cnbc make it travel nurse

The pros and cons of being a 29-year-old nurse making six figures who works just 9 months a year

• Aspen Tucker, 29, has been working as a travel nurse since earning his associate's degree in 2020.
• Tucker earned $187,000 in 2022, yet works only 9 months out of the year, CNBC reports.
• Many nurses have turned to travel contracts as a way to combat burnout and earn more money.

One travel nurse got candid about the ups and downs of working all over the country, and, spoiler alert, there weren't many downs.

Aspen Tucker, 29, has been working as a travel nurse for the last three years after leaving his South Carolina hospital job at the height of the pandemic. He was lured away by an offer of $6,700 per week in Amarillo, Texas, according to CNBC.

"I hate to say this, but I didn't give notice. I got my stuff, went to Texas, and told my manager when I got there, 'I'm sorry, I've got to go. This is a once-in-a-lifetime opportunity,'" Tucker told the outlet.

He added that the staff nursing job he left behind paid about $2,000 biweekly. In 2022, two years after becoming a travel nurse, Tucker brought home about $187,000 for the year, per CNBC.

Tucker, who began his career after getting an associate's degree, also told CNBC that he works between 48 and 60 hours per week to allow for time off. His current schedule means he works about nine months each year and spends the rest of his time in his hometown of Spartanburg, South Carolina, or vacationing.

Tucker isn't alone in opting to be a contract travel nurse with higher pay, rather than in a staff job. Ali Brown, a travel nurse from Baltimore, Maryland, began working around the country in 2014.

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In November 2022, Brown, a travel nurse for eight years, said that prior to the COVID-19 pandemic, a good contract was about $2,000 per week, but she saw the number skyrocket to $6,000 in 2020.

On average, travel nurses make about 50% more than staff nurses due to high demand. However, the big paydays come with some guidelines, according to Brown.

Travel nurses get a living expense stipend and a housing stipend, which are considered reimbursements, not income, she said.

"Travelers have to be really careful to follow the rules, though," Brown told Insider. "You need to show that you're really paying a mortgage that is fair market value, not just taking the money for other uses."

She continued: " If you get audited, you'll end up having to pay taxes on that, which will be a lot of money."

While staff workers may turn to travel nursing as a way to lessen burnout, Tucker warned that not every facility will feel friendly, especially when working with staff nurses who likely are getting paid a lot less.

"In their mind they're thinking, 'This company doesn't want to pay us, but they're willing to pay somebody to come here for a short period of time to make this kind of money.' It creates a little bit of animosity there," he told CNBC.

Additionally, Tucker said, being away from his family and having unreliable health care are also downsides. While under contract, travel nurses have health insurance, but not when they're between jobs. 

 "I used to play a lot of basketball and stuff. And now I'm like, 'If I don't have health insurance, I can't go ahead and break my leg,'" Tucker said to CNBC.

• Main content

How to Make the Most Money as a Travel Nurse

What is a travel nurse.

• How to Become
• Travel Nurse Salary
• Salary by State
• Travel Nurse vs Staff Nurse Salary
• Salary Factors
• Making the Most Money
• Highest Paying Assignments

A  travel nurse is a registered nurse (RN) who works in short-term roles at hospitals, clinics, and other healthcare facilities worldwide. Daily  travel nurse duties are often similar to traditional RN roles, but their flexibility allows them to fill gaps in areas with nursing shortages. As a result, the average travel nurse's salary can be quite high!

>> Click here to see available high-paying travel nurse opportunities!

During the COVID-19 pandemic, travel nurses were seeing some of the highest pay packages ever because of the overwhelming need for nurses, especially in hot spots like New York, Florida, and California. While pay packages might not be as high as they were a few years ago, there is still significant money to be made for those interested in pursuing travel nursing.

But, there are still a number of factors you need to consider when it comes to your travel nurse salary. Here's what you need to know to navigate pay as a travel nurse.

How to Become a Travel Nurse 

Travel nurses do need a few requirements before being considered, including being a registered nurse with a license in good standing, and typically 2 years of nursing experience. They don't need any additional certifications or credentials other than the ones they need for their specific specialty. 

While a BSN is not required to become a travel nurse, it will open more opportunities to nurses such as Magnet hospitals and Level 1 trauma centers. Without a BSN, your options might be more limited. 

How Much Money Do Travel Nurses Make? 

Under normal circumstances, many travel nurses have the potential to earn over $3,000 per week. Travel nurses can bring in over  $50 per hour, plus company-paid housing accommodations. Making it entirely possible for travel nurses to make well over $100K per year.

Travel Nurse Salary by State

Source:  Ziprecruiter

>> Show Me Online Nursing Programs  

How Does Travel Nurse Pay Differ From Staff Nurse Pay? 

Staff nurses  in a hospital are usually paid a set salary based on education and experience. They typically receive incremental pay increases at various time frames. Staff nurses can also see pay increases with overall cost of living increases.

Travel nurse pay is totally different and can be a bit of a gray area. Typical pay packages are composed of various components, including hourly pay, non-taxed travel nurse housing stipends, non-taxed per diems, travel reimbursements, and more. It’s important to speak to your recruiter about specific pay package breakdowns. 

>> Related: Top 10 Six-Figure Nursing Jobs

What Factors Impact Your Pay as a Travel Nurse?

