covid 19 lpn travel assignments

Many travel nurses opt for temporary assignments because of the autonomy and opportunities − not just the big boost in pay

Assistant Professor of Communication Studies, University of Houston-Downtown

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Travel nurses take short-term contracts that can require long commutes or temporarily living away from home. Time and again, they have to get used to new co-workers, new protocols and new workplaces.

So why would staff nurses quit their stable jobs to become travel nurses?

Well, for one, they get bigger paychecks . But U.S. nurses have other rationales besides making more money, according to a study I conducted .

To do this research, I interviewed 27 registered nurses based in different places.

Many of the people I interviewed disclosed that they left permanent positions to combat burnout. Although they welcomed the bump in pay, travel nursing also gave them the autonomy to decide when and where to work. That autonomy allowed them to pursue personal and professional interests that were meaningful to them, and it made some of the other hassles, such as long commutes, worth it.

On top of earning more money, travel nursing “gives you an opportunity to explore different areas,” said a nurse I’ll call Cynthia, because research rules require anonymity. “When you actually live there for three months, it gives you a chance to really immerse yourself in the area and really get to know not just the touristy stuff, but really hang out with the locals and really be exposed to that area.”

Other study participants said they enjoyed the novelty and educational opportunities.

“You don’t get bored or stuck in a routine,” Michelle said. “You’re always trying to learn new policies at the new hospital that you’re in, learning about the new doctors, nursing staff, new ways of doing things, where things are located. That helps keep me from feeling burned out so quickly.”

Said Patricia: “I want to see how other operating rooms across the country do things and how they do things differently. I do learn a lot of things going from place to place.”

Why it matters

A growing number of U.S. nurses were obtaining temporary assignments before the COVID-19 pandemic began.

But travel nursing became much more widespread in 2020, when hospitals were scrambling to keep their staffing levels high enough as millions of Americans were becoming infected with the coronavirus, straining capacity in many communities.

While compensation varies widely, the median pay of registered nurses in 2022 was US$81,220 , about 35% less than the $110,000 that registered nurses who traveled earned .

At the height of the COVID-19 pandemic, travel nurses could earn an even bigger premium . Many were paid twice as much as staff nurses.

Once the number of Americans with severe symptoms fell, that premium declined too . But there are still over 1.7 million travel nurses in the U.S. Hiring them is one of the main ways that hospitals cope with a long-term shortage of nurses .

But nurses with permanent jobs can get aggravated by this arrangement when they learn how much more travel nurses earn for doing the same work, as I found through another research project .

What other research is being done

Research supports a widely reported trend: More Americans have temporary jobs and freelance employment than in the past.

While travel nurses can help hospitals, nursing homes and doctors’ offices meet staffing needs, there are signs that patients don’t always fare as well with their care.

And a Canadian study found that when hospitals let staff nurses work part time and offer other alternative arrangements, their retention rates may rise .

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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.

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How the era of travel nursing has changed health care

Travel nursing is a short-term and unsustainable solution for medical understaffing.

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In 2016, I was working as an ICU nurse in Reno, Nevada. But I didn’t live in Reno. In fact, I hadn’t trained as a nurse in the US at all; I’m from Canada and went to nursing school there. My initial contract was for just 13 weeks. I was what was called a travel nurse — someone who was brought in from a different city, and sometimes even from a different country — to meet a hospital’s temporary staffing needs.

At the start of my contract, we had a couple of days of onboarding and were then expected to hit the ground running. Every morning, I would report to the trauma ICU, one of four ICU units in the hospital, and only then find out where I was assigned, which was sometimes outside the ICU entirely.

Six years ago, travel nursing jobs like my Reno gig were a fringe part of the nursing landscape. But that’s changed. During the pandemic, the need for travel nurses has soared, and so have the wages paid them. Because I was a former ICU and travel nurse, I received frequent emails from travel nursing agencies when the pandemic first erupted, offering upward of $6,000 per week and occasionally as high as $10,000, if I were willing to relocate on as little as 48 hours notice to one of the cities experiencing a Covid-19 surge.

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This was a steep increase from the average US ICU travel nurse’s salary of $1,800 per week, per this 2019 report . (I didn’t accept any of them, but I have to admit it was tempting.)

The rise of the travel nurse in the time of Covid-19 isn’t that surprising. From the earliest days of the pandemic, registered nurses bore the brunt of the increased strain on the health care system. With ICUs across the country overflowing, hospitals were forced to open specialized Covid-19 wards and staffing was strained. Nurses were often required to work grueling hours with heavy patient loads, a shortage of personal protective equipment (PPE), and limited access to Covid-19 testing.

As we enter the third year of Covid-19, the staffing shortage is only getting worse . Many nurses are facing burnout, choosing less arduous roles in non-hospital settings, or retiring from the profession altogether. Others are staying in the profession, but leaving the hospitals that employ them for travel nursing agencies, which offer them better-paying, short-term contracts.

In travel nursing, rather than working directly for a hospital as permanent employees, nurses are hired by a staffing agency, which then arranges time-limited contracts with hospitals to meet temporary or seasonal staffing needs. Over the course of the pandemic, crisis demand for additional staff sent travel nursing wages skyrocketing, and thousands of nurses across the country accepted these offers. While travel nurses previously represented 3-4 percent of all nursing staff across the nation, the figure has risen to 8-10 percent.

Travel nurses are extremely valuable to hospitals, rapidly and flexibly providing critical staff during case surges. But relying so heavily on temporary staff brings disruption. With many of their permanent nurses leaving for lucrative travel gigs, hospitals are increasingly being forced to bring in travel nurses from elsewhere to make up the deficit, leaving teams fragmented. This is especially hard on small rural hospitals, which lack the resources to compete with larger hospital networks.

The massive pay discrepancy is likely a temporary side effect of the crisis and various economic and funding constraints, but the underlying situation is not about to disappear. Covid-19 has taken a nurse shortage that predated the pandemic and dramatically worsened it.

Relying on temporary staff weakens hospital teams, drawing away the best and most experienced nurses and making it that much harder to onboard new staff, train students, and provide high-quality care. With more and more nurses burning out and quitting by the day, hospitals and the federal and state governments have yet to address the factors that would help frontline health care workers stay in the profession. Travel nurses are at best a temporary fix, and the long-term cost is unsustainable.

How travel nursing works

Travel nursing didn’t begin with the Covid-19 pandemic. The idea originated in New Orleans in 1978, as a response to the annual influx of patients during Mardi Gras. The practice became more prevalent over the next decade; by the late 1980s, travel positions had become widely available.

Travel nurses are hired by a staffing agency, rather than a hospital; the agency then arranges contracts with hospitals to provide nurses during periods of temporarily high demand and usually arranges housing for the nurses in their destination city. The standard contract is 13 weeks long, though nurses can sometimes choose to extend it to six months or longer.

In the past, travel nursing wages varied widely by state and region and were often higher than permanent staff salaries (though some of that difference came from the free housing or housing stipend and other incidentals that were often included). Since the start of the Covid-19 pandemic, though, the pay for travel nurses has increased dramatically, and much faster than permanent salaries.

“When I worked as a travel nurse, there wasn’t that much of a discrepancy between my wage and permanent staff,” said Mary Jorgensen, an operating room nurse at UW Health in Madison, Wisconsin, and a former travel nurse. “We were more attracted to travel nursing for the lifestyle of going to different locations. But now that hospitals have this over-reliance on travel nurses to try to make up for the nursing shortage crisis, the amount they’re spending on travelers is astronomical.”

