the allegations were "demonstrably false" and that the complaints failed to note "the reality that nurses received mid-assignment pay increases at various times during the pandemic."

In addition, Cross Country CEO John Martins said, "Our clients have faced unprecedented cost pressures, and although historically rare, if changes are necessary to a contract, our goal has always been to protect and insulate our clinicians from rapid swings in compensation or the sudden loss of a temporary assignment to the greatest extent possible."

Why the abrupt pay cuts?

According to the American Staffing Association (ASA), a trade group that represents travel nursing and other staffing companies, hospitals were the ones to demand staffing companies lower their rates for travel nurses as Covid-19 rates declined and many of them ran out of federal pandemic funds.

"When bill rates decline, staffing agency revenues decline and the agency must make proportionate reductions in its costs, including labor (the largest share of costs) to maintain profitability," said Toby Malara, VP of government relations at ASA.

However, Mindy Hatton, general counsel for the American Hospital Association (AHA), said that rates for travel nurses are set by the staffing companies, not hospitals.

"Travel nurse staffing agencies have taken advantage of hospitals and health systems during the pandemic by inflating prices to unsustainable levels, a significant proportion of which is not passed on to the nursing and other staff," Hatton said.

To address the high costs of travel nurses, AHA, the American Health Care Association, and the National Center for Assisted Living earlier this year asked the White House to investigate staffing agencies. According to the organizations, staffing agency prices are not directly correlated with the income individual travel nurses earn.

How these pay cuts could further exacerbate the nurse shortage

According to Maggie Ortiz, a nurse advocate, the practice of abruptly reducing pay could potentially exacerbate the current nurse shortage.

Based on data from McKinsey & Company , the United States is projected to have a shortfall of between 200,000 and 450,000 RNs by 2025. Although some nurses may be leaving the profession due to retirement, a significant portion may be leaving due to a sharp decline in job satisfaction and an increase in other stressors.

For example, a recent survey from the American Association of Critical Care-Nurses found that only 40% of RNs said they were "very satisfied" with their job, down from 62% who said the same in 2018. Overall, 67% of RNs said they planned to leave their current position within the next three years. Of this group, 36% said they planned to leave within the next year, with 20% planning to leave within the next six months.

If travel nurses continue to face sudden pay reductions, many will be less likely to engage in travel work and assist with shortages, and more will likely leave the profession all together after the trauma of the Covid-19 pandemic, Ortiz said.

"Patients need to understand that there's going to be organizations probably that close... we're seeing that there are going to be floors that are closed. They are going to be units that are closed," Ortiz said. "Every nursing issue is a patient issue." (Bauman, Newsweek , 9/25)

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Posted on September 27, 2022

Updated on March 18, 2023

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Spike in travel nurses’ pay reflects deeper staffing concerns

Independent Journalist Sarah DiGregorio recently offered good advice in a  March 14 perspective opinion article in the Washington Post to reporters following current challenges in hospital staffing. She urged a deeper examination of the root causes for reported instability in the nursing workforce and the resulting recent cases of notably high salaries now offered for those willing to take on temporary work away from their homes.

In the article,  DiGregorio shared stories from her reporting on nursing to explain why the recent spike in salaries for travel nurses reflects deeper concerns.

The pandemic has added to the stresses of nursing, leading to departures from permanent jobs and creating a situation where people willing to take on temporary employment may get $3,500 a week “and sometimes even more,” DiGregorio noted.

“Yet the problematic explosion of traveling nursing is only a symptom of a longer-running, self-inflicted disaster,” DiGregorio wrote. “Over the long-term, hospitals have failed to hire and support enough nurses to weather crises.”

DiGregorio, who is working on a book on the history of nursing, writes about how hospital executives furloughed or laid off nurses early on in the pandemic when elective procedures were suspended, and then they later had to scramble to raise staff levels.

“Ping-ponging from furloughs and layoffs to cutting hours and then to mandatory overtime is not a recipe for retention,” DiGregorio said. “The understaffing crisis is a circular problem: Not hiring enough nurses makes working conditions unbearable, leading to more nurses leaving their jobs.”

In her article, DiGregorio explains how these challenges arose long before the pandemic. She observes that the current structure of payment for U.S. medical care creates a situation where the value of nurses’ work may not be fully valued.

“From a hospital administrator’s point of view, fewer nurses taking care of more patients is much more profitable,” DiGregorio wrote. “But from a patient’s perspective, this might mean you don’t see your nurse for hours.”

Lawmakers have responded to hospitals’ concerns about rising costs charged by staffing agencies for the services of travel nurses, DiGregorio notes. Rep. Peter Welch (D-VT) and Rep. Morgan Griffith (R-VA) in January gathered signatures from more than 190 of their colleagues for a bipartisan letter to the Biden administration. In it, they asked that one or more federal agencies investigate “exorbitant price increases by nurse-staffing agencies” during the COVID-19 pandemic.

In contrast, lawmakers have not been as interested in the financial gains of hospital executives during the pandemic, even though these workers do not have as direct an impact on outcomes for patients as nurses do, DiGregorio said.

“Employing more nurses per patient is safer for patients, and it makes nurses less likely to burn out and quit. But hiring and supporting a large nursing staff is expensive, and many hospitals have been unwilling to do it,” DiGregorio said. “Travel nurses are expensive, too, but they are a short-term expense; they don’t get benefits or job security.”

‘Working too many hours with too many patients’

There’s been concern for years about how well the U.S. medical system is maintaining and attracting its nursing workforce.

The nonprofit ECRI put staffing shortages, including those of nurses, at the top of its Top 10 Patient Safety Concerns 2022 report, released last week. A high proportion of nurses are at or near traditional retirement age, with nearly 20% of registered nurses (RNs) being age 65 or older.

The American Nurses Association (ANA) has for years been asking Congress and federal officials to address what it calls “the chronic causes of cyclical nursing shortages.” In a Feb. 1 statement, the ANA said the “overhead costs associated with staffing agencies” are “only one symptom of a much larger systemic problem.”

“Nurses, like all other Americans, have the right to seek employment that meets their financial needs, allows them to work in safe conditions and to provide quality care for their patients,” ANA said.

The pandemic has only worsened problems that had been chief causes of stress for nurses for many years, ANA said.

“Nurses report that they are working too many hours with too many patients, and many are under constant stress given their responsibilities plus the fear of being assaulted at work,” ANA said. “Staffing agencies may in some circumstances provide them greater resources, flexibility, and choices about their work environments. Many nurses are choosing this option or retiring and leaving direct patient care or the profession altogether.”

‘Moral injury for nurses’

National Nurses United (NNU) has strongly urged lawmakers to pass minimum staffing ratios. This step would improve outcomes for patients and help with employee retention, easing a key source of stress that makes nurses leave the profession, Irma Westmoreland, R.N. and vice president of NNU told the House Committee on Veterans Affairs at a March 17 hearing. Westmoreland was a witness at a hearing focused on attracting and retaining medical staff within the Veterans Health Administration.

“Safe staffing is not only essential to providing the quality of care that patients need, [but] it is also critical to increasing nurse retention,” Westmoreland said in her written testimony. “Chronic understaffing can cause a decline in patient care which in turn can lead to moral injury for nurses, causing them to leave the bedside when they feel they cannot provide the level of care they were trained to give.”

Westmoreland said journalists tend to “echo cries of a `nursing shortage’ “despite data indicating the size of professionals able to do this work exceeds the need for their services in many places. In her testimony, she cited a federal report,  Supply and Demand Projections of the Nursing Workforce: 2014-2030, which was released in 2017. The report says seven states are projected to have a shortage of registered nurses in 2030, with four of these states having a deficit of topping the equivalent of 10,000 full-time RNs, or full-time equivalents (FTEs):  California (44,500 FTEs), Texas (15,900 FTEs), New Jersey (11,400 FTEs) and South Carolina (10,400 FTEs).

States projected to experience the largest excess supply compared to demand in 2030 include Florida (53,700 FTEs) followed by Ohio (49,100 FTEs), Virginia (22,700 FTEs) and New York (18,200 FTEs).

The NNU is among the unions that support a bill introduced by Rep. Jan Schakowsky (D-IL), the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021. The bill calls on hospitals to plan to have adequate staffing such as registered nurses providing direct care should not be assigned to the following number of patients in that unit.

Proposed limits in the bill include having a nurse assigned to:

• One patient in trauma emergency units.
• One patient in operating room units provided that a minimum of one additional person serves as a scrub assistant in such unit.
• Two patients in critical care units, including neonatal intensive care units, emergency critical care and intensive care units, labor and delivery units, coronary care units, acute respiratory care units, post-anesthesia units and burn units.
• Three patients in emergency room units, pediatrics units, telemetry units, antepartum units, and combined labor, delivery and postpartum units.
• Four patients in medical-surgical units, intermediate care nursery units, acute care psychiatric units, and other specialty care units.
• Five patients in rehabilitation units and skilled nursing units.

The bill also includes provisions intended to protect nurses who might face demand to violate the proposed minimum ratios or to take on work for which they are not prepared by education or experience.

As of Monday, Schakowsky had 77 Democratic co-sponsors for her bill . That tops the 56 co-sponsors, also all Democrats , whom Schakowsky had as supporters for her previous version of this bill, which she introduced in the 116th session of Congress (Jan. 2019-Jan.2021).

The American Hospital Association (AHA) objects to Schakowsky’s bill. A 2021 article in the publication Clinical Advisor quotes Robyn Begley, D.N.P, R.N., AHA’s  chief nursing officer as saying that mandated nurse staffing ratios imply a “one-size-fits-all” approach to patient care.

“Nurse leaders and nurses are best qualified to determine appropriate staffing for the needs of their patients,” Begley told the publication . “Mandated nurse staffing ratios are a static and ineffective tool that do not ensure quality care, optimal patient experience, and staff well-being.”

AHA confirmed for AHCJ that it maintains this objection to Schakowsky’s bill. Her bill uses as a reference California’s mandate on minimum nurse-to-patient staffing ratios. The state in 2004 became the first in the nation to establish minimum nurse-to-patient staffing requirements in acute-care hospitals, according to a report from the nonprofit California Healthcare Foundation. State lawmakers in 1999 passed a bill that set the stage for the creation of specific ratios for nurse staffing in different types of hospital units; for example, the minimum ratio in medical-surgical units was one nurse per six patients.

Hospital committee model

The American Nurses Association (ANA) also has called for staffing rules but has backed a different approach.

On its Nurse Staffing Advocacy webpage, ANA notes that seven states have passed staffing laws that resulted from what it calls collaborative efforts among state hospital associations, nurse executives, and ANA-affiliated state nurses associations. These are Oregon (2002), Illinois (2007), Connecticut (2008), Ohio (2008), Washington (2008), Nevada (2009) and Texas (2009)

ANA says there is a need for state action due to a lack of clarity in federal rules, which require hospitals certified to participate in Medicare to “have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed”.

