Traci Jones has worked as a registered nurse for 28 years, 18 of them in Moab—first at the old Allen Memorial Hospital and now at Moab Regional Hospital.
“I have seen such a change in the nursing profession over the past few years,” Jones said. Several factors, notably the COVID pandemic, have shifted the landscape of the healthcare industry and the nursing profession, resulting in a nationwide shortage of nurses.
Moab Regional Hospital is feeling that shortage. It currently has 44 registered nurses on staff, and over 140 other clinical employees with other kinds of nursing qualifications or other technical skills. There are 22 open positions listed on the hospital’s employment page, 16 of them clinical, and eight of them nursing positions.
“We have been working short staffed for quite some time,” Jones said, though she added that the hiring of several recent graduates from the Utah State University-Moab nursing program has made things easier.
Covid and other factors
“The pandemic was the catalyst for some healthcare providers and nurses to take early retirement or leave healthcare altogether,” said Kari McKay, human resources director at MRH. That left the hospital short-staffed, and remaining nurses started to get burned out as they took on additional duties and shifts to fill the gap. Burnout, in turn, prompts more nurses to leave the field. McKay said the shortage is also fueled by a lack of trained nurse educators, a growing aging population causing an increase in demand for healthcare, and nurses leaving permanent positions to pursue higher wages in travel positions.
“The shortage seems to be happening for multiple reasons,” agreed Annie Relph, nurse manager at MRH. “The number of people going into nursing does not meet the need of the aging population. This was a problem before people started leaving the profession.”
Molly Stack, who joined the hospital in January as a recruiter for the human resources department, added that it’s also been a challenge to fill other positions at the hospital. Part of that, she thinks, is because the pandemic changed the way people think about work and wages. Healthcare doesn’t lend itself to remote work; it’s a challenging and demanding field.
One significant way the market has responded to the demand for nurses is that travel nurse agencies have expanded—and raised their rates.
Travel nurses usually sign up through an agency to work at a hospital for a 13 or 26 week contract. The agency offers high wages—up to several times the hourly wage of permanent nurses at some hospitals—and sometimes helps with housing and relocation. Nurses get a chance to experience different locations and facilities and can make good money; hospitals are able to fill gaps in staffing or adjust for seasonal fluctuations. Travel nurses may extend their contracts, but usually for no longer than a year.
Agencies also charge a fee for connecting nurses with hospitals, meaning the cost to the hospitals is even higher—they may pay over $150 an hour for a travel nurse, when they would otherwise pay much less for a permanent nurse in the same position. One trade-off is that travel nurses are not eligible for the medical and retirement benefits offered to permanent employees. MRH also offers some perks like tuition assistance for continuing education for some of its permanent employees.
Moab Regional Hospital has always used travel nurses, said Director of Marketing and Community Relations Christy Calvin, but never to the degree it is now—and it’s never been so expensive before. Along with registered nurses, the hospital also employs traveling contract professionals such as respiratory therapists and lab technicians.
Stack said the hospital right now has 15 travel nurses and other traveling clinical employees on staff.
Travel nurse agencies have made recruiting permanent staff more challenging. When Stack posts an MRH position on a job search site, she’ll see the same job pop up through a travel nurse agency with a much higher wage attached. The hospital can’t afford to pay those wages to permanent employees; job-seekers are drawn to the higher pay, especially if they’re unsure of where they want to make a permanent home and like the idea of a temporary position. The travel nursing business is drawing some permanent nurses away from hospitals in favor of higher-paying short-term gigs.
“We have had several of our seasoned nurses leave to travel,” Jones said.
“COVID really just drove up the price,” Stack said. “It’s aggravating because they’re using the very same ecosystems we’re using to advertise our positions. Applicants apply through the agencies instead of through our posting.”
Asked if the hospital could hire short-term nurses directly, without going through an agency and paying the fee, Stack said the hospital strongly prefers to cultivate a permanent employee who will adapt and grow with the needs of the hospital and who will become invested in the community they serve. MRH can’t pay travel nurse wages for permanent positions, but they can invest in a permanent employee through benefits and training.