Over the past 18 months, it has become common for many nurses to double their paycheck by choosing the travel route. It’s not for everyone. It requires high levels of adaptability, independence, and tolerance for uncertainty, not to mention the personal freedom to pick up stakes and move temporarily, but for nurses who can take advantage of the opportunity, travel nursing can provide a financial windfall.

Lydia Mobley, a travel nurse with the major travel nursing agency Fastaff, believes that health care workers deserve more pay, and that travel nursing offers a route toward that end. “I know two amazing nurses who are some of my best friends, who are travel nurses and they are single mothers, but they still make travel work because they just want to give their kids the best life possible,” Mobley told me. Thirteen-week contracts also mean that nurses can choose to take breaks to recover in between periods of intense workload.

Mobley also sees the novelty with each contract as a perk, offering nurses (and by extension the hospitals they normally work for, and in the past at least, usually returned to) the chance to learn how other hospitals operate. “Even if a hospital happens to have maybe some older, outdated policies, at least you learned, ‘Hey, that’s a way that that probably should be done,’” she said.

In my case, the experience was very positive. It felt good to be where I was most needed, and to bring my own background and experience to an understaffed unit. By the end of my initial 13-week contract, which I chose to extend for a total of six months, I was familiar with the hospital’s processes, and actually able to provide support and mentoring to the many recently-graduated nurses on the permanent staff.

For hospitals, travel nurses provide a huge advantage in flexibility and response time in a crisis. It’s extremely difficult to hire and fully train a cohort of permanent nursing staff fast enough to respond to a surge in case numbers, which can happen in weeks or even days. Hiring travelers also means that when local case numbers begin to drop, a travel agency can send its nurses on to other states with the highest needs.

Bart Valdez, CEO of Ingenovis Health (which owns Fastaff as well as several other travel nursing agencies), told me how his company was among the first agencies to send nurses to early Covid-19 hotspots like Washington and New York. These staff became early “veterans of Covid,” he said, bringing their experience of the challenges of Covid-19 patients to other facilities.

“A less stable ecosystem”

But there are real downsides to taking this model too far, which are apparent to travel nurses as well as the permanent staff.

For one thing, hospitals end up paying far more in hourly wages for staff who are less familiar with local conditions, which can erode nurses’ teamwork and the quality of care for patients.

Kelly O’Connor, another registered nurse from UW Health, mentioned a colleague of hers left Madison, Wisconsin, for a travel position in Milwaukee the very same week that O’Connor’s unit resorted to hiring a travel nurse from Milwaukee to fill the vacancy at a much higher cost to her hospital. Travel nurses are not only paid a higher hourly wage, but the agencies generally mark up the bill by 32 to 65 percent to turn a profit. (Texas has recently resorted to banning nurses currently in permanent positions from accepting contracts in-state in an attempt to circumvent this dynamic.)

Increasingly relying on travel nurses more often can also warp the inner workings of a hospital. “There was a time when travel nurses were used appropriately, as a ‘Band-Aid,’ but this is beyond that,” O’Connor says. “There’s so much that goes into a hospital running smoothly, and historically if a travel nurse was needed, they were able to pop in, understand the ecosystem quickly, and everything would function as normal.”

But now, she notes, “we’re relying on them too much, and they’re thrown into a less stable ecosystem without the support to figure it out.”

The delicate “ecosystem” of a well-run hospital unit is made up of all the staff needed to keep a medical center running: doctors, pharmacists, lab techs, respiratory therapists, and of course, nurses. To mentor new staff and train travel nurses, the unit needs a certain base of experienced nurses, with years of commitment and investment in the local hospital and community. But with high levels of staff turnover — and many experienced nurses shifting away from bedside care or choosing early retirement due to burnout — this essential resource is in jeopardy.

When the nursing ranks are chronically understaffed and overstrained, even the best nurses can’t spare the time to properly mentor a new staff member, and instead have to tag-team just to cover all the basic tasks.

O’Connor described a revealing situation she found herself in: She realized only in the final few days of a new nurse’s multi-week orientation that she had never found time to show her trainee where the wheelchairs were kept. That’s a basic if important piece of information that would usually have been covered in week one.

“I used to feel that I helped the new nurse grow, and now more often than not we’re having to rely on each other just to get through the workload,” she says. “Nursing is already so hard. This is only making it harder than it needs to be.”

The cost of good care

If experienced, committed permanent nurses are so essential to a hospital’s functioning, providing value that no temporary travel nurse can replace, why aren’t they compensated accordingly?

One contributing factor may be that during the pandemic, crisis funding from government institutions such as the Federal Emergency Management Agency (FEMA) couldn’t easily be allocated to hiring more permanent staff, or toward efforts to retain existing experienced staff via retention bonuses, hazard pay, or other support.

But there are systemic issues at work as well. The National Nurses United is the largest professional association of registered nurses, with more than 175,000 members working at the bedside in nearly every state. Its latest report — titled “Protecting Our Front Line: Ending the Shortage of Good Nursing Jobs and the Industry-Created Unsafe Staffing Crisis” — explores the background of the nursing shortage and the worsening conditions during Covid-19. It lists a number of specific policy recommendations, such as mandated staffing ratios and better workplace safety regulations, that they believe will help create sustainable, rewarding jobs and keep nurses in the field. (On a more local level, Mary Jorgensen and Kelly O’Connor are working with other nurses to form a union with SEIU Healthcare Wisconsin, in hopes of addressing the short-staffing and other challenges that have plagued UW Health during the pandemic.)

Such reforms were needed before the pandemic, and are even more necessary now. The spike in travel nursing demand and pay shows that the system as it exists now is not equipped to respond to a major crisis without significant disruptions that will have serious consequences down the line. The worsening personnel shortage, with many nurses retiring and leaving the profession entirely, is a symptom of a system that prioritizes the short term at the expense of sustainability.

Travel nurses have been a part of the nursing workforce for decades, and as a supplement for temporary needs, they are very valuable. But it’s not fair to either travel nurses, or the patients they care for, to ask them to take on so much of the ongoing essential duties of running a hospital unit.

A hospital relying too heavily on travel nurses will lose institutional knowledge, be less able to fit in new hires or provide nursing students with a strong education, and will end up being a frustrating and draining work environment, leading to more burned-out nurses and a worsening staff shortage at a time when the US can least afford it.

Clarification, March 3, 3:40 pm: This story has been updated to clarify the role of Mary Jorgensen and Kelly O’Connor in the effort to form a nurses union with SEIU Healthcare Wisconsin.

Correction, March 4, 3 pm: Due to a copy-paste error, an update to this article previously transposed the last names of Mary Jorgensen and Kelly O’Connor.

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Lived Travel Nurse and Permanent Staff Nurse Pandemic Work Experiences as Influencers of Motivation, Happiness, Stress, and Career Decisions

Carol tuttas.

Aya Healthcare Inc, San Diego, California.