“This nebulous language and the continued failure of Congress to enact a federal law, The Registered Nurse Staffing Act, has resulted in states taking action to ensure there is optimal nurse staffing appropriate to patients’ needs,” ANA says on its website.

The bill cited here, the Registered Nurse Staffing Act, seeks to have hospitals establish staffing committees to put limits on how many patients a nurse must attend. Sen. Jeff Merkley (D-OR) has introduced three versions of this measure. He had no cosponsors for the 2014 and the 2018 versions of the bill, and only one for the 2015 version, Sen. Tammy Baldwin (D-WI).  Each of these Merkley bills called for having no less than 55% of the members of these committees be “registered nurses who provide direct patient care but who are neither hospital nurse managers nor part of the hospital administration staff. ”

“As the husband of a nurse, I know firsthand the many challenges nurses face and how critical their care is to patients,” said Merkley in a statement about the 2014 bill . “Safe staffing that enhances patient care, reduces medical errors and bolsters nurse retention all at the same time would be a tremendous improvement to the delivery of high-quality care.

Additional resources for reporting on retention of nurses and staffing levels

American Nurses Association

• ANA Calls on Congress and the Administration to Investigate and Mitigate the Root Causes of Nurse Shortages , Feb. 1 press release
• Nurse Staffing Advocacy webpage
• Nursing Staffing Think Tank webpage

American Hospital Association

• 4 letter to Federal Trade Commission , suggesting the agency ​​investigate what AHA calls “anticompetitive pricing by nurse-staffing agencies.”
• March 1 letter to members of Congress, Challenges Facing America’s Health Care Workforce as the U.S. Enters Third Year of COVID-19 Pandemic , includes details on reported cost of travel nurses.

More useful tools

• Congresswoman Schakowsky, Senator Brown Introduce Nurse Staffing Standards Legislation, press release from Schakowsky’s office. Link here to the bill .
• NNU’s Safe RN-to-Patient Staffing Ratios webpage
• Supply and Demand Projections of the Nursing Workforce: 2014-2030 , Health Resources and Services Administration, 2017.

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Home > Blog > Assessing the Value: Was Travel Nursing Worth It in 2023, and What’s the Outlook for 2024?

Assessing the Value: Was Travel Nursing Worth It in 2023, and What’s the Outlook for 2024?

September 26, 2023 by Voyage Healthcare

Travel nursing, a profession that flourished with demands for healthcare flexibility and a growing trend of nomadic living, was undeniably a popular career choice in 2023. The pertinent question, as we step into 2024, is whether the pursuit was worth it for those who embraced this dynamic career, and what the future holds for travel nursing.

Travel nursing involves registered nurses taking up temporary assignments in various locations, often filling in gaps where nursing staff is in high demand. This career path offers an opportunity to explore different parts of the country or even the world, all while gaining diverse clinical experience. The profession offers a blend of adventure, learning, and financial rewards, making it a sought-after career choice for many nurses.

The Rising Trend of Travel Nursing

Historical Growth

Travel nursing, as an occupation, emerged as a response to nursing shortages and evolved significantly over the years. Historically, during the early 1980s, the concept of travel nursing originated to address regional shortfalls and cater to seasonal population fluctuations. The industry’s growth trajectory since then has been remarkable, underpinned by an ever-increasing demand for healthcare services and a need for specialized nursing skills across various geographical locations.

Current Demand and Supply Dynamics

Fast forward to 2023, the travel nursing sector is experiencing an unprecedented boom. The ongoing global health challenges, notably the aftermath of the COVID-19 pandemic, have amplified the requirement for skilled nursing professionals across the globe. Hospitals and healthcare facilities are grappling with increased patient loads, and the specialized skills of travel nurses have become invaluable in ensuring that quality care is uncompromised.

Current market dynamics showcase a supply-demand mismatch, where the demand for travel nurses far outweighs the supply. This imbalance has led to competitive remunerations, enhanced benefits, and varied opportunities, making travel nursing a highly attractive career option. The flexibility and autonomy associated with this career are further fuelling its popularity among the nursing community, especially among those seeking diverse experiences and work-life balance.

Predictions for 2023 and Beyond

Analyzing the current trends, 2023 is poised to be a year of substantial opportunities and growth for travel nursing. The ongoing healthcare developments, demographic shifts, and increasing healthcare needs predict a sustained demand for travel nurses. Advancements in telemedicine and digital health platforms will likely further integrate travel nursing into the broader healthcare ecosystem, offering more diverse and remote opportunities.Looking ahead to 2024, industry analysts predict sustained demand for travel nurses. The ongoing evolution of healthcare needs, coupled with the desire for flexible staffing solutions, will continue to drive opportunities for travel nurses.

However, the transient nature of travel nursing also brought forth challenges, particularly concerning job security and work-life balance. Some travel nurses expressed concerns about the unpredictability of assignments and the potential impact on their long-term career trajectories. Balancing the demands of frequent travel with personal life and relationships was another area that required navigation and adaptation.

Why Consider Travel Nursing?

In a dynamic world, the allure of travel nursing comes from its unique blend of professional development, adventure, and financial incentives. But what makes it particularly appealing in 2023 and beyond?

Financial Rewards

One of the standout benefits of travel nursing is the financial reward. Travel nurses often earn competitive salaries, and the chance to work overtime can further boost income. Let’s explore some high-paying contracts with Voyage Healthcare:

• Pay: $2,495/wk (36 hrs)
• Duration: 13 weeks
• Shift: 3×12’s Flex
• Pay: Starting $2,336/wk (36 hrs)
• Shift: 3×12 Nights
• Pay: Starting $1,799 (36 hrs)
• Pay: Starting $4,880 (36 hrs)
• Shift: 3×12 Days

These contracts showcase the lucrative opportunities available, making the financial aspect of travel nursing quite enticing.

Flexibility and Adventure

Beyond the paycheck, travel nursing provides a sense of adventure and flexibility. The ability to choose assignments in various locations allows nurses to explore new cities, experience diverse cultures, and meet different people. This variety not only keeps the job exciting but also fosters personal growth.

Building a Diverse Skill Set

Travel nursing enables nurses to work in different healthcare settings, from large urban hospitals to rural community clinics. This exposure helps in building a diverse skill set, making travel nurses adaptable and highly sought after in the industry.

Real-Life Examples

Across the globe, many travel nurses have found fulfillment and success in their careers. They’ve explored breathtaking landscapes, immersed themselves in diverse communities, and have made a significant impact on the lives of their patients, all while advancing their nursing skills.

Challenges and How to Overcome Them

Like any profession, travel nursing comes with its set of challenges, such as adjusting to new environments and dealing with the uncertainty of temporary assignments. However, with the right mindset and preparation, these challenges can turn into growth opportunities.

Addressing Common Concerns

Job security.

Job security is a critical concern for individuals contemplating a career in travel nursing, given the contractual nature of assignments. However, the skyrocketing demand for healthcare services, especially post the global health crises, has made travel nursing one of the more secure professions in the healthcare sector. The ongoing shortages of skilled nursing staff across various geographical locations have led to a constant and increasing demand for travel nurses. While individual assignments may be temporary, the abundance of opportunities available means that travel nurses often have the next assignment lined up well before the current one concludes, contributing to consistent employment and income.

Work-Life Balance

Work-life balance is another common concern, given the variable and sometimes unpredictable working hours associated with nursing. Travel nursing, however, offers a unique advantage in this regard. The flexibility to choose assignments, control over the duration and location of the job, and the ability to take extended breaks between assignments contribute to a better work-life balance. Moreover, travel nurses can explore new locations, experience diverse cultures, and enjoy recreational activities that a traditional, stationary job might not permit, thereby enhancing life satisfaction and overall well-being.

Benefits and Compensation

In terms of benefits and compensation, travel nurses are often at an advantage compared to their stationary counterparts. Due to the high demand for their specialized skills, travel nurses typically command competitive salaries, often higher than permanent staff. In addition to this, many agencies offer comprehensive benefits packages, including health insurance, retirement plans, housing allowances, and travel reimbursements. These perks not only address the financial aspect but also cater to the holistic needs of travel nurses. Moreover, the opportunity to earn bonuses and overtime can further enhance their earning potential.

In conclusion, travel nursing in 2023 offers a plethora of benefits, from financial rewards with companies like Voyage Healthcare to the thrill of adventure and the chance to build a diverse skill set. And yes, while travel nursing presented its share of challenges in 2023, for many, the rewards and experiences garnered made it worth the journey. The outlook for 2024 remains positive, with continued opportunities and an evolving support landscape for travel nurses. The profession’s dynamism, combined with ongoing efforts to address common concerns, suggests that travel nursing will continue to be a valuable and rewarding career path in the coming year. If you’re ready to kick start or take on your next travel assignment in Tulsa or anywhere else in the US, Voyage Healthcare is here to help! Call them today at 800-798-6035 for more details about travel contracts.

• Registered nurses with at least one year of clinical experience are eligible for travel nursing.
• Typically, assignments last 13 weeks but can vary depending on the contract.
• Yes, travel nurses have the flexibility to choose their preferred assignment locations.
• Most travel nursing agencies offer housing stipends or assistance in finding accommodation.
• Yes, reputable agencies like Voyage Healthcare provide comprehensive benefits to travel nurses.

Read Another Blog Post: Explore the Best Books for Travel Nurses: Unlocking Knowledge and Inspiration

Don’t forget to follow Voyage Healthcare on social media to stay up-to-date on the latest news and information about travel nursing and healthcare. You can find Voyage Healthcare on:

Instagram:  https://www.instagram.com/voyagehealthcare/

Twitter:  https://twitter.com/Voyagetravel

LinkedIn:  https://www.linkedin.com/company/voyage-healthcare/

TikTok:  https://www.tiktok.com/@voyagehealthcare

Trusted Health Blog

Travel Nurse Industry: Outlook & Tips For 2023 | Trusted Health

As the healthcare industry slows from the chaos and bursting census of COVID, hospital leaders are working to maintain much tighter budgets. Historically, the summer season has always seen a slowdown in available travel jobs but this year it seems to be hitting at a time where there is an even larger pool of travel nurses. Just like any industry, travel nursing operates on the basic principle of “supply and demand”. This is creating a lot of competition, lowering pay rates, and making it a little more difficult to find that dream travel job - you know, the one in the sleepy beach town with the best pay and the shift schedule you want? We all dream of that one! While travel nursing is not going away anytime soon, you may just have to broaden your horizons a bit for the time being. Here are a few tips for job searching during this season:

Speed is key

Check daily for new jobs and be ready to apply for them. Have your profile (and any relevant requirements for your specialty) completed ahead of time so that you can be submitted to any job that you apply for immediately.  