There are a number of factors that can influence how much you can expect to make as a travel nurse. These include:

Location -  The specific location of the assignment most heavily influences travel nurse pay. Simply put, pay rates often reflect the cost of living in the area and also regional trends.

Which states pay the most for travel nurses?  Historically speaking, the highest-paying states for travel nurses include California, Texas, Massachusetts, Washington, and New York.

Southern states  tend to have lower living costs and, in turn, lower travel nurse pay.

Areas that are considered “destination locations”  (like, Hawaii and Florida) may pay lower. Though, with rapid-response assignments, this isn’t always the case.

Specialty -  The travel nurse’s specialty also impacts pay. Non-specialty nurses, such as the medical/surgical and psychiatric specialties, are typically paid a lower rate than specialized nurses. Furthermore, specialized nurses with highly sought-after skills  and credentials have the ability to earn more lucrative pay with seemingly endless opportunities. 

• Shift -  If you haven’t noticed, night shift assignments are more prevalent in the world of travel nursing. The good news is that many hospitals offer higher rates for their night shift assignments. If you want to make the most money, flexibility is key. A word of caution, if the night shift is not your thing, no amount of money is worth your safety, happiness, or license. If you provide better patient care during the day shift, stick to that. Your patients will thank you. 
• Practice level/Education - Travel RNs make more money than stationary RNs. But those who also pursue advanced practice nursing credentials stand to earn even more. For example, the average travel nurse practitioner's salary is around $131,543 per year but can go up to $218,000.

>> Show Me Online Nursing Programs

How To Make The Most Money As A Travel Nurse 

While the factors listed above do influence travel nurse pay, the following types of assignments almost always pay exceptionally well. Oftentimes, these types of assignments are not influenced by location, specialty or shift.

Everything else aside, if you’re looking to make the most money as a travel nurse, seek out these specific assignments: 

1. Rapid Response and “Crisis” Assignments

These assignments boast some of the highest rates in the travel nursing industry due to their urgent requirements. As the name suggests, these assignments require nurses to arrive at work fast -- usually within 2 weeks.

Nurses working in these assignments may have limited options in terms of location. They are also typically shorter than the general 13-week assignment - if you're ready to go, you can get started right away  in areas that need you the most. 

Assignments range from 36 to 48 hours per week but are certainly more lucrative for the nurse working 48, particularly given overtime pay rates. 

Crisis Examples

• A crisis assignment is not always because of a natural or man-made disaster. However, in some cases they are. For example, one agency was able to send nurses within 48 hours to provide support to hospitals treating patients in the aftermath of Hurricane Harvey.  
• More often, though, facilities in need of rapid response solutions include those managing unexpected census spikes, unit openings, emergency responses, EMR upgrades, and more.
• However, some facilities may leverage flexible-length assignment options to manage patient care during short-term staff shortages.
• Crisis assignments might also occur if a large number of nurses on the unit are on maternity leave at the same time, or can occur if there is an outbreak on the unit (GI illness) and the hospital needs staff immediately.

This type of assignment may be appealing to hospitals because they do not require the 13-week commitment that many other travel companies require. This means that agencies offering these types of assignments have the ability to offer travelers a larger selection of shorter and higher-paying assignments. A great option especially if you’re looking for a position to better fit your lifestyle. 

So, what's the catch? 

As mentioned, rapid response assignments require a quick turnaround. Therefore, it is absolutely crucial for nurses to have their paperwork in order if they want to reap the benefits of top pay. Credentials, tests, licenses, and other documents should be submitted to the agency as quickly as possible. Frequently, there are a limited number of positions available for these types of assignments and some agencies will be first-come, first-serve.

What Travel Nurse Agencies Say About Rapid-Response Assignments

We reached out to travel nursing agencies for more information about their rapid-response assignments. They said that most agencies will occasionally help nurses acquire licenses and certifications, including paying for new state licenses for nurses who complete an assignment with the company there. 

Agencies also offer the option to cover housing costs if the nurse stays in one of their preferred hotels. Alternatively, many travel nursing agencies provide a housing stipend calculated to cover the cost of a nurse acquiring his or her own housing during the assignment. Lastly, they also cover the travel costs nurses incur at the start and end of an assignment. 

Hospital vs Agency Bonuses

Hospital bonuses  are paid separately from the bill rate, are usually offered as completion bonuses. This means they are not paid until after you complete your assignment. These bonuses usually range from  $250-$5000.

Agency bonuses  may be taken out of the bill rate and affect your overall pay. This isn’t necessarily a bad thing, especially if you enjoy getting a large amount of money as a lump sum. 

How do you know the difference between hospital and agency bonuses? For starters, you can ask your recruiter where the bonus comes from -- hospital or agency? 

• Retention Bonus

Some agencies will pay nurses bonuses once they end up working with that agency for multiple assignments. This is commonly referred to as a retention bonus and each agency will have its own requirements. These bonuses usually range from $100-$2,000 or more. 

• Referral Bonus

A referral bonus is a fee the agency pays to travel nurses who refer other nurses to work for their agency. The funds often come out of a separate budget allocated to referral fees and should not affect the travel nurse’s pay package. 

Referral bonuses typically range from  $500-$4,000  per nurse referral. Some of the best agencies in the industry pay nurses lucrative referrals bonuses once their referral completes an assignment.

Strikes occur when a labor contract or bargaining agreement between a hospital and a union is up for renewal. When the two sides aren’t able to come up with an acceptable compromise, the union may strike. 