Researchers explored travel nurses' and permanent staff nurses' COVID-19 pandemic work experiences, seeking to understand, “How do these experiences influence nurses' motivation, happiness, stress, and career decisions?” The COVID-19 pandemic took a heavy physical and psychological toll on health care providers. Demand outweighed resources as nurses accepted the monumental task of caring for communities affected by the catastrophe. We aimed to gain insight into nurses' lived pandemic experiences in the United States, while exploring the impact of these experiences on their motives to remain in current positions or alter their career paths. In this descriptive, phenomenological study, interview data collected from 30 nurses were analyzed using qualitative content analysis. Physical and emotional trauma experienced during the early and peak months of the pandemic led nurses to evaluate their current work arrangements and to ponder alternatives. Our results suggest that pandemic work environments contributed to a change in nursing workforce distribution and exacerbated widening nurse shortage gaps. A call to action bids leaders to institute retention measures based on factors influencing nurses' career trajectory decisions in the current environment. Our findings led to recommendations for leadership approaches to promote nurses' emotional healing and mental wellness.

THE WORLD HEALTH ORGANIZATION deemed COVID-19 a pandemic in March 2020. Shock, fear, and uncertainty took a heavy toll on the well-being of nurses during the initial crisis phase and beyond. Even 18 months later, health care systems worldwide still struggled to manage sporadic volume surges of patients infected by emerging variants. A stream of recently published studies acknowledges the worldwide, pandemic-induced physical, emotional, spiritual, and mental trauma endured by nurses as humans, exacerbated by repeating surges of devastation that continue to plague them. 1 – 5

In this study, researchers took a qualitative approach to analyze perceptions articulated by US travel nurses (temporary contract nurses) and permanent staff nurses who practiced before, during, and following the height of the pandemic. Researchers aimed to describe and relate these nurses' experiences to (i) motivation to remain active in nursing; (ii) factors influencing happiness and stress in their current roles; and (iii) factors that influence professional choice in seeking new employment opportunities, including travel nursing and different permanent staff positions.

Studies published shortly after the SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) coronavirus outbreaks in 2003 and 2012, respectively, generated knowledge about their impact on health care professionals' mental and emotional well-being. 6 – 8 Lessons learned from these prior deadly coronavirus outbreaks included the imperative for instituting prompt and continuous psychiatric interventions to support frontline health care professionals. 6 This was an ominous signal to proactively establish protective measures as a state of readiness in the event of a future pandemic. Nearly 30% of 1327 US health care workers polled by The Washington Post –Kaiser Family Foundation in early 2021 considered leaving the health care sector because of the COVID-19 pandemic. 9 Similar findings exposed by researchers in Quebec, Canada, exposed the link between perceived effects of the pandemic on practice environments and the proportion of nurses reporting a high intent to leave their practice areas (nearly 30%) or to leave the profession altogether (22%). 10 Results of a cross-sectional study of Alabama nurses further corroborate, whereby more than 52% considered quitting their jobs due to the pandemic. 11 Nurses represent an already compromised cohort of essential direct care providers. A small percentage of turnover at any level results in substantial disruption of staffing capacity. Brockopp and colleagues 12 underscored the stabilizing impact of nursing leadership visibility, which in their study of critical care nurses was perceived during the COVID-19 pandemic as a beacon of hope and a healing stream of tangible recognition. Sadly, findings of a recent AONL longitudinal study exposed that the mental and emotional wellbeing of nurse leaders, whose role includes supporting direct care nurses, is also under siege from the pandemic. 13

Researchers from a leading US health care workforce solutions firm worked with an international marketing research company to explore and compare the lived COVID-19 pandemic work experiences of travel nurses and permanent staff nurses. The researchers aimed to gain an understanding about how these experiences influence nurses' motivation, happiness, stress levels, and career decisions.

METHODOLOGY AND DESIGN

This qualitative, descriptive, phenomenological study was approved by the marketing research company's institutional review board. To avoid influencing participants' responses and put forth assurance of confidentiality, the research company (a qualified independent, nonemployer party) invited prospective participants, screened invitee respondents for eligibility, and then enrolled and interviewed the study participants. The research company served as a firewall through nondisclosure of participant identities to the workforce solutions firm and by securely retaining the study data.

A technologically randomized list of travel nurse invitees was generated from the workforce solutions firm's database, and that of permanent staff nurse invitees from the research company's database. The research company distributed an e-mail invitation to 488 prospective participants, yielding a 26% response rate. Eligible candidates were RNs practicing for the past 2 or more years in an acute hospital inpatient or emergency department. Invitation respondents were screened for eligibility in order of receipt. Those who qualified were selected, confirmed, and enrolled across 3 categorical cohorts: (i) 10 veteran travel nurses (nurses who took travel assignments both prior to and during the pandemic); (ii) 10 new travel nurses (nurses who first worked as a travel nurse during the pandemic); and (iii) 10 permanent nurses (nurses holding a staff position at a hospital and have never taken a travel assignment.) Interviews were scheduled once a balance of 10 participants was enrolled in each category.

We anticipated that 30 interviews would be sufficient to achieve thematic saturation (where no additional breadth and depth of insights emerges), and, if not, we were prepared to enroll additional respondents. The research company carried out the interviews as an entity distant and separate from the research participants and their realities. During May and June 2021, one researcher from the market research company engaged each participant in a 30-minute, semistructured, individual telephone interview. The researcher used a standardized interview guide consisting of open-ended and probing questions. Each interview was recorded, and the researcher took notes. Thematic saturation was achieved prior to the completion of all 30 interviews. Nonetheless, all 30 scheduled interviews were fulfilled, which further verified the evidence and yielded a collection of rich data. Participant demographics are shown in Table ​ Table1 1 .

Abbreviations: DNP, Doctor of Nursing Practice; PACU, postanesthesia care unit.

Audio recordings and interview notes were systematically examined using qualitative content analysis. Key concepts were identified and categorized at a descriptive level, preserving the verbatim expressions of nurses' lived experiences. Iterations of content analysis facilitated the emergence of meaningful essences, manifesting as themes.

Five themes became distinctly evident: (1) Pandemic effects drive major shifts in nurses' career path choices; (2) Animosity is growing between permanent staff nurses and travel nurses; (3) Happiness levels and stress levels influence career decisions; (4) Emotional impact of the pandemic is extensive; and (5) Nurses are seeking support from hospital management. The substance underpinning each theme is presented as follows.

Pandemic effects drive major shifts in nurses' career path choices

Permanent staff participants appreciated attributes of permanent job status such as perceived compensation package stability, balance and compatibility with personal and family life circumstances, and team camaraderie.

...my teammates ... they are my sisters.

These nurses generally signaled an intent to remain in a permanent staff work arrangement.

New travelers were those who switched from permanent staff positions to take their first travel assignment during the pandemic. The most frequently cited reason for these nurses' decisions to embark on this new path was the higher hourly pay differential. But monetary compensation was not the sole driver. Pandemic circumstances created a call to purpose-driven action, and these nurses sensed a duty to respond.

Nursing is my calling, and this was made even more clear to me during the pandemic.

The new travel nurses reported that gaining experience at different hospitals strengthened their competence and expanded their skills, while boosting confidence. Taking on difficult but manageable experiences is one of the building blocks of resilience. 14 By venturing into travel nursing during a pandemic, the new travel nurses engaged in a robust professional growth experience.

The pandemic made me learn a new level of what I could handle.

This cohort also reported a sense of freedom to focus solely on their patients due to the absence of commitments beyond direct care duties typically expected of permanent staff.

Veteran travel nurses reported that pandemic-induced physical and emotional trauma wore them down and motivated them to contemplate leaving beside nursing to (i) explore alternative career paths within or outside of the nursing profession, (ii) continue their education, or (iii) take a break or early retirement.

I mentally can't do it anymore with COVID.... I'm bringing home way too much baggage.