Be flexible with your assignment requirements

Market pay rates have decreased across the board so waiting to apply to roles with the highest rates may make it difficult for you to land a job. The same applies to specific geographic locations, shifts, and general job requirements. Don’t take a position that is outside of your scope or makes you feel unsafe, but try to keep an open mind to places, shifts, or units that you hadn’t previously considered. It’s all a learning experience after all! It can be helpful to keep a pulse (pun intended) on available jobs regularly - even long before you’re applying - to understand what’s available and set your expectations accordingly. Specific shift requests/scheduling, large amounts of requested time off, and having a travel pair will all make you less marketable during this time so try to be as open as possible.

Use your connections

Have an old Nurse Manager that you’re still in contact with? Check in with them to see if they are hiring travelers and if they can help you get an assignment back on a unit you previously thrived on. If they have availability and can work it into their budget needs, it’s a win-win - they know you’re already suited for the role, and you get a job you know you can do well until the market picks back up. This applies to local assignments too - you can stay at home or with a family member/friend on a contract until you find something in a location you want to head off to next. If a manager is working on making this happen on their side, be sure to reach out to your Nurse Advocate ASAP so they can get the process started on their end, too! There are a lot of parties that need to align and hoops to jump through to seal a “back door offer” - so the quicker that your Nurse Advocate can start getting in contact with everyone, the better.

Trusted’s Care Team will work tirelessly to help get you the best job possible during these times. Join now and start applying to open jobs today!

Paige is a seasoned travel nurse with years of experience in Pediatrics and Occupational Health/COVID response. The Texas-raised University of Florida graduate completed travel assignments in California, Texas, New York, Florida, and Arkansas in a variety of different healthcare settings before transitioning to become a Clinical Success Partner and later a Brand Associate in the Marketing division at Trusted. She is a previous DAISY Award winner and is passionate about cultural travel, outdoor adventuring, and of course, dogs.

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As COVID surges, ‘travel nurses’ are in more demand than ever, and can make $5,000 per week

Jesse Mogler had been working as an emergency room nurse for less than a year when the pandemic started. During that time, he says, he worked with travel nurses—maybe one or two per shift—in the busy ER of San Juan Regional Medical Center in Farmington, N.M. They were often less experienced than staff nurses, he says, and helping to orient them to the practices of the specific ER took time from more senior nurses on the floor. Still, the travel nurses were helpful, especially on the unpopular late shifts.

By the time he left, over a year later, the COVID-19 pandemic was in full swing, and the floor was primarily staffed by travel nurses—especially during the evening and overnight shifts. By midnight, he says, sometimes even the nurse in charge of running everything—known, appropriately, as the charge nurse—was a “traveler.”

Mogler, who finished nursing school in 2018, found that he was rapidly becoming one of the most experienced nurses on the floor. He was charged with looking after a higher number of patients than ever before, sometimes overseeing six to 10 emergency cases, he says.

In school, he says, teachers constantly reinforce that preventable accidents or deaths among the patients a nurse is assigned to can result in an inquest and the loss of your nursing license—to say nothing of the trauma of knowing you had a role in unnecessary suffering. “It increasingly felt like every shift, we [were] about one traumatic accident, one trauma or critical patient away from unnecessary deaths,” he says. “It was risky to be a patient. It was risky to be a nurse.”

Looking for higher compensation for an increasingly draining job (as well as the ability to move on quickly from an environment that felt unsafe), he posted on a travel nurse job board and got a rush of text messages and voicemails from recruiters. He started his first contact in October and will be working in Durango, N.M., until the end of 2021—making four times the hourly rate he made as a staff nurse.

COVID has transformed many aspects of health care—from early ventilator shortages to endlessly delayed routine procedures. But one of the most striking effects the virus has had is on the career market for the people that care for you. The explosion of travel nurses has massively increased pay for those willing to work for the highest bidder. Healthcare job board Vivian estimates that the average travel RN salary in the U.S. is presently almost $3,200 per week, based on 59,000 active job listings in the past 90 days. That works out to almost $90 per hour for the average 36-hour travel nursing week, according to Vivian. It’s also more than twice the median hourly pay of a staff nurse in the United States in 2020, according to the Bureau of Labor Statistics. But a rotating cast of for-hire staffers has also, some say, destabilized hospitals where employees soon entering year three of the pandemic were already at a breaking point. As ICUs begin to fill up again with a winter COVID-19 surge and the Omicron variant, as well as flu season, this shaky system keeping hospitals afloat will be put to the test. 

Becoming a “traveler”

Travel nurses were around as far back as the 1970s, says Peter Buerhaus, a nursing policy expert from Montana State University. “They have never been a large component of the nursing workforce,” he says. The field, once used to bridge brief localized nursing shortages, started growing pre-pandemic: A market report from Grand View Research published in early 2020 found that in 2019 alone the market for travel nurses grew by 7%, driven in part by hospitals’ ongoing attempts to cut permanent-staffing costs.

The market has ballooned in size since the pandemic began. Staffing Industry Analysts (SIA) estimates that the U.S. travel nurse staffing industry grew 35% in 2020, from $6.2 billion in 2019 to $8.4 billion. By the end of 2021, SIA predicts a further 40% expansion, to $11.8 billion.

“While the volume of travel nurses on assignment grew in 2020 and 2021, much of the market size growth has been due to large increases in pay rates due to the imbalance of demand with supply,” notes Timothy Landhuis, North America director of research at SIA.

The active Facebook group “ Traveling Nurse Jobs $5,000 a week and up ” has more than 100,000 members and is peppered with listings and posts from recruiters. Job boards and groups like the Facebook group are the main ways that travel nurses find work. The business of AMN Healthcare, one of the largest health care staffing firms, is driven predominantly by word of mouth, CEO Susan Salka told a Bank of America virtual conference on the state of health care in May.  

Health care staffing firms have posted impressive returns during the pandemic. AMN reported a whopping 60% bump in revenue over 2020 in its third quarter 2021. Cross Country Healthcare, another prominent firm, was even higher, with a 93% year-over-year increase in Q3 2021.

Usually, travel nurses are restricted to the specific states or regions where their nursing licenses are valid. During the first wave of the pandemic, those restrictions were waived by state governments, and travel nursing provided a framework to move people across state lines to where they were needed most, says Polly Pittman , director of the Health Workforce Research Center at George Washington University. By the time of the third wave, when COVID-19 was ubiquitous, nurses could still work almost anywhere. A bidding war ensued.

“I think travel nurses have an important function, in moderation,” says Pittman. But a large body of research shows that overuse of travel nurses isn’t good—for hospital bottom lines, for staff morale, or for patients.

During the pandemic, big hospital systems that can afford to pay have been able to hire the nurses they needed, says Pittman. Smaller health care facilities that provide care to some of those most vulnerable to COVID-19—like San Juan Regional, a community hospital with about 250 beds—have struggled to maintain staff and find the funds to pay for travelers.

Paying travel nurses has a serious effect on hospital bottom lines, which also impacts quality of care . NSI Nursing Solutions, a national health care staffing and retention agency, conducted a survey of over 3,000 hospitals in 2021 and estimated that hospitals could save an average of $3 million for every 20 travel nurse positions eliminated.

And it hurts relationships with the regular workforce. The widespread use of travel nurses during this pandemic has left staff nurses asking why hospitals can’t find the money to pay them better and hire more staff nurses to reduce their load, multiple sources including Pittman told Fortune . “It creates this downward spiral of low morale,” Pittman says.

Exhausted and overburdened, many staff nurses are leaving the profession altogether or, like Mogler, turning to travel nursing. “If you have a regular nurse making $50 an hour and a travel nurse making $150 an hour, that’s a big gap,” says Martha Dawson, president of the National Black Nurses Association. “I can’t hold that against the nurse, because for them that’s the current system that provides them with earning power.”

“A smoldering fire”

Jewel Scott, a postdoctoral nursing scholar at the University of Pittsburgh, compares nursing before the pandemic to a smoldering fire. If you were right beside the profession, you could see the heat of issues like low staffing ratios, ever-increasing responsibilities, and lack of institutional support flickering. Farther away, though, they were invisible. “Then COVID-19 hit, and [it was like] somebody poured a gallon of gasoline on the fire,” Scott says.

Once upon a time, nearly all nurses got a single one-year qualification—known as the LPN, or licensed practical nurse—and spent their entire career at one or two facilities. Nursing has professionalized significantly in the past 40 years, as health care generally has become more high-tech and specialized. Today, most American nurses get a three-year degree, which makes them RNs, or registered nurses, and many go on to further qualifications. They can become nurse practitioners, who work without the supervision of a doctor, go into more specialized positions like nurse anesthetist, and some even get Ph.D.s and go into academia.

All of those factors mean that acute care RNs, the mainstay of hospital and nursing home staffing, are in much shorter supply than they used to be. “There are always background shortages of nurses,” says Buerhaus. Local shortages can result from factors like several nurses on a ward all going on parental leave at the same time, or poaching by a competitor hospital, he says.

But trends in the past few decades have exacerbated structural shortages—and made the national workforce more vulnerable. The baby boomers who make up the bulk of the RN workforce have been retiring in large numbers since their generational workforce peaked in 2000. Pre-pandemic, about 70,000 of these nurses retired per year.

As a fraction of the total workforce, that’s not a huge percentage. “But when you think about the 20 and 30 years of experience that are leaving the workforce, that’s a big number to replace,” Buerhaus says. For the past few years, he and his colleagues have been hearing from hospitals that experienced nurses in complicated, demanding areas like intensive care and emergency care have been difficult to hire.

At present, about 3.08 million registered nurses are employed around the country, according to the Bureau of Labor Statistics. Demand is predicted to grow by 9% by 2030—that means almost 300,000 nurses. But even though the mainstay of the labor force is retiring and demand for nurses is growing, nursing schools around the country are turning away qualified applicants—over 60,000 last year, the American Association of Colleges of Nursing reported in April.

There just aren’t enough faculty available to staff nursing schools—especially faculty who are people of color. They make up less than 10% of full nursing professors, Scott notes. About one-quarter of nurses identify as people of color. Studies show that outcomes are better for students who learn from people with a mix of ethnocultural backgrounds, regardless of the student’s race. Students who are people of color especially benefit because they have the opportunity to be mentored by people who share their lived experiences and feel more like they belong. 

In her case, Scott says having a Black nursing professor, Marva Price , reach out to talk to her about pursuing graduate studies led her to seek out further qualifications and eventually become a nursing professor herself. “Without a doubt, representation matters,” she says.

And training nurses isn’t just about what happens in the classroom. Few hospitals have invested in nurse training on the job, says Joanne Spetz , director of the UCSF Institute for Health Policy studies. Now that the older nurses who were carrying so much weight are leaving, she says, there’s nobody who can do that vital teaching.