In June, U.S. Senator Kevin Cramer (R-ND) introduced the Travel Nursing Agency Transparency Study Act, which would initiate a study on the travel nursing industry and its effects on the healthcare system. A press release on the bill from Cramer’s office says,
“Over the past few years, there have been anecdotal reports of hiring agencies inflating prices and monopolizing the nursing workforce, potentially leading to a number of concerning consequences for providers, patients, and taxpayers, including inflated prices for care, further nursing shortages, and continued strain on the entire health care system.”
The bill is supported by the American Hospital Association.
“Due to a decline in hospital employment and higher demand for care, especially during the delta and omicron surges, nearly all healthcare facilities have relied on travel nurse staffing agencies to address staffing shortages,” a letter from the AHA in support of the bill reads, citing dramatic statistics: hospitals have spent a median of almost 40% of their total nurse labor expenses on travel nurses in January 2022, as compared to under 5% in January 2019; hours worked by travel nurses rose from 4 percent to 23 percent of total nurse hours worked between 2019 and 2022.
“However, we are concerned that these staffing agencies have been exploiting workforce shortages by inflating prices to increase their own profit margins throughout the pandemic,” the letter continues, reporting that travel nurse agencies raised their rates by 213% between 2019 and 2022.
Healthcare industry experts say the trend is most apparent in rural areas, where recruiting and retaining healthcare professionals is already a challenge.
Amid the nursing shortage, elected officials and healthcare facilities have looked for ways to fill the gap. Governors across the country called in the National Guard in January to assist with healthcare.
Some states have issued temporary nursing licenses to allow nursing students to work while studying. Utah has created an emergency license that allows nurses licensed in other states to practice in Utah.
Locally, MRH partnered with Utah State University-Moab to hire work-study licensed practical nurses, who could work part-time while earning more advanced degrees.
“All obtained their RN license this summer and are working as full time RNs at the hospital,” said McKay. “We strive to provide work schedule flexibility and professional development opportunities.”
“It is a great situation as they already live here and do not need to find housing,” Jones agreed.
Hospital staff also try to assist with housing for prospective employees moving from elsewhere. McKay said the hospital owns five housing units and leases seven.
“This is a necessity for us to retain existing staff and to offer temporary housing for those moving into the area or working as a traveler,” she said.
“I do so much hands-on work trying to recruit people here and helping people find housing,” Stack said. “If I’m hiring people who aren’t invested in this community and this part of the world, it doesn’t do anything to enrich what we do here.”
When Stack started in January, one traveling emergency room nurse on staff was costing the hospital $165 an hour. Much of that rate goes to the travel nurse agency, rather than the nurse, though even after the agency has taken its cut, travel nurses are making more per hour than their permanent, full-time colleagues. Stack said depending on experience and skills, nurses might make between $30 and $40 per hour. MRH determines wages based on industry data.
Stack said the market has started to ease: when that emergency room travel nurse left, she reposted the position at $95 per hour, and received plenty of applications, she said.
In spite of the challenges, many MRH staff have a positive view of their workplace and the industry outlook. As Stack noted, rates for travel nurses are coming down, and many staff praised the hospital’s partnership with USU. Stack also pointed out that the travel nursing program is a necessary part of the healthcare landscape, and can even be a recruiting tool for permanent employees.
“Without a doubt, we’ve had some absolutely stellar people land with us through travel agencies,” she said. Many traveling nurses are impressed with the environment and the opportunities at Moab Regional Hospital, compared to bigger, busier facilities where they feel disconnected. Some also fall in love with Moab’s natural beauty and with the community. Some decide to stay.
“There are quite a few folks who’ve said, ‘Moab is the place where we want to be,’” Stack said, and they apply for permanent positions that have lower wages, but full-time benefits and the assurance of steady work that anchors them in a community they love.
Stack also said that while some career nurses decided to retire during or after the worst of the pandemic, other people were inspired to join the healthcare industry.
“Any person’s burden could be someone else’s opportunity,” Stack said.
Jones added that even in the face of extra shifts and longer hours, MRH staff are dedicated to their work. “Our facility provides very conscientious, attentive care,” she said. “When we are short staffed, we just run faster. We are a great team here and everyone pitches in to make sure the patients are well cared for. We genuinely care about our neighbors and our visitors and take pride in the work we do.”