Across all 3 subgroups, some nurses indicated they want to leave bedside nursing or the profession entirely. Reasons for this included feeling unsafe when personal protective equipment was scarce, inadequate staffing creating unavoidable compromises to patient care, logistical impossibility to deliver proper or timely treatment, and proning patients themselves, resulting in physical ailments such as back, wrist, and elbow injuries. Table ​ Table2 2 summarizes key findings related to career path intentions.

Abbreviations: ED, emergency department; ICU, intensive care unit.

Animosity is growing between permanent staff nurses and travel nurses

Permanent staff nurses know that travelers are paid more. This perception of pay inequity between the 2 groups provokes animosity, jeopardizing morale and teamwork. While some permanent staff were grateful and welcoming, others were resentful and unimpressed with the travel nurses' presence. A benefit that appeals to travel nurses also contributes to animosity from permanent nurses. Travel nurses' enjoyment of freedom to focus more intently on patient care in the absence of additional responsibilities was perceived by some permanent staff as disinterest in how the unit is running and not being invested or ready to go the extra mile. Travel nurses reported feeling pressured to work overtime as a demonstration of their commitment to the team to overcome this perception. Half of the travel nurses reported being treated like outsiders; for example, being excluded from Nurses Week festivities. One travel nurse observed, “A lot of [permanent] nurses are burned out ... so they are not very nice.” Some travel nurses perceived they were bullied by staff nurses and given the heaviest assignments.

We are just a Band-Aid, they don't consider us part of the team.

Happiness levels and stress levels influence career decisions

Participants were asked to rate their job happiness and stress levels on a scale of 1 to 10 corresponding to 2 time periods: (1) prior to the pandemic and (2) at the time of the interview. Nearly every nurse reported greater happiness prior to the pandemic than at the time of the interviews, suggesting that the effects of the pandemic impacted job satisfaction. Veteran travelers and permanent nurses were very happy prior to the pandemic, while new travelers were not so happy at that time. Veteran travel nurses' prepandemic happiness scores dropped proportionately greater compared with the other groups by the time of the interviews.

All nurses gauged stress as 10+ at the height of the pandemic, which many described as teetering at the breaking point.

You feel like you just can't do it anymore, it's too much.

In the months leading to the interviews, the initial acute phase of the pandemic eased slightly, and stress ratings tapered somewhat, but still exceeded prepandemic levels. New travelers ranked highest in prepandemic stress levels, which, combined with their low happiness scores, perhaps tipped the scale in favor of shifting to travel nursing.

Veteran travel nurses reported the highest levels of happiness and lowest levels of stress prepandemic. Conversely, by the time of the interviews, their happiness levels dropped and their stress levels increased proportionately more than those of the other groups. More veteran travel nurses expressed intent to leave bedside nursing or the profession than the 2 other groups. Figures ​ Figures1 1 and ​ and2 2 depict changes in nurses' happiness and stress levels, respectively.

Self-rated nurse happiness levels.

Self-rated nurse stress levels.

Emotional impact of the pandemic is extensive

The extensive physical and emotional trauma that nurses experienced while working through the pandemic is perhaps the most profound factor currently influencing their career decisions. Most participants described being traumatized by the combination of the pandemic crisis, the acuity of the patients, and the number of deaths they helplessly witnessed (a video is available at https://vimeo.com/586883328/7fba6f4ad9 , which presents a compelling collection of nurses' experiences, portrayed in their own words).

I didn't know what real burnout was like until the pandemic.

Many nurses reported their primary motivation to remain in nursing is the desire to help people.

I get a rush when I'm in a bad situation and I can fix it ... it's uplifting and encouraging.

However, patient acuities and volumes, inadequate staffing, and visitor restrictions hindered them from making that impact. These nurses felt defeated when they could not make a difference despite working extended hours. Chronic inadequacy of staffing resources combined with burgeoning patient volumes and relentless physical demands was oppressive.

The “why” changed. I'm no longer working to help people; only doing it for the money.

At the height of the pandemic, nurses were working 48 to 72 hours a week. They routinely worked 12+-hour shifts with no breaks. Without enough technicians, RNs had to prone patients on their own, leading to back, wrist, and elbow injuries.

I'm so exhausted it's bordering on dangerous.

Visitor restrictions caused considerable emotional stress and trauma. Patients were alone, and nurses wanted to do more to care for them but could not. Nurse to patient ratios were grossly inflated, while patient acuities spiked in tandem. Nurses felt it was impossible to do their jobs.

The pandemic was helpless nursing. We couldn't help the COVID patients.

I have seen more death in the past year than I did the 10 years before that in total.

Holding the phone for family members to say goodbye has taken its toll.

The nurses felt emotionally damaged and said they are suffering from anxiety as well as posttraumatic stress disorder (PTSD). They did not perceive hospital administration to offer mental/emotional support.

It's up to me as a nurse to take care of my own mental health.

Nurses are seeking support from hospital management

One of the reasons cited for low happiness and peaking stress before and during the pandemic was hospital culture and the perception of an unpleasant work environment. Perceived lack of support from hospital leadership and the effects of “hospital politics” motivated some nurses to switch to travel nursing. With short-term assignments, travel nurses enjoy avoiding corporate aspects of hospital employment dubbed “hospital politics.” Greater visibility of management figures and leaders who are perceived to advocate for nurses' well-being could increase nurses' perceived sense of happiness.

Hospital administration giving us pizza does not address emotional distress and PTSD.

Hospitals don't care about the emotional aspects, only the bottom line.

A profound yet unanticipated essence that emerged in our findings was a uniform sentiment vocalized by every participant during the interview process:

No one asked me, “Are you ok?”

Findings from this study provided fresh insight into nurses' perceptions, as well as factors influencing their career path decisions in a pandemic-ravaged practice environment. Our results suggest that pandemic work environments contributed to a change in nursing workforce distribution and exacerbated widening nurse shortage gaps. This knowledge beckons health care leaders to mind the gap forged by these circumstances. Like Brockopp and colleagues, 12 our researchers observed how the research interview process itself doubled as a comforting, therapeutic outlet, where nurses willingly engaged with the interviewer in that safe moment to release pent up thoughts and feelings. Here, the power of the one-on-one interpersonal exchange is exemplified. Nurses incorporate this mode of therapeutic communication with patients every day but now—“It's time for us to care for each other.” We listened as the voice of nurses expressed a sense of disruption that urged them to contemplate altering their career trajectories. By iteratively honing their clinical and professional skills over the course of travel assignments traversing a series of states and hospitals, veteran travel nurses constitute a cohort of highly experienced, clinically astute, adaptable, and resilient health professionals. Their expressed intent to leave the profession triggers a dire warning that an exodus of nursing experience and knowledge may be imminent. Now is the time to offer veteran travel nurses and seasoned permanent staff nurses appealing new roles to facilitate the transfer of this wealth of knowledge to early- and mid-career nurses.

The pandemic jolted the profession to its core, and like the rest of the world's stage there is no turning back. “Geriatric Millennials” (aged 36-45 years), who now account for the largest proportion of the US workforce (including nurses), are leading the charge in what is being called “the great resignation.” 15 Traditional recruitment and retention interventions such as financial “carrots,” float pools, etc, are not sufficient in this new environment. Nurses are thinking differently, intentionally, and more confidently about their career path options.