When the pandemic hit, these background issues became an urgent problem. “Hospitals were hit by this very fast, overwhelming demand for this very narrow specialty,” Buerhaus says. Trainee nurses and novice nurses were pressed into service in critical care, alongside the experienced nurses who remained. It’s a vicious cycle. “Poor staffing causes nurse attrition, and nurse attrition sustains poor staffing,” reads a recent commentary from the American Association of Critical-Care Nurses. This cycle has become more intractable during COVID-19. A recent McKinsey & Company survey suggests that as many as 22% of the country’s nurses may plan to leave direct patient care in the next two years. The top issue for the survey’s more than 300 respondents: insufficient staffing. “During the pandemic, what is considered to be a safe number of patients to care for has been stretched to the absolute limit,” says Sue Anne Bell , a University of Michigan nursing professor who specializes in disaster preparedness and has been deployed to communities for four months during the pandemic.

In addition to lowering nurse job satisfaction, turnover dramatically increases labor force costs. Each RN lost to a hospital costs on average $40,038 in 2021, the NSI report finds. Those individual losses add up quickly: With each percentage point a hospital improves its turnover rate, it saves an average of $270,800 annually. Nurse turnover also detracts from quality of care, a team of researchers wrote in a recent quantitative study, “with potentially increased rates of medication errors, falls, or other nurse-sensitive outcomes including health care–associated infections.” 

A “national crisis”

In that sense, travel nursing has created a tricky problem: While it elevates and provides relief for a small subset of burned-out nurses, it magnifies the issues making the job so hard in the first place. The long-standing issues that paved the way for the current crisis also aren’t going away anytime soon, says Georges Benjamin, president of the American Public Health Association. They could be solved over time, he says, although it would take sustained effort.

But the first step in solving a problem is acknowledging that it exists. On Sept.1, the American Nurses Association submitted a letter to the Department of Health and Human Services Secretary Xavier Becerra. The association asked him to declare “a national nurse staffing crisis and take immediate steps to develop and implement both short- and long-term solutions.”

“We do hope to hear from Secretary Becerra soon,” ANA president Ernest Grant told Fortune a week after the letter was submitted As of this article’s publication in December, the ANA had received no response.

As for Mogler, the nurse that left his staff job for a travel position, he struggles with his choice. “I don’t feel great having left a very sick and needy population in a very understaffed hospital and coworkers who…were not able to take the same transition I did,” he says.

But the risk of handling a too-big workload and the feeling that his hospital wasn’t supporting him or his colleagues were too big an incentive to leave. As it is, he says, “I’m going to transition from one contract to the next until either the money is no longer worthwhile or situations start to improve and staff nursing becomes more appealing.”

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clock This article was published more than  2 years ago

As covid persists, nurses are leaving staff jobs — and tripling their salaries as travelers

The American Hospital Association represents a wide variety of hospitals, including nonprofit, for-profit, government and others. A previous version of this article said the group represents only nonprofit hospitals. The article has been corrected.

Wanderlust, and the money to fund it, made Alex Stow’s decision easy. After working a couple of years in an intensive care unit, he signed up to be a travel nurse, tripling his pay to about $95 an hour by agreeing to help short-staffed hospitals around the country for 13 weeks at a time.

“Travel” proved a bit of a misnomer. His current assignment is in Traverse City, Mich., only a few hours from his old full-time job in Lansing — close enough that he still works per-diem shifts at his previous hospital.

Now Stow, 25, is buying a truck and a camper and preparing to hit the road. He’ll work where he wants and take time off to see the country between nursing assignments.

“As soon as I found out that was a thing, I thought, ‘That’s got my name written all over it,’ ” said Stow, who agreed to discuss his new work life if the hospitals were not named.

If 2020 was the year travel nursing took off , with 35 percent growth over the pre-pandemic year of 2019, this year has propelled it to new heights, with an additional 40 percent growth expected, according to an independent analyst of the health-care workforce.

The continued pandemic; an aging, burned-out and retiring nurse workforce; the return of hospital services that were shut down last year; and a shortage of foreign recruits and nursing students have combined to make travel nursing one of the most critical and sensitive issues in health care.

“Of all the things that keep CEOs of hospitals up at night, this is the key one,” said Chip Kahn, president and chief executive of the Federation of American Hospitals, which represents about 1,000 for-profit facilities.

Hospitals accuse the travel companies of price gouging. The companies say they are responding to the laws of supply and demand in an increasingly mobile work environment. Nurses’ unions say there would be no shortage if nurses were adequately paid and afforded better working conditions.

The one area of agreement is that health-care staffing is suffering from fundamental problems that must be addressed for some measure of balance and efficiency to return.

“We need a better way to think about how we oversee and distribute and monitor the supply of our health-care workforce,” said Bianca K. Frogner, director of the Center for Health Workforce Studies at the University of Washington School of Medicine. “We don’t have any kind of centralized workforce commission in this country.”

Stow’s hourly pay is near the median of $99 an hour for critical-care travel nurses at the moment, according to Barry Asin, president of Staffing Industry Analysts, a research firm that focuses on the contingent workforce.

But a quick search turns up ads for even higher pay: $9,486 per week for ICU nurses, posted by Aya Healthcare , one of the industry leaders; nurses with cardiovascular experience can make even more. Travel companies also may offer a full slate of benefits, and some pay nurses a bonus to refer other nurses to them.

The highest pay is going to nurses with experience in specialized hospital units such as the various types of ICUs , those willing to move to remote locations for weeks or months and those willing to respond immediately to emergency needs, people in the industry said. Demand for other health-care workers such as respiratory technicians also continues unabated.

In contrast, a full-time registered staff nurse earns an average of just less than $74,000 per year, according to a 2018 report from the Department of Health and Human Services. About 2.6 million nurses worked in hospital settings in 2018, according to the government.

The travel-nurse market, which Asin said could accommodate well over 100,000 such staffers this year, had more than 40,000 vacancies in October, according to his data. Companies continue to recruit staff nurses to become travelers. Especially for younger and older nurses who aren’t tied to homes or families, the money and travel can be an attractive proposition.

“If people can go somewhere else and earn a year’s salary in three or four months, they will,” said Karen Donelan, a professor of health policy at Brandeis University who follows nurse staffing issues. “But they’re walking into high-covid zones. So this is a risk-reward scenario.”

Tracking the coronavirus

U.S. hospitals have faced periodic nurse shortages for years , and demand was high even before the pandemic, fueled by aging patients and more people with insurance, said Bart Valdez, chief executive of Ingenovis Health, which has 6,000 travel nurses, including Stow, at hospitals across the country. The arrival of the omicron variant may put more people in U.S. hospitals with covid-19.

The average age of a nurse is 50, and ICU nurses are older — an aging workforce edging toward retirement. The number of nurses needed to replace them has been limited by a shortage of faculty members in nursing schools, said Akin Demehin, director of policy for the American Hospital Association, which represents a wide variety of hospitals.

Hospitals are again offering elective surgeries and procedures that were canceled during the first year of the pandemic, putting more pressure on nursing staffs. The flow of foreign nurses into the United States was all but shut off by the pandemic and is not close to normal, said Kahn, of the Federation of American Hospitals.

Then came the pandemic-fueled “great resignation” that has created labor shortages across the United States. In health care alone, 534,000 people left their jobs in August, according to the Bureau of Labor Statistics. Some left for other jobs, but others simply quit or retired. In long-term care such as nursing homes and assisted-living facilities, 400,000 health-care workers have left since the pandemic began, said Frogner, of the University of Washington.

Asin said that “2020 was the year of, ‘Everyone to the barricades — let’s solve this national problem.’ And 2021 is the year of, ‘If this is what it’s going to be like, I’ve got to reevaluate my life.’ ”

Burned out by the pandemic, 3 in 10 health-care workers consider leaving the profession

As coronavirus cases spiked in their areas, hospitals also have hired per-diem nurses and retired nurses. In some particularly dire cases, the government sent in military and public health personnel. Massachusetts announced last month that hospitals there will reduce non-urgent procedures because of rising covid-19 cases and staff shortages.

The nation’s largest nurse union maintains that hospitals are suffering the consequences of the just-in-time staffing model they created to cut costs by keeping the number of full-time staff nurses as small as possible.

“This current staffing crisis is one of the hospital industry’s making,” Deborah Burger, president of National Nurses United, said in a written statement. “They need to take a long hard look at how their treatment of permanent staff and exploitation of the nursing ethos has inevitably led to this unsustainable model of staffing hospitals.”

In the current crisis, these conditions have led to charges that travel companies are gouging hospitals. If there are staff shortages , hospitals must close beds. Four members of Congress last month asked Jeff Zients, the White House’s coronavirus coordinator, to look at the issue, and in February the American Hospital Association complained to the Federal Trade Commission.

“The rates that are being paid and the amounts the nurses are making are frequently out of line with physicians,” Kahn said. “Those companies that have those nurses are in a position to gouge and leverage. I don’t think that can continue forever.”

Hospitals have been able to use government coronavirus relief funds to pay some of their expenses, but that may not always be the case, said the American Hospital Association’s Demehin.

Valdez, of Ingenovis Health, said that “if you need the nurses to support patients and you need them there immediately, you’re going to have to pay to get them there, because they have so many different opportunities. It’s a high number — I recognize that. But it’s a higher cost not to get the services to the patients.”

Stow said he occasionally sees the conflict firsthand when he is working side by side with staff nurses, performing the same tasks for vastly greater pay.

“With any population of people you’ll get a couple here and there. . . . They might show it a little bit, and they might treat you a little differently,” he said. “I think most of the nurses that you work with, they realize we’re not what caused this. We’re, as of right now, kind of a Band-Aid for the situation.”

Coronavirus: What you need to know

Covid isolation guidelines: Americans who test positive for the coronavirus no longer need to routinely stay home from work and school for five days under new guidance planned by the Centers for Disease Control and Prevention. The change has raised concerns among medically vulnerable people .

New coronavirus variant: The United States is in the throes of another covid-19 uptick and coronavirus samples detected in wastewater suggests infections could be as rampant as they were last winter. JN.1, the new dominant variant , appears to be especially adept at infecting those who have been vaccinated or previously infected. Here’s how this covid surge compares with earlier spikes .

Latest coronavirus booster: The CDC recommends that anyone 6 months or older gets an updated coronavirus shot , but the vaccine rollout has seen some hiccups , especially for children . Here’s what you need to know about the latest coronavirus vaccines , including when you should get it.

WA is stuck with a travel nurse dilemma, pitting care against costs

When Kevin Saavedra landed at Seattle’s Harborview Medical Center in February, it became the sixth hospital he’s worked at in less than three years.

