Cassie Jupin grew up wanting to be a nurse. She sought a position at St. Peter’s Health Partners Hospital in Albany, New York and landed a position in the same maternity ward where she was born.
“Knowing that I can come back to work any day and work with a group of women and people who just make it so easy,” was gratifying, Jupin said. “Everyone is here to help you.”
When she graduated from nursing school last July, she and her classmates joked about taking traveling nurse jobs that paid much more than entry-level staff jobs.
“They were about $140 to $150 depending on the area you were looking in,” she explained. Payment was not per day. It was per hour.
According to a survey by the American College of Healthcare Executives last year, retaining nurses like Jupin was the most pressing staffing issue for 90% of CEOs at community hospitals like St. Peter’s.
The pandemic has exacerbated nursing staff shortages, causing contract nurse rates to skyrocket during successive waves of Covid infections. During the Omicron surge in winter 2022, national rates increased to an average of $150 per hour, according to consulting firm Syntellis. That was three times the national average for full-time nurses.
As hospitals increasingly rely on contract nurses, travel nurse spending has increased by more than 250% since the pandemic began.
“Hourly wages paid to registered nurses continue to experience significant volatility, which accounts for a significant portion of total labor costs,” said Flint Brenton, CEO of Syntellis Performance Solutions.
A nurse instructs a colleague in the care of a Covid patient in the Covid intensive care unit of the University Hospital Leipzig.
Sean Gallup | News from Getty Images | Getty Images
At the same time, the use of highly paid staff by travel nursing agencies also led to a vicious circle in staffing.
“The agency’s staff received high pay rates and had complete control over their hours,” explained Carol Boston Fleischhauer, executive director and chief nurse officer on the advisory board, and as a result, “more in-house nurses left permanent employment for outside opportunities, increasing revenue.”
The 29-year-old traveling nurse jumped at the chance to make $187,000 and work just 9 months a year: ‘A once-in-a-lifetime opportunity’
Travel nurses in house
St Peter’s is part of the Trinity Health System, which has not been immune to the need for contract care. But Trinity has been able to better manage staff turnover by using its own traveling nurse program — an idea that originated with its own nurses over a decade ago.
“We realized that if you will, we could develop our own internal agency that could bring people to Trinity Health’s attention for all of our hospitals,” said Jennifer Misajet, chief nursing officer at St. Peter’s Hospital.
This internal program, called First Choice, tripled in size during the pandemic as older nurses sought to reduce their full-time employment and younger nurses sought higher pay and greater flexibility in their working conditions.
“It’s not like it used to be when nurses became in-patients for 30 years. Many recent graduates expect to work in an inpatient setting for just a few years, and then they want to pursue their master’s degree or become a registered nurse practitioner,” said Trinity CEO Mike Slubowski.
With nearly 90 hospitals in 26 states, First Choice has helped Trinity better control contract nursing costs while maintaining relationships with nurses who can help them maintain a consistent quality of care.
“If they wanted to work somewhere else, like Fresno, California, or Boise, Idaho to cover there, you know, we have the same clinical information system everywhere… and so it’s familiar with delivering care in that environment,” said Slubowski.
With more than 30,000 registered nurses in its system, nearly 1 in 10 of Trinity’s nurses currently work with First Choice. That now includes about a dozen senior executives like Misajet in St. Peter.
“We really tried to meet our nurses where they are and they are in different places,” Misajet said. In her case, she chose to work part-time rather than retire to spend more time with her family.
Analysts say more hospitals are following Trinity’s lead and launching their own in-house staffing programs to reduce labor costs on agency contracts. At the same time, they face higher costs to retain their full-time caregivers. According to its most recent financial statements, Trinity increased employee pay by 5.5% in 2022.
For new nurses like Jupin, who may be tempted by high-paying traveling nurse jobs, the message from hospital management is clear.
“They don’t want you to go away – especially our manager,” the maternity nurse said. “The first thing she always said to us is, ‘Please come to us if you need anything because we want you to stay here for the long haul.'”
According to a recent survey by the American Nurses Association, better pay and staffing conditions remain the top concerns for most nurses, but flexibility is also key for more than half of them. Increasingly, it is also proving to be key for hospital systems such as Trinity.