Nurse leaders are cognizant of the relationship between meaningful acknowledgment and nurses' intent to stay. 13 In a recent study of Korean working nurses, researchers found that press media channels of recognition (news posts, articles, documentaries) and national sources of encouragement yielded the highest scores representing intent to stay. 16 During the acute phase of the pandemic, waves of acknowledgment behavior were showcased in the United States and other countries (public applause from buildings and streets, banners, billboards, social media posts, full-page newspaper accolades, etc) but have since tapered off. Participants in our study perceived that recognition of their essential roles, the risks they take, sacrifices they make, and the direct impact of their work was temporary and fleeting.

One day you're a hero, the next you're a martyr. At first, we were very appreciated, now we are forgotten.

Finally, findings of this study revealed a simple but profound common denominator. Every participant perceived that during the height of the pandemic, no one asked them individually, “Are you ok?”

RECOMMENDATIONS

The findings of this study inspire a call to intervene with leadership behaviors aimed to assuage the negative effects of the prolonged public health crisis impacting nurses' physical, mental, and emotional well-being and by extension influencing their career decisions. Based on the findings of this study, the authors suggest 6 actionable approaches to facilitate healing and advance mental well-being across the nursing workforce.

On-demand mental health and well-being resources

Right now, nurses need support and resources to bolster their coping skills. One inclination may be to refer nurses to an employee assistance program, but with the surge in demand, it can take months to get an appointment with a provider. Digital on-demand coaching, therapy, and support programs are conveniently accessible from portable devices with no appointment wait-times. There are multiple resources, some for purchase and some that are budget neutral, all of which would require a cost-benefit analysis. Researchers in Quebec, Canada, observed that nurses who were well prepared to maintain better control during the pandemic were less likely to leave their jobs. 10 Compartmentalization, resilience, mental toughness, and agility mindset skills training for staff nurses and nurse leaders are worthy investments to bolster stability and preparedness for the long term.

Prioritize time off

In this study, nurses reported working extended hours ranging from 48 to 72 hours per week. When not working, nurses may still be on the call list to help supplement staffing during coverage gaps. This does not allow time for rest and recovery. Honoring scheduled time off includes removing nurses from the call list, thereby facilitating freedom to fully disconnect and recharge during that period if they choose to. Leaders can analyze workforce reports, including PTO (paid time off) accruals, payroll, staffing/scheduling data to identify which employees need to take a break, and then encourage and accommodate them to do so.

Well-being rounding

Purposeful rounding principles are characterized by deep, active listening, empathetic acknowledgment, and expressing authentic interest at an individual level. This best practice is therapeutically implemented by nursing staff and leaders to build trusting relationships with patients and improve quality outcomes. 17 , 18 These principles can also be adopted by facility leaders in the form of purposeful positive working rounds to promote nurses' well-being. 19

Seek to understand each employee's current happiness and stress levels

New travel nurses self-rated the lowest happiness levels and highest stress levels prior to the pandemic and acted on the opportunity to embark on travel nursing during the pandemic. Here, we realize the importance of monitoring nurses' happiness and stress levels as one barometer of intent to leave—whether to work as a permanent nurse at another hospital, switch to travel nursing, or leave the profession altogether. Surveys and rounding can be used to collect data for a quantitative pulse check, facilitating timely stay interventions. Periodic one-on-one or group discussions can be effective to identify root causes of unhappiness and stress and to develop a restorative plan. Nurse leaders typically juggle a continuous flow of competing priorities, limiting their capacity to devote this important time and attention to their teams. Hence, some health systems choose to capitalize on the role of the nurse retentionist to focus exclusively on these matters. 20

Connect the work to the why

Nurses in all groups affirmed that they entered the profession to make a difference in people's lives.

Helping people is why I became a nurse, to comfort them, make them less scared and put a smile on their face.

Many nurses became disenchanted and demotivated during the pandemic. Despite toiling relentlessly, they felt they were unable to make a positive impact. Sharing timely, positive patient feedback reassures nurses that they are indeed making a difference in people's lives. Digital apps exist to promote real-time patient engagement and to channel timely positive feedback from patients directly to nurses and their managers. Paper surveys and particularly handwritten recognition cards are also effective. A steady flow of recognition and just-in-time positive feedback can help nurses reconnect to why they became nurses.

The simple but powerful question, “Are you ok?” can foster a dialogue that shows the empathetic and caring side of leaders while providing nurses with an opportunity to share their experiences and talk about how they are feeling. Leaders who open this dialogue, listen actively, and respond compassionately can be better positioned to foster healing and well-being of their teams and to rekindle the motivation and engagement that energize nurses to reconnect to why they love what they do.

Findings from this qualitative study contribute to a growing body of knowledge toward understanding how the pandemic impacted nurses and what that means in terms of astutely managing nurse staffing resources in the “new normal” practice environment. Our key findings resonate with other similar studies 1 – 5 and emphasize the need to ensure nurses (i) perceive that their individual and collective well-being is authentically cared about, and (ii) receive a steady flow of support, encouragement, and timely acknowledgment from multiple levels of leadership, across various channels. Absence of timely and sustained attention to these needs poses a serious threat to the integrity of an already compromised nursing workforce. The current health care environment warrants a deeper dive to discover meaningful and practical advancements that can facilitate respect, healing, and restoration toward a proud, capable, committed, and motivated nursing workforce. Patients and communities are counting on us to mind the gap.

The authors acknowledge the nurses who so generously volunteered their time to participate in this study. Thank you for the steady stream of contributions you make every day and night in your clinical practice to keep patients safe across our nation.

Conflicts of Interest: None to declare.

Travel Nurse Pay Triples Amid COVID-19 and Hospitals Use These 6 Extreme Hiring Tactics

From paying travel nurses over $10,000 per week to pooling nursing students to begging retired RNs and army medics to come back to work  - here’s how hospitals and employment agencies are trying to stay staffed through the COVID-19 pandemic.

As COVID-19 cases in the U.S. have surpassed the 10,000 mark , healthcare facilities are working overtime to try to keep nurses on staff to care for the influx of patients who need care. 

The challenges in staying staffed are numerous--not only are healthcare facilities being overwhelmed by the sheer number of patients who are coming in droves to be tested (with often very limited test kits, leading to long waits and crowds), but the number of patients with severe complications is increasing. As staff are exposed to more infected patients and have less access to PPE to keep them safe, their own risk of infection increases too. And, if a nurse becomes infected--or shows COVID-19 symptoms and is unable to get tested (again, because of a lack of testing kits)--they will have to self-quarantine, further reducing the staff pool. 

All of those staffing challenges have led to hospitals and healthcare facilities around the country falling into almost desperate measures to recruit nurses. 

6 Drastic Ways Nurses Are Being Recruited for COVID-19

Here are just some of the ways that hospitals and healthcare staffing agencies are doing their part to keep nurses on the front lines in the wake of COVID-19: 

1. States are waiving individual state nurse licensure requirements

In states that have declared a state of emergency, there may be exceptions to licensure requirements . This means that it can be easier to bring in travel nurses, or out-of-state nurses who have licensures only in their home state, to allow them to work in an affected area. Some states are also issuing temporary licenses to allow for faster staffing, and many hospitals are waiving certain requirements, like BSN stipulations, for crisis staffing. 

• New York has recently become the epicenter of the COVID-19 outbreak and the state is waiving the state nurse licensing requirements . Anyone with a valid RN license from any state is currently eligible to work in the state. In fact, the state needs to hire over 200 travel nurses fast. If you're able to help, go here to apply! 