In such a case, patients still need care. Therefore, hospitals will usually hire travel nurses to fill the temporary need. Due to the urgency, travel nurses who work strikes make much more money than they do when working on typical travel nurse assignments. 

How to Find the Highest-Paying Travel Nurse Assignments

First of all, you can always  ask recruiters directly about their highest-paying assignments.  Let them know that money is a motivator and that you are not interested in assignments that pay less than a certain amount. The best travel nurse recruiters will be honest with you about pay while giving you their best pay packages from the beginning. 

We suggest working with agencies that are known to pay high rates and who specialize in rapid-response and strike nursing. Hospitals pay these agencies higher rates to urgently provide highly specialized staff on a short-term basis. Those high rates are passed along to their travel nurses. 

Top 11 Tips For Travel Nurses (From a Travel Nurse Recruiter!)

1. crisis contracts.

Crisis contracts were extremely popular during the pandemic. Travel nurses were able to garner premium pay and had the opportunity to make significant amounts in a short period of time. While these specific types of crisis contracts are not readily available, healthcare companies around the country still need to fill gaps, especially for short periods of time. 

2. Find Your Own Housing

We suggest taking a housing stipend and securing your own housing. This will give you the freedom to choose your price point. Agencies will often house nurses in pricier accommodations (they have a reputation to uphold.) Additionally, agencies sign corporate leases -- leases that come with a “corporate” price tag. Some agencies are able to offer free housing if you stay in one of their preferred hotels. Most other agencies do not cover this cost outright, though, they’ll help you set it up.

3. Be Flexible

If money is your motivation, flexibility is key. Sometimes the highest paying assignments pay higher because they are not the most ideal. They may be in a less-than-desirable location or on a hard-to-fill time shift, such as nights or variables. Though it’s not always the case, nights, variables and weekends may come with higher pay or shift differentials.

4. Work With Agencies Who are Known for Their High Pay and Transparency

Every agency is different and will structure its pay packages differently as well. Transparency is key. The most trustworthy agencies will publish their compensation packages publicly and will disclose take-home pay. This focus on transparency allows nurses to skip the negotiating or fact-finding step and rapidly decide if the position is right for them. 

Industry jargon and terms like “blended rates” get confusing. Negotiations can increase confusion and lead to mistrust between nurses and recruiters. That’s why working with agencies that do not allow for negotiations may prove to be the best agencies to work for. They likely give the nurse their best rate from the “get-go” and therefore actually have no room left for negotiations. If you’re able to negotiate with a recruiter, why weren’t they offering you their best rate from the beginning? Something to consider.

5. Make Sure Your Profile is Up-to-Date

Top-paying travel nursing assignments come with a timestamp -- they are in high demand and competition is fierce. Truth is, agencies can’t simply submit you for a job just because you want to be considered. They literally have to “sell” your skills to the hospital.

How do they do this?  Through your paperwork, commonly referred to as your “profile” -- resume, references, skills checklists, license, etc. Having organized paperwork that can quickly (and easily) be submitted to a new agency will increase your chances of landing high-paying assignments. The quicker you get your paperwork to your recruiter, the faster they can submit you to a top-paying job.

Side note,  many nurse managers hire travel nurses on a "first come, first serve" basis. Why? Because your agency has already vetted you, the hospital doesn’t need to do more research to determine if you’re qualified. The hospital needs your skills to fill a temporary staffing need. If you treat every high-paying job with extreme urgency your chances of landing the job will increase. We recommend keeping your paperwork up to date and storing it online on the cloud using something like Dropbox or Google Drive. This will make it easy to simply share your paperwork folder with your recruiter.

Another tip, if you don’t have a scanner, download a scanning app -- works like a charm and you don’t have to lug around a bulky machine. Many agencies are getting tech-savvy and developing mobile apps that allow nurses to directly upload documents to their profile with the company, where they can be stored and updated when the app notifies nurses of their expirations, etc.

6. Work With Multiple Agencies

The truth is, no agency will have assignments available in every location in the US. More truth, some hospitals pay each agency at a different rate and local agencies may have better relationships with the hospitals in their area. Bottom line, it’s a good idea to work with multiple agencies, this will increase your opportunities.

Word of advice -- if you work with multiple recruiters, don’t be shady. Be honest with them about each other. Don’t "pit" them against each other. And, by all means, keep in touch with them even if you don’t choose their assignment (this time). Chances are they’ll want to work with you again in the future. Who knows, you might even make a new friend!

7. Maintain Multiple State Licenses

Did you know that many hospitals will not even look at your professional profile if you are not licensed in their state? It’s true. You’ll increase your chances of continuously landing high-paying jobs by maintaining active licenses in multiple states.

For example, rates in northern states usually increase during the winter months -- so, a license in Massachusetts is a must! If you want to work in a certain state, you need to have a license. Period. Even better – have a compact nursing license? This will automatically set you up for success. 

If you don’t have a license in that state, and you want to travel there soon, apply now! Some states have quick licensure turnaround of just 48 hours. Other states, like California, can take up to 6 months to process licensure paperwork.  Some agencies do assist or reimburse for licensing fees.

8. Work Agency Per Diem and Pick Up Extra Shifts

Travel nurses who want to make even more money will often work local agencies’ per diem shifts. They’ll also volunteer to work extra shifts during their assignments.