He drives from place to place, his two Rottweilers in tow, and has a growing list of states he’d be eager to return to.

Saavedra is a travel nurse, one of thousands in the United States contracted to work short-term stints in hospitals. Historically, the role has helped bolster staffs during occasional times of peak injury or illness — winter flu season, for example.

Now, hospitals need them to survive, but the shift has come at a big cost.

Hospitals continue to lean on travelers because the influx of patients has not slowed in months — some are in for COVID-19 treatments, but many are admitted for summer injuries or delayed care due to the pandemic.

Health care leaders say they are caught in a messy cycle: Hospitals need travel nurses to cover standard shifts, but travelers are expensive, and the longer hospitals retain high levels of contract nurses, the worse financial shape they’ll be in.

Salaries for travelers, whose pay rates can be up to two or three times more than a permanent staffer’s, are one of the major reasons hospital systems in the Pacific Northwest — home to a large community of travel nurses — are having budget problems, hospital leaders say. And it leads to morale issues with the permanent nurses.

Short-term solutions are unclear, leaving hospitals and their staffers to navigate complex discussions around the future of the health care workforce. That might mean slowly reducing the reliance on these travel nurses or providing new and different opportunities for nurses who call Seattle home.

It’s quiet at the start of a recent night shift on one of Harborview’s telemetry floors, where staffers focus on cardiac monitoring, and Saavedra has time to chat with one of his favorite patients, who’s been recovering from back surgery for the past week.

Robin Rebecca Lerum, of Gig Harbor, is still in pain and unable to walk just yet, though she’ll start physical therapy the following day, but piles on praise for the nursing staff the minute Saavedra walks in. Despite her injuries, she always thanks them, he said.

“It’s like a bottomless well of patience here,” said Lerum, 64. She pauses to wipe away a few tears. “The compassion and kindness is kind of overwhelming.”

It’s Saavedra’s sixth shift in a row, though he was only initially scheduled to work three, and he’s exhausted. But patients like Lerum make things easier — and are partly why, along with Seattle’s cultural diversity and natural beauty, he’s extended his Harborview contract three times.

Before starting in Seattle, Saavedra worked monthslong contracts in New Jersey, Missouri, Texas and North Carolina. He likes the pay, but is also drawn to the freedom the nomadic role offers, the opportunity to live in different parts of the country and the ability to often sidestep hospital politics.

“People are always like, ‘Oh, it’s all about the money,’ ” the 29-year-old Charleston, South Carolina native said. “And that is a very good incentive. But underlying, if you’re being treated right, if you like your co-workers, if you’re being taken care of — you’ll actually want to stay.” 

“For me, it’s about what you want out of life, and your happiness and mental health,” he continued.

On Saavedra’s floor at Harborview, travelers make up at least half the nurses on the night shift, charge nurse Taylor Radford said. She’s noticed traveler numbers are starting to fall slightly, but the unit still depends on them. And that’s hurt the bottom line.

This summer, the Washington State Hospital Association reported hospitals across the state suffered a net loss of about $929 million in the first three months of 2022. While operating revenue increased by 5%, operating expenses increased by 11%.

Association CEO Cassie Sauer said at the time that if the trend continued, hospitals would likely have to cut some services or close inpatient units — or, in a worst-case scenario, close or file for bankruptcy. Some large Seattle hospitals have already shown signs of strain.

In August, for example, a lack of bed space and an increasing number of high-cost patients staying for long periods forced Harborview to temporarily divert some patients to nearby hospitals . 

The hospital began to again accept all types of patients the following week, but Mark Taylor, Harborview senior associate administrator, later said he wasn’t confident they’d be able to avoid similar disruptions in the future.

In addition, Providence Regional Medical Center Everett has temporarily stopped accepting patients to its inpatient pediatrics unit. Yakima Valley Memorial Hospital is having trouble staffing all their beds.

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Because of the continued staffing strains, travel nurses are still in fairly high demand in the Seattle area despite some nationwide reports that the “travel-nurse bubble” has popped. While rates are starting to settle back down after soaring to new heights earlier in the pandemic, local hospital leaders say they’re already starting to see demand creep back up as fall — and respiratory illness season — approaches. 

At Providence Swedish, for example, previous bill rates, set by staffing agencies, capped at $150 per hour have fallen to about $111 per hour.

“I don’t think the [travel-nurse] bubble has burst,” Kevin Brooks, chief operating officer of Providence Swedish, said in an interview. “I think it’s normalizing in a post-pandemic world, at a rate much higher than we were pre-pandemic.”

“Supply and demand 101”

During the pandemic, as nurse burnout peaked and turnover rates rose, so did the number of people interested in leaving full-time employment for these contract spots.

Silas Emrys, another traveler working at Harborview, discovered contract nursing during a time when he was tight on cash. He had been working at a hospital in Denver for about a year, and liking it for the most part — but he felt like he wasn’t paid enough because of the high cost of living there. Then, a new business venture for his parents, who had moved home to the Philippines, went south.

“I had pretty much sent all my savings to help them out,” said Emrys, 35. “I was close to bankruptcy. My credit cards were maxed out.”

A few months later, he started his first travel assignment at Harborview.

He sometimes misses the stability of a permanent staff job, but says it’s hard to find one that pays as well as travel jobs do. 

“I want to be able to comfortably take care of them,” he said of his parents. “They’re older and … I want them to live their life in pursuit of their own happiness. I can’t have that in the back of my mind — them struggling — without trying to help.”

Brooks acknowledged the benefits of travel nursing and said it’s easy to see why nurses would be drawn to the job. 

“It builds great flexibility in their lifestyle and they get to tour the country and see different places,” Brooks said. “And for some of them, it’s just a great economic opportunity. And no one faults them for this, by the way. I get it. It’s supply and demand 101. But it certainly is a problem for us to solve in health care.”

Between January and June this year, Providence Swedish spent about $167 million on traveler contracts — more than three times the amount the hospital system spent on travel nurses during the same time period in 2019 (before Swedish merged with Providence).

MultiCare, another large Washington hospital system with locations in the Puget Sound region and the Spokane area, is spending about $30 million more per month on overtime, premium pay and travelers compared with before the pandemic, according to hospital figures sent to The Seattle Times.

By mid-2022, MultiCare had spent $187 million on travelers — compared with $160 million in all of 2021, $71 million in 2020 and $68 million in 2019. 

Virginia Mason Franciscan Health spent 500% more on travelers in the last 12 months compared with the prior year.

Hospitals say they’re doing what they can to reduce traveler head counts and costs, but the travelers are still filling needed roles, Brooks said.

That reality is frustrating to many permanent staff nurses — some who had been at the same hospital for years without seeing anything close to a traveler’s salary, and who were suddenly tasked with leading training after training for temporary co-workers.

“The nurses see what the travelers are making that are working right next to them,” said Edna Cortez, a registered nurse at Seattle Children’s who has considered traveling but says she loves her patients too much to leave. “I’ve been at Children’s for 30 years and I’ve worked with travelers that have way less experience than me and make more money than I do as a staff nurse. That’s really difficult.”

It’s not their fault, she said, adding that it’s up to hospitals to better balance wages and keep in mind how the pay gap might affect the morale and mental health of permanent staffers.

“Nobody blames them. … And we really appreciate the support and the help of our travelers,” said Erin Doyle, who’s worked as a Children’s nurse for almost three years. “They are doing us a great service by helping us. But it is hard and frustrating when it gets to the point where almost half of our staff on certain floors and on certain units are travelers.”

Some recent negotiations between hospitals and their permanent nursing staffs have led to ratified contracts that include significant raises and incentives, including at Children’s and Providence Swedish. While workers say the pay increases are just the first step toward increasing long-term retention rates, Cortez called the new contracts huge wins.

Still, health care labor unions have argued that hospitals had long known about the coming nurse shortage and they could have done more to bolster their workforce. 

Brooks, of Providence Swedish, has pushed back against that thought, saying that at his hospital system, administrators hired “to patient demand,” meaning that although there’s always a need for more nurses, the hospital was “volume-adjusting [its] workforce appropriately” heading into the pandemic. 

“We do desire to pay our own caregivers more and reduce agency [staffers], and we’re trying to walk that line,” he said. 

A changing industry

Hospital and health care experts have acknowledged for months that the industry is evolving, and that goes well beyond the reliance on contract nurses. They’ve witnessed a recent rise in telenursing and gig nursing opportunities. Many new nurses are prioritizing part-time work, opting for a more stable work-life balance. Tech companies are digging into health care. 

One new startup in particular has caught the eye of Providence Swedish leaders. 

CareRev, an online marketplace started by a former RN in San Francisco, aims to connect nurses with open shifts at different, local hospitals. Unlike travel contracts, which often require nurses to work the same assignment for a minimum of 12 weeks, CareRev pairs nurses up with one-off shifts. Nurses could work at a different hospital every week, blocking out whichever days or times they want.

Earlier this year, Providence Swedish picked up more than 1,000 nursing shifts through CareRev. While the gig system isn’t the most ideal for hospitals, most of whom would prefer to employ their own staffers, Brooks said, health care leaders really have no choice but to get on board.

“The train has left the station,” said Brooks. “Nurses are going to do this. It’s too convenient for them not to. And so we can bury our head in the sand or we can accept the reality that the workforce is changing and we need to be able to accommodate gig workers.”

While pay rates for gig nurses vary by hospital, they generally trend closer to traveler rates, as opposed to those of permanent staffers, said Natalie Kozimor, a Providence Swedish spokesperson.

At the same time, the priority remains on retaining permanent staffers, he said.

And while a wave of burnt out nurses made the jump to travel roles during the pandemic, some have made the opposite move. 

Nicole Bohn, who joined UW Medical Center Northwest as a traveler at the end of April, said she sought out an assignment in Washington because she’d heard good things about nursing in the Northwest.

She started on an orthopedic floor, supporting patients with broken bones or recovering from surgery, and liked it so much that she decided to apply for a permanent position. Starting in October, Bohn will be a night-shift clinical nurse educator, providing support to new night nurses in the emergency department and acute care and intensive care units.

Hospitals would like to see more nurses making the shift like Bohn, but they are realistic. Relying on travelers and shouldering the extra cost won’t go away quickly.

“This is probably a new normal for an unforeseen duration,” Brooks said. “This is not a short-term crisis.”

The opinions expressed in reader comments are those of the author only and do not reflect the opinions of The Seattle Times.

TravelNursing

What Does the Future of Travel Nursing Look Like?

By Gareth Havard, Contributor

Nursing is one of the cornerstones of healthcare, yet factors like an aging population, practitioner retirement and new legislation have led to a marked rise in the demand for registered nurses. The knock-on effect of this has been an unprecedented growth in travel nursing across the country, as providers seek to bridge the gap between supply and demand. This article looks at the exciting future of travel nursing and the factors that play a role in this.