2. Retired and non-working RNs are being asked to come back to work

Some areas of the country, such as Westchester County in New York , are begging anyone who has a Registered Nursing license to come work in this time of emergency. That includes all retired RNs and nurses who haven’t worked in a while.

Even outside of direct COVID-19 care at the critical care level, nurses can be employed at other necessary posts, such as nursing home facilities, childcare facilities, and community health programs. 

3. Staffing agencies are paying travel nurses up to $6,000 per week + quarantine pay

Fastaff, a Denver-based nursing staffing agency, told the Denver Business Journal they are getting requests for hundreds of nurses at a time--when they normally only employ 1,000 nationwide at a time. 

• While some agencies are offering travel nursing positions with crisis pay, many travel RN positions right now with Faststaff are reaching $4K/week, plus potential bonus, sign-on, and quarantine pay. 
• Even higher pay can be found advertised in this Facebook group by various staffing agencies - as you’ll see, night shift ICU assignments in New York are paying over $6,000 per week right now. 
• NuWest Healthcare hired hundreds of travel nurses in 2 weeks to work in Washington State. They are now looking for help in some of the hardest-hit hospitals in New York City - travel, housing, and crisis pay is available. Go here to apply. 

4. The army asks retired nurses and medics to help in civilian hospitals 

In an email written by Lt. Gen. Thomas Seamands, deputy chief of staff for Human Resources Command, requested former service members that served in the medical field to return to active duty. The email specifically asked for help from those who formerly served in the following roles, 

• Critical Care Officer (60F)
• Anesthesiologist (60N)
• Nurse Anesthetist (66F)
• Critical Care Nurse (66S)
• Nurse Practitioner (66P), ER Nurse (66T)
• Respiratory Specialist (68V)
• Medic (68W)

5. Arkansas Proposes $55 million in nurse pay raises

Governor, Asa Hutchinson, announced a $116M plan for hospitals to help with combating COVID-19. Within the plan, he outlined significant pay raises for nurses - $1,000 additional per month for all nurses in Arkansas and $2,000 per month for nurses who work in facilities with COVID-19 patients. 

6. Student nursing programs policies are being changed

The Nursing and Midwifery Council in the UK  is proposing to update its student nurse clinical requirements to allow for student nurses to be permitted to fulfill their clinical requirements while serving as emergency helpers in COVID-19, with “specific conditions of practice to ensure appropriate safeguards are in place.”

And while student nurses in the U.S. have mostly been barred from getting on the ground level through their clinical placements, many student nurses are still employed at healthcare facilities in different capacities, such as techs, clerks, CNAs, and in other roles.  

What the Future Will Hold for Nursing After COVID-19

Clearly, this pandemic has demonstrated that the U.S. healthcare system is in drastic need of some significant improvements. No one truly knows what a post-COVID-19 future will hold, from the economical effects to how it will change the country’s preparation for future viral threats. 

What is for certain, however, is that healthcare will be more important than ever, and if you’re looking for recession-proof employment, nursing will definitely offer you security, stability, and the opportunity to make a difference. Especially for all the people who will remember the pandemic and helpless feeling of living through this pandemic, this could really be the call you’ve been waiting for to go to school for nursing. 

It’s probable that this pandemic will lead to embracing more technology in healthcare, from making nursing school online more accessible for remote learners, but also bringing more opportunities in telehealth available as well. Doctors are already predicting that this pandemic will cause more patients in the future to embrace seeing a doctor online, to prevent future exposures. 

Either way, the point is, if you’ve ever thought about becoming a nurse, chances are, there will be plenty of opportunities to get involved in healthcare in the coming months and years.

There's no time like the present to get started on a nursing career - in fact, most schools offer online programs. 

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Travel nurses took high-paying jobs during Covid. But then their pay was slashed, sometimes in half.

In early 2022, Jordyn Bashford thought things were as good as they could be for a nurse amid the Covid pandemic.

A few months earlier, she had signed an agreement with a travel nurse agency called Aya Healthcare and left Canada to work at a hospital in Vancouver, Washington.

Before the end of her first shift at PeaceHealth Southwest Medical Center, she said she realized other travel nurses there were earning even more than she was and asked for more money. Aya quickly amended her agreement and raised her hourly pay from $57 to $96. 

In January, her rate increased again to $105 as part of a new agreement. She thought that the high pay — and a generous living stipend of nearly $1,300 per month — meant she and her fiancé could finally make plans to buy a house. 

But two months later, when her assignment was renewed, Aya slashed her hourly pay back down to $56, and then cut it still more to $43.80 — less than her initial rate.

“I do know that travel nursing is fluid, and you can lose your job at any time, but I wasn’t expecting [my hourly pay] to fall 50%,” Bashford said.

The boom in travel nursing during Covid exposed a practice that has existed since the industry’s birth 50 years ago, according to experts. Nurses attracted by talk of high wages found themselves far from home with their salaries slashed at renewal time, and only then grasped the wiggle room in their signed contracts, which were really “at-will” work agreements. But the sheer number of nurses working travel jobs, and the difference between what they thought was promised and what they pocketed, has led to a substantial legal pushback by travel nurses around the country on the issue. 

This summer, Stueve Siegel Hanson, a Kansas City, Missouri, law firm, filed class-action lawsuits against four travel nurse agencies: Aya, Maxim, NuWest and Cross Country. As of Dec. 27, all were still pending. Austin Moore, the lead attorney, said the suits allege the companies pulled a “bait-and-switch,” offering nurses agreements at high rates and then slashing their pay after they’ve signed. Many of the alleged incidents occurred in March and April when, as NBC News has previously reported, the demand for travel nurses, which soared during the pandemic, began to drop.

“To go take a travel assignment is a really big deal, and to get there to have the rug pulled out from under you, for someone to collapse your pay, I just think it’s unconscionable,” Moore said. “They’re on the hook for a lease, and they’re scrambling trying to find another job, and it’s a really terrible set of circumstances.”

Maxim, Cross Country and NuWest said they could not comment on pending litigation.

In a statement, Aya said allegations of bait-and-switch “are demonstrably false. ”

“ Travel nurse companies contract with hospitals to provide temporary staffing to help them support their communities. Nurses are the heart of healthcare and we value the nurses who work for Aya, and go above and beyond to ensure they have an exceptional experience with us.”

“As is evidenced by Ms. Bashford’s employment with Aya," the statement said, "nurses also received mid-assignment pay increases at various times during the pandemic. Further, we understand when the government reduced subsidies to hospitals following the height of the pandemic, they in turn reduced pay to travel nurses.” 

$5,000 per week

Even in the industry’s earliest days, the 1970s, nurses could find themselves earning less than they expected. Advertisements touted an hourly rate of $8 to $11, but many nurses wound up making less than $6, according to Pan Travelers, a professional association of travel nurses.

Back then, there were no written agreements for the travel nurses, according to Pan Travelers. That began to change in the mid-1980s. At the same time, the number of agencies multiplied, fed by the hefty commissions that hospitals paid them.

Travel nursing became even more prevalent during Covid. Prior to the pandemic, there had already been a growing shortage of nurses nationwide, and the virus made the shortage worse. Agencies started offering nurses work agreements and renewals that extended far beyond the typical 13 weeks, according to six nurses who spoke to NBC News.

In January 2020, right before the pandemic, there were about 50,000 travel nurses nationwide, or about 1.5% of the nation’s registered nurses, according to Staffing Industry Analysts (SIA), an industry research firm. That number doubled to at least 100,000 as Covid spread, but according to SIA, the actual number at the peak of the pandemic may have been much higher. 