9. Communicate With Your Recruiter

Recruiters are the connection between you and the highest-paying travel nursing assignments. It’s important to communicate with them about your compensation needs. Looking for a high-paying assignment? Ask. Need a sign-on or completion bonus? Ask. Can’t live happily with an income below a certain amount? Tell them. Remember, a closed mouth doesn’t get fed.

10. Ask for Sign-On, Completion, and Retention Bonuses

Some travel companies may offer bonuses. Bonuses are paid either on day #1 of your assignment, upon completion of the assignment, or when you work multiple assignments with your agency. Inquire about bonuses. 

11. Refer Your Friends to Agencies

In the travel nursing industry, referrals are golden. Nurses are much more likely to trust their friend’s opinion of an agency they’ve actually worked for than they are an advertisement or recruiter. This is why agencies pay nurses referral bonuses to refer their friends. Referral fees differ but some agencies pay as high as $4,000 per nurse referral! 

Find Nursing Programs

Travel nurse faqs, what does a travel nurse do.

• A travel nurse is employed by a temporary staffing agency to work a contract with a healthcare facility for a short amount of time, usually around 13 weeks. 

What is the highest paid travel nurse? 

•  Any specialty area travel nurse, such as OR, ICU, MICU/SICU will have a higher earning potential. Additionally, APRNs such as a CRNA, will earn the highest wages. 

Is travel nursing worth the money?

• Travel nursing can be highly profitable, but you’ll want to consider all of the factors involved with the job, such as short-term contracts, inconsistent benefits and pay, new environments, and sometimes, high stress. 

What do you need to be a travel nurse? 

• In addition to being a Registered Nurse, typically, you need at least one year of experience on the floor to become a travel nurse. 

Is it hard to become a travel nurse? 

• Travel nursing can be competitive, but if you want to become a travel nurse, there are endless opportunities. You can increase your appeal by earning certifications in specialty areas. 

How much money do travel nurses make? 

• The take-home pay for travel nurses can vary widely based on the area’s need, the nurse’s specialty and any certifications, and other factors, but most travel nurses make well over six figures. 

Why do hospitals hire travel nurses? 

• Hospitals and other healthcare facilities may hire travel nurses when they are lacking their own staff, when the patient census becomes too high for their current staffing, or when a medical crisis, like COVID-19, or an emergency occurs. 

Angelina has her finger on the pulse of everything nursing. Whether it's a trending news topic, valuable resource or, heartfelt story, Angelina is an expert at producing content that nurses love to read. She specializes in warmly engaging with the nursing community and exponentially growing our social presence.

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I spent 18 months and $34,000 traveling the world but was burnt out and unhappy—this was my No. 1 mistake

I n August 2022, I quit my dream job. Looking to heal my burnout and find happiness beyond work, I spent a year and a half — and $34,000 — exploring South America and Asia .

For the first several months, I dashed through my bucket list destinations, hiking to snow-capped peaks and glacial lakes in Patagonia and bathing in warm waters in Thailand. 

But the thrill quickly petered out. I stood on the dramatic coastal bluffs of Jeju Island, Korea, and felt apathy. While roaming Japan, I peered with jealousy at people on their laptops in Starbucks. 

I was living my dream, but feeling burned out and hollow. That's when I realized I'd made a huge mistake: I had changed my circumstances, but not my state of mind .

The No. 1 mistake I made on my sabbatical

It dawned on me that I was approaching my sabbatical the same way I'd approached my career — like a workaholic . 

Back home, working doggedly in pursuit of more success and prestige had turned me into an anxious mess unable to live in the present. Now I was making the same missteps by traveling on a meticulously planned, militaristic schedule.

DON'T MISS:  The ultimate guide to earning passive income online

I was checking off destinations so that I could wear the number of places I'd been like a badge of honor. Then my life would be as worthwhile as the travel influencers I envied, I thought. 

Something had to change if I was going to enjoy my time off. These are the key three steps I took to transform my sabbatical and my life, and what they taught me about balancing well-being and ambition . 

1. I significantly cut back and shifted focus

I felt defeated, lying in bed in Tokyo, mourning what was supposed to be my big life plan: knock out visits to all 34 countries left on my bucket list during my sabbatical.

That way, I could get all the travel out of my system, go home, and focus solely on career and family planning goals. I wouldn't fall too far behind my peers, who were hitting milestones like buying homes and having kids.

But my burnout gave me the clarity I needed to slash my sabbatical bucket list in half, to focus on quality over quantity. What was the point of seeing so many places if I didn't truly enjoy them? 

I relinquished the desire to tell people I'd been to over 50 countries. I accepted that I'd continue traveling later if I wanted to, even if it meant less time to pursue professional goals.  

Learning how to prioritize my well-being meant letting go of control and of the metrics I thought defined my self-worth. I began to measure success through the moments I felt truly alive, at peace, and connected with others, instead of the quantifiable accomplishments that might make my resume and online bio more impressive.

2. I chose to 'miss out' on hot activities

I learned to ignore FOMO in favor of listening to my needs, even if it meant "missing out" on many of the most hyped and Instagrammable things to do. 

Instead of traveling two hours to the mountain backpacker paradise of Pai, Thailand, I stayed in Chiang Mai to read articles and watch mini-docs from charming cafes. Instead of embarking on a Caribbean island tour from Cartagena, Colombia, I opted to sleep in after a night out dancing with friends. 