The Future of Travel Nursing and Specialty Needs

Travel nurses are registered nurses from different clinical backgrounds assigned to fill short-term employment needs where needed. These jobs usually occur in high-demand locations or when a specific type of specialization or skill is required. Although by definition a transient role, this type of nursing offers numerous benefits compared to fixed contract work, including:

• Higher pay and benefits
• Wide schedule and role choices
• Being paid to experience different locations

What began as a temporary solution to a national shortage has now become a full-fledged branch of nursing. One that is a key part of delivering the care needed in a constantly adapting health system.

The Acute and Chronic Shortage

The facts are stark. The US Bureau of Labor Statistics forecasts that job opportunities for registered nurses are projected to grow at a faster rate than all other occupations through 2026. It also predicts that an additional 1.1 million nurses are needed to avoid a further shortage.

This deficit is being felt currently, resulting in an unprecedented demand for travel nurses that can bridge the skills gap that healthcare and hospital settings around the country are experiencing.

But what does the future hold for travel nursing? Given the changing political and economic climate, it is, of course, impossible to predict precisely. But there are certain key factors that are inevitable.

Three Factors Affecting the Future 

1. The Legal Landscape

The Affordable Care Act has resulted in an additional 20 million people gaining health insurance coverage. While the turbulent political landscape means the long-term future of this law is not clear, its impact is still likely to continue for the foreseeable future.

In addition, proposed laws for patient-nurse ratios as enacted in states such as California could easily become applied to more locations. This would create a requirement for a mandatory number of nurses for every shift, and likely spawn a subsequent call for more qualified practitioners where needed.

2. An Aging Population

Currently, the United States has the highest number of residents over the age of 65 than at any other time in history, and that's expected to grow . Furthermore, the population is living longer, with a greater need for health services as once-terminal conditions are now treatable.

3. Rate of Retirement

The American Nurses Association has reported that 500,000 nurses are expected to retire by 2022 , meaning a significant percentage of the current workforce is expected to leave the profession within the next few years.

This isn't just limited to practicing nurses, however. Nursing teaching faculties are experiencing the same retirement issue, with the anticipated outcome being a further limit on the number of nurses entering the profession.

Looking Ahead

Overall, these changes strongly indicate a continued increase in demand for registered nurses, and the simple fact is, as long as this shortage exists, there will be a greater demand for travel nursing to fill the gaps. This also means an increased opportunity for the enhanced wages, role flexibility and ability to travel that goes with it.

Take pay for instance. Travel nursing salaries are typically higher than in permanent fixed roles . By taking assignments in high-need locations and specialties, travel nurses are empowered to dictate their potential remuneration. In addition, many facilities allow a traveling nurse to work overtime, further increasing earning potential.

Future Opportunities

Ultimately, the ability to provide qualified, suitable healthcare is a cornerstone of modern society. And while the issues listed above pose a challenge, the fact remains that they are inevitable.

This means the future of travel nursing is poised for an exciting upward trajectory. LEARN MORE about travel nursing .

Travel Nurse Pay Breakdown | Expenses & Tax 2022

I was originally drawn to the travel nursing field for the opportunity to travel the country while getting paid at the same time. I knew travel nurses were paid fairly well and had been bombarded with various emails advertising travel nursing pay scales as high as $40 an hour.

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I am typically not the type of person to do something just for the money. I tend to be more interested in the experience, but I also realize that I have bills to pay too. I didn’t really pay attention to the breakdown of my travel nursing pay, all I cared about was whether or not I had enough money to live and to get from point A to point B.

Fortunately, I had a wonderful travel experience but wish I took the time to really understand travel nursing pay scales, expenses and how to deal with taxes. Many of your recruiters don’t take the time to break these topics down for you so it is ultimately your responsibility to seek out the information and educate yourself.

Non-Taxable Travel Nurse Pay

The most alluring advertisement travel nursing agencies use to get you in the door is the infamous “tax advantage plan”.  This can also be referred to as per-diem, stipends, reimbursements or a combination of all three. What this basically means is that if you are traveling away from your home for work, there are certain expenses that are tax deductible and certain reimbursements that are non-taxable.

The most common types of stipends or reimbursements that you will hear about in the travel nursing world are referred to as meals and incidentals (incidentals include taxi/bus fares, parking, and tips), lodging or housing stipends, and travel reimbursements which cover your expenses to and from each assignment; other non-taxable items can include retirement plans, license reimbursements and health insurance. When travel nursing companies advertise pay rates, they will often tell you a blended rate. A blended rate combines an hourly taxable wage such as $20 an hour with your non-taxable reimbursements and stipends to give you a higher hourly rate. Here is an example of a typical pay package:

• $20 per hour – taxable base rate that is reported to the IRS
• $250 per week for meals and incidentals – non-taxable
• $2,000 a month for lodging – non-taxable
• $500 for travel reimbursement – non-taxable

Your blended rate is calculated by breaking down your non-taxable stipends into an hourly rate and adding it to your taxable base rate.   For instance, if you worked 36 hours per week on a 13 week assignment, your hourly rate would look something like this based on the above scenario:

Flex Pay and Rigid Pay

There are two different types of pay packages: flex pay and rigid pay.

Flex pay packages allow you to mix and match, add or subtract various non-taxable stipends such as healthcare, retirement, and license reimbursements to your pay package, while rigid pay packages are non-negotiable.  The benefit of flex pay is that you can decrease your hourly taxable base rate and increase your non-taxable earnings by adding more benefits such as 401K. Many travel agencies have to be careful not to enter the illegal realm of wage re-characterization when dealing with flex pay packages. To learn more about wage re-characterization visit traveltax.com .

Travel Nurse Overtime

There are some travel contracts offering overtime; for example, some agencies will ask you if you want to work 4 days a week instead of 3 days a week. Overtime by law has to be paid time and a half of your taxable base rate. So, if you make $20 and hour, then your overtime pay will be $30 an hour. In the world of nursing, $30 an hour isn’t really that much extra money for an extra shift; however, over the long run it does add up. If this is something you are considering doing than make sure you negotiate a higher taxable rate for lower non-taxable stipends if possible so that you really get more bang for your buck. I have never heard of a part-time travel contract so if you are looking to work part-time than it would be better to consider an agency job in your desired destination.

Discover available travel nursing positions today!

Disadvantages of Non-taxable Stipend Pay

We also have to take into consideration retirement. I know many of you aren’t necessarily thinking about your social security check right now, but it is important to take into consideration that the social security payments are based on 35 of your highest income earning years. Non-taxable money is not considered income.

Last but not least, if you get injured on the job, you only receive 2/3 of your hourly taxable base rate. These are some scenarios to take into consideration when thinking about a travel nursing pay package.

Travel Nursing Pay: Things to Consider

With all things considered, a travel nurses pay rate, is very comparable to a staff nurse’s pay rate. However, there are some out of pocket expenses travel nurses have to be aware of that regular staff nurses don’t have to consider;

• Most travel nursing agencies do not offer paid time off. If you are thinking of taking a vacation or are taking time off in between assignments then you will not be paid
• Most travel nurses have to pay for their own certifications such as BLS and ACLS
• Sometimes travel nursing agencies will not pay for your annual physical and TB tests
• If you want to take an assignment that is across the country, your travel reimbursement might not cover the entire cost

Just like any of other profession, it is important to budget and prepare for the unknown. Take care of yourself make sure you are well organized.

What is an “IRS Tax Home”?

In order to qualify for these non-taxable stipends or reimbursements, one must maintain what the IRS calls a tax home. A tax home is your place of residence that you maintain and pay for while you are out on your travel assignment. Ideally, the IRS would like a travel nurse to take an assignment somewhere and then return to their tax home where they maintain a PRN or full-time nursing job.

Most travel nursing agencies will have you sign a form stating that you do have a tax home. If you do not have a residence that you are planning on maintaining when you are traveling, you will be referred to as an itinerant worker. As an itinerant worker, you will be required to pay taxes on all income earned including stipends and reimbursements. When applying with different travel agencies, make sure they are aware of your itinerant status. You can get more information about tax homes here .

Ready to start travel nursing? Start here!

Tips to Make Traveling a Snap

All of this talk about taxes and the IRS can be a little scary. Here are a few easy tips to follow to make your traveling experience a little less complicated:

• Maintain a mileage log. You will have to write down you odometer reading the beginning of the year on January 1 and again at the end of the year on Dec 31. If you start traveling in the middle of the year you can look back at your maintenance records for previous odometer readings. You must also document your mileage to and from your place of employment.  Click here to print a mileage log.
• Return to your tax home in between assignments if possible or at a minimum of once per year. Document when you travel back to your tax home. Here is a travel log for your trips back home .
• Maintain a PRN or agency job in the same vicinity as your tax home. The IRS would like to know that you do business on a regular basis where you live.
• There is no need to keep track of meal or grocery receipts. The IRS gives you a set stipend for meals. If you exceed the stipend you are considered to be living above your means and will not be reimbursed.
• Keep a copy of all of your travel contracts. Make sure they have a beginning and ending date on them. This proves that you were really working on a temporary basis.
• Don’t work in a city more than 12 months in a 24 month period. The IRS will think you abandoned your tax home.
• There are tax people who specialize specifically in travel nursing. I recommend getting in contact with these people prior to starting your assignment. If you want to tackle this on your own then I recommend getting organized. Here is an organizer that helps you keep track of all your tax information;

Don’t let the IRS or financial aspects of travel nursing scare you.  Travel nursing should be an enjoyable experience not an accounting nightmare.

As with any tax issues, you should seek advice from a licensed tax professional before filing. This article only offers suggestions and isn’t meant to be tax advice. We leave that to the pros.

Professionals can help you through this experience in combination with educating yourself about nursing pay packages. It sounds complicated in the beginning, but the more you learn the lingo, the more prepared you will be to negotiate your next travel contract.

Start your travel nursing adventure here!

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How Long Can a Travel Nurse Stay in One Place?

Travel nurses typically receive tax-free reimbursements for various expenses because they travel for work away from their tax-home. However, there are limits as to how long a travel nurse can stay in one place and continue to qualify for tax-free reimbursements. In this article, we’ll discuss all of this topic’s angles so travel nurses can approach it with confidence.

How Long Can an Itinerant Travel Nurse Work in the Same Place?

First, you must have a tax-home in order to qualify for tax-free reimbursements. If you do not have a tax-home, then the IRS considers you to be an itinerant worker.

We covered tax homes extensively in a previous article. We encourage you to view that article here .

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Itinerant travel nurses can still work travel nursing assignments. However, they must pay taxes on all of their compensation. In fact, an itinerant travel nurse must pay taxes even if a travel nursing agency pays them tax-free reimbursements.