When the pandemic was at its worst, some travel nurses were earning $5,000 or more weekly,  as NBC News previously reported .

Erin Detzel never earned that much. But in November 2021, at $78 per hour, she said the money was enough to get her to move with her husband and two kids to Florida for her first-ever travel assignment.

Detzel’s 4-month-old daughter had respiratory distress syndrome and had also been hospitalized with respiratory syncytial virus, or RSV. That Detzel’s mother-in-law was in Florida was another inducement to move.

“We needed help,” Detzel said. “I didn’t want to put my baby in day care, so that’s kind of why we did this. My mother-in-law’s the only family member that could watch them.”

Detzel rented a house. But by February, after her first 13-week contract, Covid hospitalizations had waned and the demand for travel nurses had fallen. Her hourly pay was decreased to $62. Then it dropped again, to $32.50.

Travel nurses are typically hired by recruiters via phone calls or posts on social media and in online forums, and according to the 11 nurses NBC News spoke to around the country, the recruiters often use words like “contract.” All but one said it’s the norm for the recruiter to name a price.

Bashford said she found her recruiter through an online travel nursing forum. She said she sought out Aya’s job postings, with advertised payment amounts, on its website after a recruiter started corresponding with her.

Detzel said she agreed to go on an initial 13-week assignment from AB Staffing, an agency that is not named in the lawsuits, after a recruiter cold-called her and told her what she’d be making.

In a sample of four recruiting posts in a nursing Facebook group from 2022 from three of the agencies that are being sued, two from Maxim and Cross Country used the word contract, while two from Maxim and NuWest didn’t. The posts gave specific terms for how long the nurses were needed, as well as pay, hours, and room-and-board stipend. The two that mentioned contracts, however, used that word generally or in connection with the duration of the job, not the rate of pay. There were no Aya recruiting posts in the forum in the timespan sampled.

In the travel nurse industry, hospitals have the leverage to push the agencies for pay cuts when their demand dips, said Robert Longyear, vice president of digital health and innovation at Wanderly, a health care technology firm for staffing.

Hospitals and agencies have written agreements that allow for fluctuation, Longyear said. On top of the nurse’s agreed salary, the hospitals are also paying the agencies commissions that can reach  40% , according to a spokesperson for the  American Health Care Association , which represents long-term care providers.

Given the costs, when there are fewer patients, or less demand, hospitals will go back to travel agencies and tell them they’re exercising their option to decrease nurses’ pay, and then agencies will tell the nurses their pay has been reduced. 

The recruiters were the first to deliver the news about pay cuts to Bashford and Detzel. 

Bashford said she got the news about her second cut the same way. “I received a text from my recruiter saying, you know, your rate got decreased even lower,” she recalled.

If a nurse balks, Longyear said, “The agency can say, ‘Hey, look, I’m going to cancel this job. If you want to keep working, this is the new rate.’”  

He said this is a long-established practice, but that the pay cuts are just more noticeable now that travel nurses are promised more and paid more. And he said that because so many nurses are pursuing more lucrative assignments, it might be more common for agencies to start someone off high and then slash their pay mid-assignment.

When a travel nurse takes a job, the contract the nurse signs is an “at-will” work agreement.

NBC News reviewed Detzel’s AB Staffing work agreement, Aya agreements for three nurses, including Bashford’s, as well as versions of Cross Country and NuWest work agreements and the August 2021 Cross Country terms and conditions handbook. All mention the adjustable nature of work conditions. Cross Country and Aya explicitly mention “at-will” employment, which means an employer may terminate, and an employee may leave, a position at any time. The NuWest agreement explains the employee can be terminated at any time without saying “at-will.”

Bashford received emails saying, “Congratulations! Your contract was extended” from her recruiter each time she was approved for another 13 weeks, but she also had to sign new agreements with changed rates, including the cut to $43.80.

Moore, who is representing the nurses, said, “I doubt a nurse has ever successfully negotiated [the at-will provisions of] one of these contracts. They are form agreements and the agencies don’t change their terms.”

Richard Brooks, a visiting professor at Yale Law School, said some courts might view a company presenting the option ​between a sudden pay decrease or termination as within the realm of legality ​for at-will employment, depending on state contract laws. 

Brooks and other legal experts said the nurses still have some avenues of redress to pursue, however.

Sachin Pandya, a law professor at University of Connecticut School of Law, said that an at-will clause affects “the probability that the employer can change terms and conditions without violating state contract law.” He said the clause might not matter for legal claims that, by their change in pay, the employer violated some other source of law like fraud or wage-and-hour statutes. 

Avery Katz, a professor at Columbia Law School, adds that the language in a contract “is not the end of the story.”

“Even if there’s a contract, even if the contract says I have no right to recover, you made me these promises,” Katz said. “And then I relied on them by picking up and moving to another state and renting an apartment.”

Aya said that Bashford’s experience shows that nurses are able to negotiate the terms of their employment, and that “the harmful gist of [Bashford’s] accusations — that the company greatly lowered her pay below what she reasonably expected from the outset — is simply not true.” 

‘You can’t afford to lose me’

Jordyn Bashford and Erin Detzel are both former travel nurses now.

Detzel moved her family back to Ohio. She said the hospital and travel agency treated her like the equipment in hospital stockrooms. “It’s almost like I was a supply,” she said.

AB Staffing did not respond to a request for comment.

Bashford, now a staff nurse at a different hospital in Washington, recalls bonding with her teammates during the most challenging days of the pandemic, but also the long hours and how she was effectively training newcomers on the job. With six years of nursing experience, two of them in the ICU, she said she was one of the most experienced nurses on her floor some days, which she found shocking. 

But what most bothered her, like Detzel, was being made to feel disposable.

“The part that really just blew me away was like, ‘You can’t afford to lose me,’” Bashford said, referring to the ongoing national shortage of nurses. “That just felt very, very true. And somehow they thought that they could just dispose of us, and I don’t understand.”

Jean Lee is an associate reporter with NBC News’ Social Newsgathering team in Los Angeles. She previously reported for the NBC News consumer investigative unit.

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15 men brought to military enlistment office after mass brawl in Moscow Oblast

Local security forces brought 15 men to a military enlistment office after a mass brawl at a warehouse of the Russian Wildberries company in Elektrostal, Moscow Oblast on Feb. 8, Russian Telegram channel Shot reported .

29 people were also taken to police stations. Among the arrested were citizens of Kyrgyzstan.

A mass brawl involving over 100 employees and security personnel broke out at the Wildberries warehouse in Elektrostal on Dec. 8.

Read also: Moscow recruits ‘construction brigades’ from Russian students, Ukraine says

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Read the original article on The New Voice of Ukraine

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Double-blind, Placebo-controlled, Randomized Study of the Tolerability, Safety and Immunogenicity of an Inactivated Whole Virion Concentrated Purified Vaccine (CoviVac) Against Covid-19 of Children at the Age of 12-17 Years Inclusive"

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Recruitment of volunteers will be competitive. A maximum of 450 children aged 12 to 17 years inclusive will be screened in the study, of which it is planned to include and randomize 300 children who meet the criteria for inclusion in the study and do not have non-inclusion criteria, data on which will be used for subsequent safety and immunogenicity analysis.

Group 1 - 150 volunteers who will be vaccinated with the Nobivac vaccine twice with an interval of 21 days intramuscularly.