I started to genuinely enjoy everything I did more, once I prioritized the pursuit of joy over a sense of obligation to do all the things I thought would make me a more accomplished traveler or professional.  

3. I gave up trying to work and make money while traveling

In my first few months traveling, I frequently stayed up late to formulate and pitch freelance story ideas. I was trying desperately to maintain a connection to work, since my self-esteem depended heavily on my job.

But trying to multitask was burning me out even faster. 

I completely gave up freelancing. Instead I focused on delving into topics I didn't have the energy to study while I was working full-time, such as history, geopolitics and real estate investing. For the first time in years, I felt like a curious human learning about the world, instead of a worker bee defined by my productivity. 

Developing a fulfilling identity completely disconnected from work has helped me significantly. I make time now for rest and play without feeling guilty. And I can approach work with more vitality and fresh ideas. 

Now I meditate, journal, and take walks every day

Returning home to Los Angeles in late February, I felt the lessons I'd learned during my sabbatical slipping away. I was swallowed by anxiety and workaholism again, back in my old environment and looking for a new job.

To gradually reconnect with the person I had become during my sabbatical, I began to meditate , journal about what I'm grateful for, and take walks every day . 

I'd always wanted to, but I never made time for these daily practices before, because I worried they'd detract from my productivity. Now these routines help me maintain and build on the emotional work I did during my trip.

Instead of slipping into burnout or feelings of unworthiness, I'm embracing the time I spend figuring out what's next. I'm learning to cultivate a fulfilling identity and life even when I'm not working a dream job or traveling the world. 

Helen Zhao  is a former video producer and writer at CNBC. Before joining CNBC as a news associate, she covered residential real estate for the LA Business Journal. She's a California native and a proud USC Trojan and UCLA Bruin.  

Want to make extra money outside of your day job?  Sign up for CNBC's new online course  How to Earn Passive Income Online  to learn about common passive income streams, tips to get started and real-life success stories. CNBC Make It readers can use special discount code CNBC40 to get 40% off through 8/15/24.

Plus,  sign up for CNBC Make It's newsletter  to get tips and tricks for success at work, with money and in life.

Travel nurse who left rural job says N.L. is pushing people out of public health system

Stacey button says she was underappreciated as an lpn in springdale.

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Stacey Button felt unsupported and overworked as a licensed practical nurse in rural Newfoundland, an experience fraught with so much stress and dejection that she left her home and a full-time job to become a travel nurse.

She says she now has job flexibility, is treated with respect and gets paid far more than she did back home.

As well, Button says that if the Newfoundland and Labrador government doesn't make major changes to the public health system, it will be challenging to persuade many other nurses to stay in Newfoundland and Labrador.

"You can't have it both. You can't expect people to do this crazy hard job and then also try to rein them in and, like, squeeze them as tight as you can," said Button.

"Health care needs nurses more than nurses need to work here."

A Globe and Mail report in February revealed that the provincial government spent $36.5 million on nurses from private agencies within months, and shelled out cash for travel nurses' training, cable bills and a variety of other expenses.

Newfoundland and Labrador Health Minister Tom Osborne has called travel nurses a "necessary evil" on numerous occasions , and has said there are full-time nursing jobs for every nurse in the province, but that nurses should temper their expectations because the available jobs may not be in the specific units or locations they want.

Button says the province is aware it has a nursing problem, and is choosing to blame it on nurses.

"You can't, you know, say we don't want agency nurses, that they're the worst. And then also be like, well, we're also not going to give our home nurses anything that they're asking for, so they're the worst," said Button.

Overworked and underappreciated

Around 10 years ago, Button moved with her husband and three dogs to take a permanent, full-time position at a hospital in Springdale, near Green Bay, in central Newfoundland. She previously worked as an LPN for a year in her hometown of Corner Brook.

In Springdale, she says she worked mostly in a nine-bed acute care ward, and was the only LPN working alongside one registered nurse on overnight shifts.

Travel nurse who left job in rural Newfoundland says government can’t have its cake and eat it too

Although LPNs have a different scope of practice and schooling requirements from registered nurses, Button says she was expected to complete the same tasks as her RN counterpart. She says the two of them had to do everything, from patient admissions to helping in the emergency room.

According to the Newfoundland and Labrador Association of Public and Private Employees, which represents around 2,000 LPNs in the province, the maximum amount registered nurses can make is $71 an hour, while LPNs make around $32 an hour — less than half of an RN's top salary.

Health care needs nurses more than nurses need to work here. - Stacey Button

"If you walked into the nursing station, you wouldn't be able to tell who was who," said Button. "And yet you're looking at someone who's making almost double what you're making."

Button says she worked 12-hour shifts for seven days within a two-week period, but says she was asked to work overtime almost every day she had off. Button says the hospital was understaffed, so she was often overwhelmed with work and received little support from management.

"I just think that people want three things from their job, right?" said Button. "They want respect, they want flexibility and they want to feel like they're being paid what they're worth. And I just didn't feel any of that here."

Button decided to become a travel nurse in the summer of 2023. Shortly after she left, she found out she was replaced by a travel RN.

In an emailed statement to CBC News, N.L. Health Services spokesperson Mikaela Etchegary said there are travel RNs working in both the emergency department and the long-term care facility in Springdale.