Therefore, if you’re an itinerant travel nurse, then you can work in the same place for as long as you would like. That said, the hospital or agency may limit your time in any given location. However, those limits do not pertain to your tax-status.

The Reason Travel Nurses Can’t Stay in One Place for Too Long

Travel nurses who do receive tax-free reimbursements can’t stay in one place for too long because their tax-home will shift to that location. This is actually much worse than it sounds.

You see, the IRS defines a tax home as, “the entire city or general area in which your business or work is located…regardless of where you maintain your family home.” Therefore, your tax-home is more about where you work, and less about where you call home.

Now, here’s the thing. If your tax-home shifts, then you need to pay taxes on all the tax-free reimbursements you collected for the entire period you were there. This retroactive treatment can result in a large unexpected expense.

How Do We Define a “Place” or the Length of Time?

Next, it’s important to note the ambiguous language the IRS uses in their definition of a tax home. They say it is the, “entire city or general area”. What is a “general area”?! That could be lots of things!

As a result, there are some “places” that we have an exact explanation for. But there are other “places” that are more difficult for us to define. Therefore, we must rely on prior IRS court cases for guidance.

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The IRS also provides a definition for the length of time you can stay in any “general area” and continue to qualify for reimbursements. In this case, the IRS says that your assignment cannot be “indefinite.” They define an indefinite assignment as an assignment that is, “realistically expected to last for more than 1 year.”

General Criteria

As you can see, the IRS does not provide a clearly defined rule for how long workers can stay in one place before their tax-home shifts there. However, we now have 3 general criteria. They are as follows:

• The amount of income relative to your total income matters
• Location is defined as a “city or general area”
• 12 months is the maximum duration

How Long Can a Travel Nurse Stay in One “Place”?

While there is no hard-rule on how long a travel nurse can work in one place, the general rule of thumb is to never work in one place for more than 12 months in any rolling 24-month period. However, you must also ensure that the income you earn in any one travel destination does continually constitute the majority of your total income.

How Long Does a Travel Nurse Have to Leave Before They Can Return to the Same Place?

Therefore, how long a travel nurse must leave before they can return to the same place depends on the following three criteria:

• How long the travel nurse has already worked there.
• How long the travel nurse intends to stay upon returning.
• The percentage of annul income that the specified location accounts for

We have a lot to unpack here. Let’s look at some examples.

Example 1: Travel Nurse Returns Home for 30 Days

Let’s say you work as a travel nurse in Place(X) for 360 days, which is nearly 1 year. Then, you return to your tax-home and work PRN at your local hospital for 30 days. Next, you return to Place(X) as a travel nurse immediately following your 30 days at home.

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How long can you work in Place(X) before you run afoul of the general guidelines? If you said, “Just over one month.”, then you are right! You’ve only worked one month away. Therefore, 11 of the previous 12 months were in Place(X).

This is a scenario that many people in the industry believe will satisfy the requirements. Unfortunately, it does not. You wouldn’t be able to complete the standard 13-week contact when you returned.

Example 2: Travel Nurse Routinely Returns to the Same Location

Now let’s say that you work as a travel nurse in Place(X) for 6 months. Then, you take 2 months off for fun. Then, you return to your tax home and work for 4 months. Now let’s say that you repeat this process for several years, always returning to Place(X).

Technically, you’re never working in Place(X) for longer than 12 months in any rolling 24-month period. However, if you are earning more income in Place(X) than you do at your tax home, then your tax home will shift to Place(X) at some point.

Remember, first and foremost, your tax home is where earn your income. If you continually earn most of your income in the same place, then that place will eventually become your tax home.

The bottom line is that travel nurses must continue to move around in order to maintain their current tax home. Now let’s take a look at how all of this relates to different kinds of “places”.

How Long Can a Travel Nurse Stay at the Same Hospital?

The generally accepted rule of thumb is never to work more than 12 months in any rolling 24-month period at the same hospital. Additionally, you want to make sure that no hospital away from your tax home becomes the leading source of your income over a period of multiple years.

How Long Can a Travel Nurse Stay in One City?

The generally accepted rule of thumb is never to work more than 12 months in any rolling 24-month period in the same city. Additionally, you want to make sure that no city away from your tax home becomes the leading source of your income over a period of multiple years.

Many travel nurses wonder if they can work in the same city for years as long as they always change hospitals. If you do that, then your tax home will shift to that city.

How Long Can a Travel Nurse Stay in One Area?

The generally accepted rule of thumb is never to work more than 12 months in any rolling 24-month period in the same area. Additionally, you want to make sure that no area away from your tax home becomes the leading source of your income over a period of multiple years.

This is the trickiest one to deal with because we do not have a clear definition of “area”. For example, let’s say you repeatedly work travel nursing assignments at 2 hospitals that are 50 miles apart from one another.

These hospitals aren’t in the same city. They may not even be in the same metropolitan area.

However, you could reasonably live midway between the 2 hospitals and your commute would be 25 miles to each hospital.

25 miles is definitely a reasonable commute. It would not require you to stay overnight to meet the demands of work. Therefore, your tax home would most likely shift to this area if you worked there for more than 12 months in a 24-month period.

The easiest way to manage your travel healthcare career.

Again, there is no steadfast rule. Therefore, we can’t provide an exact distance that each hospital you work at needs to be from one another. However, it certainly should be far enough away that you couldn’t reasonably commute to both hospitals from some equidistant point.

How Long Can a Travel Nurse Stay in One State?

A travel nurse can stay in one state indefinitely IF they continue to move to different areas such that they never spend more than 12 months in any rolling 24-month period in the same area. Additionally, you want to make sure that no one area away from your tax home becomes the leading source of your income over a period of multiple years.

As you can see, the rules are fairly straightforward. However, the IRS’s guidelines are not specific with respect to the definition of an “area”. But, the spirit of the rules is quite clear. The bottom line is that travel nurses need to move to different locations fairly frequently in order to maintain their tax homes.

Please note that we are not tax advisers or CPAs. This article is for informational purposes only. Please consult a registered tax professional with experience in the travel healthcare industry in order to discuss your unique circumstances.

Related posts:

• Travel Nursing Pay – Qualifying for Tax-Free Stipends and Tax Deductions: Part 2: Maintaining Temporary Status In our previous blog post we laid out the criteria under...
• Travel Nursing Pay – Qualifying for Tax-Free Stipends: Part 3: The 3 Factor Threshold Test Now that we have made the distinction between indefinite work...
• 6 Things Travel Nurses Should Know About GSA Rates Understandably, there is a lot of confusion about GSA rates...

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How to Get Out of a Travel Nursing Contract the Right Way

By Sarah Wengert

When you sign your contract for a travel nursing assignment, you should do so knowing it’s an important, binding agreement. Travel nursing contracts are there to protect clinicians, facilities, and agencies, and to ensure a staffing need is adequately filled and patient care standards are properly met. That said, there are infrequent circumstances that may merit a contract cancellation.

Who Can Cancel a Travel Nurse Contract?

Both facilities and travelers can cancel contracts, and there are many unique scenarios that could lead to either party doing so.

Hospitals cancel contracts for several reasons. Often it’s due to an error or unforeseen change in seasonal demand forecasts — either of which could lead to an overstaffing problem. EMR/EHR conversion contracts are sometimes canceled for various reasons, too. The healthcare staffing industry also saw many hospitals cancel contracts throughout the COVID-19 pandemic. For example, as elective surgeries were canceled in droves, travel OR nurse contracts followed suit. However, probably the most common reason a hospital might cancel a travel nurse contract is that a traveler’s performance is unacceptable.

Travelers can also cancel a contract in dire circumstances. A supportive recruiter/agency should help you try to troubleshoot to avoid cancelation, when possible, before guiding you through a last-resort cancelation.

Reasons for Breaking a Travel Nurse Contract

In two words: Life happens. But, of course, it’s always more complex than that!

If a traveler legitimately needs to seek a contract cancelation, it’s usually due to a situation like major personal health problems, a family emergency/serious family illness, an unacceptable work environment that may even endanger a traveler’s license, or other such valid reasons.

In the case of an unacceptable work environment, a traveler should make a good faith effort to resolve the issue in other ways before going straight to the level of contract cancelation. First, express your concern to your recruiter. Discuss the issue with them and ask to speak to a member of the agency’s internal clinical team — a quality healthcare staffing agency will have one to better support their travelers on clinical issues! Let your agency’s support system work with the facility as necessary to correct any work environment issues you feel may be endangering you personally or putting your nursing license in jeopardy.

When it comes to a serious personal health problem, well, you can’t pour from an empty cup. If you need time to manage and heal from an illness or other personal health emergency, most agencies and facilities will understand. And it’s similar with an unavoidable family emergency.

Depending on your specific circumstance, you might also consider that a total contract cancelation could be avoided and perhaps the contract could just be amended. For example, you have to go home to help with a family emergency, but you would be able to resume the contract in three weeks. In that case, you might consider discussing all possibilities with your recruiter and potentially avoiding an outright cancelation.

Bad reasons for breaking a travel nurse contract? You found a better assignment with higher pay and decided to bail on this one. You’re just not feeling it. You don’t love (fill-in-the-blank location) like you thought you would. If you find yourself wanting to cancel for these or other such frivolous reasons, just don’t!

Remember, it’s not just about a contract. Your patients, colleagues, facility, and agency are all depending on you, so you should just bide your time and meet your commitment in these types of situations. The contract will be over before you know it and you can move on then — with your professional reputation and integrity intact.

Canceling a Travel Nurse Contract the Right Way

The first thing to ask yourself is,  “ What does the contract say? ”  Every travel nursing contract should specifically address what happens in the event of a cancellation by either you or the facility. If your contract does not cover this situation, then you might also check any service agreements you signed with your travel nursing agency. Some agencies will have you sign a service agreement that covers the professional conduct travelers are required to maintain while on assignment. These types of agreements can also cover what happens in the event of a cancellation by the facility and/or the traveler. If an agency uses service agreements, they’re usually signed on a yearly basis and cover all assignments a traveler might work during the year.

After you review what your contract stipulates — or, in some cases, what it does not state — you should call your recruiter immediately. Be 100% up front with them and explain the reason you want to dissolve your contract. As a healthcare professional, you agreed to a contract and should have a good reason for wanting to sever it.

After you fully explain your situation and reasoning to your recruiter, then it’s your turn to listen. A great recruiter is willing to listen and provide helpful feedback and solutions. In fact, in this trying situation, you’ll see just how good your recruiter and agency are. When you come to a recruiter with a legitimate need to cancel, you should never feel threatened or bullied by them or the agency. You might also find that they’re willing to work with you to minimize the damage and provide you with other travel opportunities in the future.