Group 2 - 150 volunteers who will receive a placebo twice with an interval of 21 days intramuscularly.

In case of withdrawal of volunteers from the study, their replacement is not provided.

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• from 12 to 17 years inclusive (12 years 0 months 0 days - 17 years 11 months 30 days).

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• For girls with a history of mensis - a negative pregnancy test and consent to adhere to adequate methods of contraception (use of contraceptives within a month after the second vaccination). Girls should use methods of contraception with a reliability of more than 90% (cervical caps with spermicide, diaphragms with spermicide, condoms, intrauterine spirals).
• For young men capable of conception - consent to adhere to adequate methods of contraception (use of contraceptives within a month after the second vaccination). Young men and their sexual partners should use methods of contraception with a reliability of more than 90% (cervical caps with spermicide, diaphragms with spermicide, condoms, intrauterine spirals).

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Claudia Looi

Touring the Top 10 Moscow Metro Stations

By Claudia Looi 2 Comments

Komsomolskaya metro station looks like a museum. It has vaulted ceilings and baroque decor.

Hidden underground, in the heart of Moscow, are historical and architectural treasures of Russia. These are Soviet-era creations – the metro stations of Moscow.

Our guide Maria introduced these elaborate metro stations as “the palaces for the people.” Built between 1937 and 1955, each station holds its own history and stories. Stalin had the idea of building beautiful underground spaces that the masses could enjoy. They would look like museums, art centers, concert halls, palaces and churches. Each would have a different theme. None would be alike.

The two-hour private tour was with a former Intourist tour guide named Maria. Maria lived in Moscow all her life and through the communist era of 60s to 90s. She has been a tour guide for more than 30 years. Being in her 60s, she moved rather quickly for her age. We traveled and crammed with Maria and other Muscovites on the metro to visit 10 different metro stations.

Arrow showing the direction of metro line 1 and 2

Moscow subways are very clean

To Maria, every street, metro and building told a story. I couldn’t keep up with her stories. I don’t remember most of what she said because I was just thrilled being in Moscow.   Added to that, she spilled out so many Russian words and names, which to one who can’t read Cyrillic, sounded so foreign and could be easily forgotten.

The metro tour was the first part of our all day tour of Moscow with Maria. Here are the stations we visited:

1. Komsomolskaya Metro Station  is the most beautiful of them all. Painted yellow and decorated with chandeliers, gold leaves and semi precious stones, the station looks like a stately museum. And possibly decorated like a palace. I saw Komsomolskaya first, before the rest of the stations upon arrival in Moscow by train from St. Petersburg.

2. Revolution Square Metro Station (Ploshchad Revolyutsii) has marble arches and 72 bronze sculptures designed by Alexey Dushkin. The marble arches are flanked by the bronze sculptures. If you look closely you will see passersby touching the bronze dog's nose. Legend has it that good luck comes to those who touch the dog's nose.

Touch the dog's nose for good luck. At the Revolution Square station

Revolution Square Metro Station

3. Arbatskaya Metro Station served as a shelter during the Soviet-era. It is one of the largest and the deepest metro stations in Moscow.

Arbatskaya Metro Station

4. Biblioteka Imeni Lenina Metro Station was built in 1935 and named after the Russian State Library. It is located near the library and has a big mosaic portrait of Lenin and yellow ceramic tiles on the track walls.

Lenin's portrait at the Biblioteka Imeni Lenina Metro Station

5. Kievskaya Metro Station was one of the first to be completed in Moscow. Named after the capital city of Ukraine by Kiev-born, Nikita Khruschev, Stalin's successor.

Kievskaya Metro Station

6. Novoslobodskaya Metro Station  was built in 1952. It has 32 stained glass murals with brass borders.

Novoslobodskaya metro station

7. Kurskaya Metro Station was one of the first few to be built in Moscow in 1938. It has ceiling panels and artwork showing Soviet leadership, Soviet lifestyle and political power. It has a dome with patriotic slogans decorated with red stars representing the Soviet's World War II Hall of Fame. Kurskaya Metro Station is a must-visit station in Moscow.

Ceiling panel and artworks at Kurskaya Metro Station

8. Mayakovskaya Metro Station built in 1938. It was named after Russian poet Vladmir Mayakovsky. This is one of the most beautiful metro stations in the world with 34 mosaics painted by Alexander Deyneka.

Mayakovskaya station

One of the over 30 ceiling mosaics in Mayakovskaya metro station

9. Belorusskaya Metro Station is named after the people of Belarus. In the picture below, there are statues of 3 members of the Partisan Resistance in Belarus during World War II. The statues were sculpted by Sergei Orlov, S. Rabinovich and I. Slonim.

10. Teatralnaya Metro Station (Theatre Metro Station) is located near the Bolshoi Theatre.

Teatralnaya Metro Station decorated with porcelain figures .

Taking the metro's escalator at the end of the tour with Maria the tour guide.

Have you visited the Moscow Metro? Leave your comment below.

January 15, 2017 at 8:17 am

An excellent read! Thanks for much for sharing the Russian metro system with us. We're heading to Moscow in April and exploring the metro stations were on our list and after reading your post, I'm even more excited to go visit them. Thanks again 🙂

December 6, 2017 at 10:45 pm

Hi, do you remember which tour company you contacted for this tour?

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VP Harris to unveil nursing home rules in battleground state of Wisconsin

By Andrea Shalal

WASHINGTON (Reuters) - U.S. Vice President Kamala Harris will travel to the political battleground state of Wisconsin on Monday to announce two final rules aimed at improving access to long-term care and ensuring the quality of care-giving jobs, a White House official said.

The White House said Monday's announcements finalized two rules first announced in September as part of U.S. President Joe Biden's pledge to crack down on nursing homes that endanger resident safety, and to improve access to high-quality care.

Harris will announce the rules in a meeting with nursing home care workers in La Crosse, Wisconsin, marking her third trip to the state this year and her seventh since taking office.

Biden visited Wisconsin last month after clinching the Democratic Party's nomination as he focused on securing votes among suburban women, Black voters and Latinos across the Midwest ahead of the November presidential election.

A new Reuters/Ipsos poll released earlier this month showed Biden leading his Republican rival former president Donald Trump by 4 percentage points, up 1 percentage point from March.

Wisconsin and Michigan are part of the "blue wall," along with Pennsylvania, that Biden will need to hold to secure a second term. In 2016, Trump flipped all three to win the White House, but Biden took them back four years ago.

One of the rules would set federal minimum staffing levels for nursing homes, addressing longtime complaints about abuse and neglect in the industry that were highlighted during the COVID-19 pandemic.

It requires all nursing homes that receive federal funding through Medicare and Medicaid to have 3.48 hours per resident per day of total staffing. That means a facility with 100 residents would need at least two or three RNs and at least 10 or 11 nurse aides as well as two additional nurse staff to meet the minimum staffing standards, the White House said.

The second final rule will help improve access to home care services for the 7 million seniors and people with disabilities who rely on these serves, while improve the quality of care-giving jobs, many held by women of color, the White House.

It will ensure adequate compensation for home care workers by requiring that at least 80% of Medicaid payments for home care services go to workers’ wages.

States will also be required to be more transparent in how much they pay for home care services and how they set those rates, and set up advisory panel including beneficiaries, home care workers and other key stakeholders.

(Reporting by Andrea Shalal; Editing by Michael Perry)