Button says it's well-known in the travel nursing community that taking a stint in Newfoundland and Labrador is lucrative — something she feels is ironic, because she says the same system that's rewarding travel nurses is shoving out those who already live and work there.

"It's very disheartening," said Button. "As a travel nurse, I feel like I'm being paid what I'm worth for the amount of work I did."

Making what you're worth

NAPE president Jerry Earle, whose union represents about 2,000 LPNs, says the scope of practice expected from LPNs has changed significantly over the last five to six years, but the amount they're paid hasn't kept pace.

He says the union has taken this issue to the provincial government, and says the health authority has agreed to conduct a review into LPN scope of practice and how it correlates with compensation.

In an emailed statement to CBC News, Department of Health and Community Services spokesperson Tina Coffey said the provincial government signed a memorandum of understanding with NAPE and the Canadian Union of Public Employees. The MOU includes $2.48 to $3.11 per hour on top of what LPNs are currently making, as well as a five per cent increase for LPNs with 15 to 25 years of service in the province.

Earle says private nursing agencies are preying on vulnerable and overworked nurses, as well as a strained health-care system, bleeding the province of millions of dollars that should be invested into itself, as opposed to a private company.

"We have had a number of practical nurses and other health-care workers reach out to us and say, we would return to the system if things were better," said Earle.

"Things have to get better. We can't have people working 24 hour shifts and working days off, not able to get annual leave. That can't continue and that has to be addressed."

Button says travel nursing has been life-changing. She has travelled to Nova Scotia with a close friend and is hoping to go to Nunavut this summer, all while being able to better support herself and her family. She also says she's finally able to enjoy her days off, uninterrupted by calls to work overtime.

She misses her dogs and her husband in Springdale, and says she loves the town and many of the colleagues and managers she worked with. But the pressure of working in a health-care system that's so understaffed it seems to be falling apart at the seams, Button says moving home right now isn't worth it.

"I just think nursing in this province is not a place, not a thing I want to be a part of at the moment," she said.

"And the pay is not great and the government doesn't seem to be taking anybody seriously. I feel like I'm helping my family financially more by being a travel nurse than I ever could being a staff nurse here."

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‘it’s absolutely outrageous’: houston resident charged surprise $400 ‘facility fee’ after doctor visit, kprc 2 investigates ‘facility fees’ and what to look for on your medical bills.

Amy Davis , Investigative Reporter

Andrea Slaydon , Senior Investigative and Special Projects Producer

HOUSTON – Unexpected, unexplained fees are driving up the cost of doctor visits for families across Houston. We are talking hundreds of dollars in charges above your co-pay. They’re called “facility fees,” and patients are told days or weeks after their appointments they have to pay up.

“It’s absolutely outrageous,” said Mindy Easterbrook.

Outrageous new charges that Easterbrook has never been charged when she takes her two children with Type 1 diabetes to see their doctor.

“They see an amazing doctor there. We absolutely love her, but we’re getting charged facility fees now by Texas Children’s Hospital on top of our regular doctor fees that we’re being billed,” said Easterbrook.

One $290 item on her bill is labeled “observation/treatment room.” Another fee of $405 says it’s a “room, staff and supply charge.”

Texas Children’s Hospital told Easterbrook she will incur these fees at every visit with her children’s endocrinologist where her daughter and son check in every 3 months.

“For these facility fees, you don’t get a choice. You can’t opt-out. You don’t know what these fees are going for,” said Maribeth Guarino.

Guarino has studied facility fees as a healthcare advocate for the U.S. Public Interest Research Group Education Fund or “PIRG” for short.

She says facility fees are common at hospitals where patients are billed separately for doctors, specialists and room charges. But in recent years as hospital systems buy up doctor’s offices, they are adding these facility fees to regular doctor bills.

RELATED: What is a facility fee?

When did Hospitals in the Houston area start charging facility fees?

Texas Children’s Hospital told KPRC 2 it began adding the fees to its doctor’s offices that it considers “hospital-based clinics” on November 1, 2023.

“Right now, these outpatient departments that hospitals own are licensed under the same number as the hospital and so that’s how they kind of get away with “it’s a hospital location” even though the location might actually be 2-10 miles away from the actual campus of the hospital,” explains Guarino.

Other viewers have sent us their bills showing their own fees. One viewer’s bill shows a $200 facility fee. In their case Blue Cross Blue Shield paid $74 leaving the patient owing $126 above their co-pay.

While the chatter is largely from Texas Children’s patients locally, other hospitals here and across the country are charging the same type of fees.

Methodist, Memorial Hermann and MD Anderson all confirmed with KPRC 2 News that they also charge facility fees to patients visiting doctors outside of their traditional hospitals.

15 states have passed laws limiting the fees in some way but only Connecticut has banned facility fees for non-emergency, outpatient care.

Federal lawmakers are currently working on the ‘Lower Costs, More Transparency’ Act. If passed by both the House and Senate, it would end facility fees outside of traditional hospitals.

Until then patients like Hunter, Skye and their mom don’t have a choice.

“Our kids come first. We have to have them seen,” said Easterbook.

“Patients cannot be on the hook for these charges especially when they’re already struggling to pay and delaying care because they’re afraid of the cost,” said Guarino.

What can I do about facility fees on my medical bill?

So, what can you do about these facility fees? We know that many patients have had those facility fees waived as a one-time courtesy when they called the TCH billing department.