Open communication is key if you ever need to modify or cancel a travel nursing contract. If you intend on traveling again once the situation is resolved, make sure to tell your recruiter that. As previously mentioned, with the blessing of your agency and facility it might even be possible for you to take off a few weeks and then return to your assignment when you’re able. The point is, don’t just call your recruiter and say, “I need to break my contract.” Explain your situation and work with your recruiter to find a solution that will make you, the facility, and your company as happy as possible.

Also, you should give as much notice as possible. If you foresee a potential contract-canceling issue on the horizon, it’s never too early to bring it up as a possibility to your recruiter. That way they can help you monitor the situation and plan ahead. If it never ends up happening, they’ll be elated for you and the contract. Depending on your situation you should also attempt to cover as many of your scheduled shifts as you can. This is a show of good faith and will mean a lot to the other parties involved.

Canceling a contract is never something we’d encourage. However, things do happen that are beyond our control and might require such a drastic decision. If you handle yourself properly, you can minimize any costs and negative outcomes from breaking your contract.

Consequences of Canceling a Travel Nursing Contract

Depending on the terms of your contract, there may be repercussions that fall on you, your recruiter, and/or the agency you’re working with. For example, if your agency provided housing, it’s probably still on the line for that, and you may be required to pay the remainder of the lease. If you secured your own housing, you will have to navigate that situation on your own. Another example: Your health benefits may lapse when your employment ends — something to especially consider if you or a covered family member is facing a health emergency — so you can make a plan to maintain benefits through another channel. Again, much of this should be outlined in your contract.

Canceling contracts can also affect your future contracts and employment opportunities , even for permanent staff positions. It may make it more difficult for you to get good references. You may have to face tough questions during future interviews. Depending on the circumstances, your agency might have your back, or you might not be invited back to work with them again. Travel nursing agencies thrive on having good relationships with facilities and travelers. If the facility is in the wrong, your agency should side with you. However, if you’re in the wrong, you may find that your agency will decline working with you on future contracts. Some facilities will also move you to a DNU or DNR status and be unwilling to hire you in the future.

Also, finding yourself in a situation where you need to cancel an assignment is often very stressful. First, your reason for wanting to cancel is likely a major stressor. Then on top of that, you have a lot of work to do and hard conversations to have if you’re going to cancel the right way. Throughout this process, don’t forget to take care of yourself to manage these types of consequences to your mental and physical health.

Bottom Line

Contract cancelations should be avoided at all costs. However, certain circumstances can make them necessary. Travelers don’t appreciate having their contracts canceled by a facility, so it’s important to practice a “golden rule” approach here and only move to cancel as a last resort and due to an emergency situation. Remember that your patients and colleagues may be the ones who suffer the most, but that you’re also putting the facility, your recruiter, and the agency in a real pinch.

If you do wish to cancel, communicate openly and honestly with your recruiter, work with them on the best solution, give as much notice as possible, and try to work your scheduled shifts. Also understand that you may face professional, financial, and other consequences. Above all, we hope you never have to face the kind of situation that necessitates a travel nursing contract cancelation, but if you do, please take care of yourself and lean on your recruiter!

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Politics latest: Keir Starmer accused of 'rank hypocrisy' by Rishi Sunak after setting out what he'll do to tackle small boat crossings

Labour leader Sir Keir Starmer lays out his party's plans to try and tackle small boat crossings if it wins power. Listen to the latest episode of the Electoral Dysfunction podcast as you scroll.

Friday 10 May 2024 18:30, UK

• Starmer says small boat crossings 'one of the greatest challenges we face'
• Explained: What's in Labour's plan to try and tackle problem
• Darren McCaffrey: Will Labour's plan cut it with voters?
• Starmer says no flights to Rwanda will take off under Labour
• Sunak accuses Starmer of 'rank hypocrisy'
• Electoral Dysfunction:  Jess Phillips says Elphicke defection like 'being punched in gut'
• UK exits recession | Economy 'returning to full health'
• Faultlines:   Can British farming survive?
• Live reporting by Tim Baker

Across the UK, anger is brewing amongst some farmers.  

Protests have already been held in London, Dover and Cardiff, with more planned - mirroring similar tensions seen across Europe in the last six months.     

They say they’re annoyed about cheap foreign imports and changes to subsidies forcing them to give up land in favour of environmental schemes.    

But what does this mean for the food on our table - and does British produce risk becoming a luxury product for the wealthy only?    

On the Sky News Daily , Niall Paterson is joined by West of England and Wales correspondent Dan Whitehead to find out why farmers are so concerned, and speaks to Liz Webster, the founder of Save British Farming, about why she believes eating British isn't just good for our farmers - it's good for the nation's health, too.   

In response to our report, Farming Minister Mark Spencer, said: "We firmly back our farmers. British farming is at the heart of British trade, and we put agriculture at the forefront of any deals we negotiate, prioritising new export opportunities, protecting UK food standards and removing market access barriers. 

"We've maintained the £2.4bn annual farming budget and recently set out the biggest ever package of grants which supports farmers to produce food profitably and sustainably."

The Welsh government said: "A successful future for Welsh farming should combine the best of our traditional farming alongside cutting-edge innovation and diversification. 

"It will produce the very best of Welsh food to the highest standards, while safeguarding our precious environment and addressing the urgent call of the climate and nature emergencies."

👉  Listen above then tap here to follow the Sky News Daily wherever you get your podcasts   👈

Following the defection of the Dover and Deal MP Natalie Elphicke to Labour, Beth, Ruth and Jess discuss the surprise move and whether it could have been handled differently by Sir Keir Starmer.

They also talk about Beth's interview with the former immigration minister Robert Jenrick and his warnings about Reform UK.

Plus, how significant was the defeat of former Conservative mayor of the West Midlands Andy Street? Beth and Jess were both there to tell the story.

And they answer a question on Labour and the Muslim vote, and what the party can do to restore confidence and trust.

Email Beth, Jess, and Ruth at [email protected] , post on X to @BethRigby, or send a WhatsApp voice note on 07934 200 444.     

👉 Listen above then tap here to follow Electoral Dysfunction wherever you get your podcasts 👈

In January 2023, Rishi Sunak made five promises.

Since then, he and his ministers have rarely missed an opportunity to list them. In case you haven't heard, he promised to:

• Halve inflation • Grow the economy • Reduce debt • Cut NHS waiting lists and times • Stop the boats

See below how he is doing on these goals:

The Sky News live poll tracker - collated and updated by our Data and Forensics team - aggregates various surveys to indicate how voters feel about the different political parties.

With the local elections complete, Labour is still sitting comfortably ahead, with the Tories trailing behind.

See the latest update below - and you can read more about the methodology behind the tracker  here .

Speaking to Sky political editor  Beth Rigby , Sir Keir Starmer has defended his decision to allow Tory MP Natalie Elphicke into Labour.

Ms Elphicke was on the right of the Conservative spectrum, and previously defended her sex-offender ex-husband, comments which she apologised for this week following her defection.

Addressing Tory voters, Sir Keir says he wants Labour to be a "place where they who have ambitions about their families, their communities, their country, can join and be part of what we are trying to build for their country".

Asked by Beth if he was ruthless, Sir Keir said: "Yes, I'm ruthless in trying to ensure we have a Labour government that can change this country for the better.

"Not ruthless for my own ambition, not ruthlessness particularly for the Labour Party - I'm ruthless for the country. 

"The only way we'll bring about a change in this country is if we're ruthless about winning that general election and putting in place a government of public service, that’ll be a major change.

"Politics, I believe, should be about public service, that's what I've been about all my life."

More now from political editor Beth Rigby's interview with Labour leader Sir Keir Starmer.

She reminded him that he previously ruled out doing a deal with the SNP - but has not done so for the Liberal Democrats.

Sir Keir again ruled out a coalition with the SNP - adding that he is aiming for a "majority Labour government".

He says Labour needs "to keep working hard, keep disciplined and getting our message across, which is something fundamental to me".

Pushed on his lack of ruling out a possible agreement with the Lib Dems, Sir Keir says: "I'm going for a majority.

"That's the answer I gave you a year ago. It's the same answer I'm giving you now."

Sir Keir Starmer was earlier today pushed on whether Rwanda deportation flights will take off if he was prime minister - although it was not clear if he would cancel flights which had already been organised.

Sky News understood that previously booked deportation flights to Rwanda would still go ahead if Sir Keir entered Number 10. 

But the Labour leader has now gone further.

Speaking to political editor Beth Rigby , Sir Keir has ruled out any flights taking off.

"There will be no flights scheduled or taking off after general election if Labour wins that general election," he says.

He says: "Every flight that takes off carries with it a cheque to the Rwanda government. 

"So I want to scrap the scheme - so that means the flights won't be going."

Sir Keir says he would rather spend the money on his own measures to counter small boats.

"No flights, no Rwanda scheme. It's a gimmick," he says.

By Alix Culbertson , political reporter

Scotland's new first minister has told Sky News that the controversial gender recognition reforms "cannot be implemented."

John Swinney,  who became first minister this week , has faced questions over his stance on gender recognition after MSPs voted in 2022 to pass a bill to make it simpler for people to change their gender without having to obtain a medical diagnosis.

The UK government blocked the bill from being made into law and the Supreme Court rejected a request by the Scottish government for a judicial review.

Asked if he would be fighting to push the bill through, Mr Swinney told Sky News: "The reality of the situation we face is that the Supreme Court has said that we can't legislate in that area. We can't take forward that legislation."

The UK economy is no longer in recession, according to official figures.

Gross domestic product (GDP) grew by a better-than-expected 0.6% between January and March, the Office for National Statistics (ONS) said.

Economists had predicted the figure would be 0.4%.

Prime Minister Rishi Sunak said it showed the economy had "turned a corner".

He told Sky News's Ed Conway: "I am pleased that while there's more work to do, today's figures show that the economy now has real momentum, and I'm confident that with time, people will start to feel the benefits of that.

"We've had multiple months now where wages are rising, energy bills have fallen, mortgage rates are down and taxes are being cut... I'm pleased with the progress that we're making."

Mr Sunak added: "I am confident the economy is getting healthier every week."

You can read more here:

Rishi Sunak has criticised Sir Keir Starmer's position on Rwanda as "rank hypocrisy".

Speaking to broadcasters, the prime minister says the Labour leader has announced things the government is "already doing".

He gives the example of "punching through the backlog, having more law enforcement officers do more, that's all happening already".

"We've announced all of that more than a year ago," the prime minister adds.

"The question for Keir Starmer if he cares so much about that, why did he vote against the new laws that we passed to give our law enforcement officers new powers? 

"They've now used those to arrest almost 8,000 people connected with illegal migration, sentenced them to hundreds of years in prison.

"And if it was up to him, all those people would be out on our streets, so I think it's rank hypocrisy property of his position."

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