A Texas Children’s spokesperson also told me that telehealth visits and urgent care visits will not incur facility fees.

That federal bill is not before the U.S. Senate where it appears to have bipartisan support. You can reach out to your senator if you want them to ban these fees.

The Texas Hospital Association told KPRC 2 News the fees are necessary. They sent this document that explains that hospitals would have to reduce staff, cut services, and close outpatient clinics if these fees are banned.

KPRC 2 News reached out to several of the larger hospital systems in the Houston area to see if they charge facility fees. Find the full statements below.

Texas Children’s Hospital

Over 70 years ago, Texas Children’s was founded on the guiding principle that every child deserves the highest quality care regardless of their family’s ability to pay. Since then, navigating healthcare has become increasingly complex, but we remain resolute that cost should never stand in the way of our patients receiving the care they deserve. If any of our patients are struggling to either understand their bill or need financial assistance, we have a wonderful team dedicated to assisting them every step of the way. We are fully committed to meeting patient families where they are at and assisting them with any challenges or questions they have.

Why did TCH decide to add the facility fee so that they appear on a patient’s bill after what they believed were regular doctor office visits?

Texas Children’s follows the appropriate guidelines when billing health plans for the services rendered on behalf of a patient. It is important to understand that a patient’s out of pocket expense is determined by the assigned benefits within their individual health plan and not by Texas Children’s.

How can patients know when they will see this fee on their bill before they book an appointment?

Texas Children’s is fully committed to price transparency with our patients and offers a number of ways for them to receive a pre-visit estimate ahead of time.

*It is also important for patients to know that if patients schedule a TeleHealth visit or a visit at a Texas Children’s Pediatrics or Urgent Care location, the visit will not include a facility fee charge as that charge is only applicable in a hospital-based location.

Is there a way for patients who see the same doctor for routine visits (monthly visits, for example) can appeal so that they are not paying the facility fee with each appointment?

The facility fee is applicable to each individual visit in a hospital-based location until a patient meets their insurance deductible, after which the fee for each visit will transition to the co-insurance rate predetermined by the patient’s health insurance plan.

Billing FAQ from TCH

Houston Methodist

Houston Methodist does not charge facility fees at its physician-based clinics. There are a few hospital-based clinics where a facility fee is charged such as the transplant clinic, wound care clinic, radiation oncology clinic and the infusion clinic. Facility fees help hospitals offset the higher cost of providing specialty outpatient services to patients allowing us to provide a higher level of care that is safe and convenient for our community.

Billing FAQ from Houston Methodist

MD Anderson

MD Anderson facilities are hospital-based locations offering multidisciplinary hospital-level care in the outpatient setting, which requires specialized staffing and infrastructure. MD Anderson provides patients with one financial statement, which includes both physician and hospital charges, but these may be processed differently by a patient’s insurance. This information is shared with all new patients and is available online. Patients with questions can contact MD Anderson’s Patient Business Services for clarification.

Memorial Hermann

“Memorial Hermann has approximately 90 hospital outpatient departments across the system. These are not doctor’s offices. They are outpatient departments of the hospital that provide highly specialized services. In outpatient departments with a physician-led care team, the physicians are not employed by Memorial Hermann. In compliance with regulatory requirements, patients are provided notice that they are receiving care in an outpatient hospital department and the physician’s billed services will appear separately from the hospital payment. These hospital payments (also known as “facility fees”) cover all of the other essential aspects of care including nurses, lab technicians, technology and other functions – services for which the hospital would not otherwise be paid. Memorial Hermann does not bill facility fees from any of its primary care clinics.

Offering complex care in an outpatient setting means that care is more affordable and more convenient for patients to access, and these hospital payments enable us to effectively partner with physicians to provide that care. We also know that navigating health care costs is complex, so we offer patients access to resources like our good faith price estimate tool so they can make well-informed decisions about their care.”

Billing FAQ from Memorial Hermann

A weekly newsletter with content from KPRC 2's Amy Davis.

Copyright 2024 by KPRC Click2Houston - All rights reserved.

About the Authors

Passionate consumer advocate, mom of 3, addicted to coffee, hairspray and pastries.

Andrea Slaydon

Award-winning TV producer and content creator. My goal as a journalist is to help people. Faith and family motivate me. Running keeps me sane.

Recommended Videos

The WHO overturned dogma on how airborne diseases spread. Will the CDC act on it?

The World Health Organization has issued a report that transforms how the world understands respiratory infections like Covid, influenza and measles .

Motivated by grave missteps in the pandemic, the WHO convened about 50 experts in virology, epidemiology, aerosol science, and bioengineering, among other specialties, who spent two years poring through the evidence on how airborne viruses and bacteria spread.

However, the WHO report stops short of prescribing actions that governments, hospitals, and the public should take in response. It remains to be seen how the Centers for Disease Control and Prevention will act on this information in its own guidance for infection control in health care settings .

The WHO concluded that airborne transmission occurs as sick people exhale pathogens that remain suspended in the air, contained in tiny particles of saliva and mucus that are inhaled by others.

While it may seem obvious, and some researchers have pushed for this acknowledgment for more than a decade, an alternative dogma persisted — which kept health authorities from saying that Covid was airborne for many months into the pandemic.

Specifically, they relied on a traditional notion that respiratory viruses spread mainly through droplets spewed out of an infected person’s nose or mouth. These droplets infect others by landing directly in their mouth, nose, or eyes — or they get carried into these orifices on droplet-contaminated fingers. Although these routes of transmission still happen, particularly among young children, experts have concluded that many respiratory infections spread as people simply breathe in virus-laden air.

“This is a complete U-turn,” said Dr. Julian Tang, a clinical virologist at the University of Leicester in the United Kingdom, who advised the WHO on the report. He also helped the agency create an online tool to assess the risk of airborne transmission indoors.

Peg Seminario, an occupational health and safety specialist in Bethesda, Maryland, welcomed the shift after years of resistance from health authorities. “The dogma that droplets are a major mode of transmission is the ‘flat Earth’ position now,” she said. “Hurray! We are finally recognizing that the world is round.”

The change puts fresh emphasis on the need to improve ventilation indoors and stockpile quality face masks before the next airborne disease explodes. Far from a remote possibility, measles is on the rise this year and the H5N1 bird flu is spreading among cattle in several states. Scientists worry that as the H5N1 virus spends more time in mammals , it could evolve to more easily infect people and spread among them through the air.

Traditional beliefs on droplet transmission help explain why the WHO and the CDC focused so acutely on hand-washing and surface-cleaning at the beginning of the pandemic. Such advice overwhelmed recommendations for N95 masks that filter out most virus-laden particles suspended in the air. Employers denied many health care workers access to N95s, insisting that only those routinely working within feet of Covid patients needed them. More than 3,600 health care workers died in the first year of the pandemic, many due to a lack of protection.

However, a committee advising the CDC appears poised to brush aside the updated science when it comes to its pending guidance on health care facilities.

Lisa Brosseau, an aerosol expert and a consultant at the Center for Infectious Disease Research and Policy in Minnesota, warns of a repeat of 2020 if that happens.

“The rubber hits the road when you make decisions on how to protect people,” Brosseau said. “Aerosol scientists may see this report as a big win because they think everything will now follow from the science. But that’s not how this works and there are still major barriers.”

Money is one. If a respiratory disease spreads through inhalation, it means that people can lower their risk of infection indoors through sometimes costly methods to clean the air, such as mechanical ventilation and using air purifiers, and wearing an N95 mask. The CDC has so far been reluctant to press for such measures, as it updates foundational guidelines on curbing airborne infections in hospitals, nursing homes, prisons, and other facilities that provide health care. This year, a committee advising the CDC released a draft guidance that differs significantly from the WHO report.

Whereas the WHO report doesn’t characterize airborne viruses and bacteria as traveling short distances or long, the CDC draft maintains those traditional categories. It prescribes looser-fitting surgical masks rather than N95s for pathogens that “spread predominantly over short distances.” Surgical masks block far fewer airborne virus particles than N95s, which cost roughly 10 times as much.

Researchers and health care workers have been outraged about the committee’s draft, filing letters and petitions to the CDC. They say it gets the science wrong and endangers health. “A separation between short- and long-range distance is totally artificial,” Tang said.

Airborne viruses travel much like cigarette smoke, he explained. The scent will be strongest beside a smoker, but those farther away will inhale more and more smoke if they remain in the room, especially when there’s no ventilation.

Likewise, people open windows when they burn toast so that smoke dissipates before filling the kitchen and setting off an alarm. “You think viruses stop after 3 feet and drop to the ground?” Tang said of the classical notion of distance. “That is absurd.”

The CDC’s advisory committee is comprised primarily of infection control researchers at large hospital systems, while the WHO consulted a diverse group of scientists looking at many different types of studies. For example, one analysis examined the puff clouds expelled by singers, and musicians playing clarinets, French horns, saxophones, and trumpets. Another reviewed 16 investigations into Covid outbreaks at restaurants, a gym, a food processing factory, and other venues, finding that insufficient ventilation probably made them worse than they would otherwise be.

In response to the outcry, the CDC returned the draft to its committee for review, asking it to reconsider its advice. Meetings from an expanded working group have since been held privately. But the National Nurses United union obtained notes of the conversations through a public records request to the agency. The records suggest a push for more lax protection. “It may be difficult as far as compliance is concerned to not have surgical masks as an option,” said one unidentified member, according to notes from the committee’s March 14 discussion . Another warned that “supply and compliance would be difficult.”

The nurses’ union, far from echoing such concerns, wrote on its website , “The Work Group has prioritized employer costs and profits (often under the umbrella of ‘feasibility’ and ‘flexibility’) over robust protections.” Jane Thomason, the union’s lead industrial hygienist, said the meeting records suggest the CDC group is working backward, molding its definitions of airborne transmission to fit the outcome it prefers.

Tang expects resistance to the WHO report. “Infection control people who have built their careers on this will object,” he said. “It takes a long time to change people’s way of thinking.”

The CDC declined to comment on how the WHO’s shift might influence its final policies on infection control in health facilities, which might not be completed this year. Creating policies to protect people from inhaling airborne viruses is complicated by the number of factors that influence how they spread indoors, such as ventilation, temperature, and the size of the space.

Adding to the complexity, policymakers must weigh the toll of various ailments, ranging from Covid to colds to tuberculosis, against the burden of protection. And tolls often depend on context, such as whether an outbreak happens in a school or a cancer ward.

“What is the level of mortality that people will accept without precautions?” Tang said. “That’s another question.”

Amy Maxmen | KFF Health News