How 2 CNOs are tempering staff resentment toward travel workers

For hospitals facing COVID-19 surges and staffing strain, travel workers have been a much relied upon resource to help fill workforce gaps, creating an environment in which these organizations must compete for nurses in the labor market with agencies that offer lucrative, temporary contracts amid increased demand.

Aya Healthcare, a healthcare staffing company, told Becker's the company is experiencing an increase in demand from all over the country, with more than 58,000 open jobs, driven by various factors including the pandemic, an increase in permanent vacancies across hospitals nationwide, burnout and overall higher census.

Vivian Health, a marketplace for healthcare hiring, reported the same trend. In September, Vivian Health saw all-time highs for demand for travel nurses — 68 percent higher demand than September 2020. The marketplace also saw all-time high average pay for travel nurse contracts, at $3,110 per week (a 39.4 percent increase compared to September 2020).

Here, Marissa Jamarik, DNP, RN, vice president and system CNO of Charleston, S.C.-based Roper St. Francis Healthcare, and Elizabeth Guffey, RN, CNO of Scotland County Hospital in Memphis, Mo., discuss the benefits travel workers bring to their organizations, as well as how they've worked to address any feelings of resentment from their hospital staff about the lucrative pay travel workers are offered.

Benefits of travel workers

At Roper St. Francis, a system with four flagship hospitals and about 6,000 employees, there are about 300 travel workers, including nurses and respiratory therapists. Scotland County Hospital, a critical access hospital with about 150 employees, has had three or four travel nurses at the facility at any given time during the pandemic.

While Roper St. Francis and Scotland County Hospital are different sizes and have different circumstances, the CNOs of both organizations acknowledged the benefits of their travel workers.

Dr. Jamarik said Roper St. Francis goes to its own staff first to fill staffing gaps and has had different strategies for bonus pay for its staff. However, "that only goes so far because they get tired. It's exhausting for them. And frankly the volume of patients far exceeded the number of staff that we had. So, the travelers that were brought in for COVID were welcomed to help alleviate that."

She added, "the staff were saying we needed to be back at a safe staffing level. We needed to get patients out of our emergency room. From that sense, they were a huge relief."

Now that the emergency department volume has stabilized at Roper, the system also is encouraging staff to take some time off.

"We have the travelers here, and if that means one staff member can have a day off, then we're encouraging it because their well-being and their ability to deal with all the trauma from taking care of those sick patients over a long period of time, we want them to recover and be well. So, travelers also serve that purpose," Dr. Jamarik said.

Additionally, from the clinical side, Dr. Jamarik said travelers also bring with them knowledge of processes used at hospitals in other states or areas they've worked in, which they can share with Roper or whatever organization they're at.

Ms. Guffey, with Scotland County Hospital, expressed similar sentiments, noting that bringing in travel workers can be "a double-edged sword."

"If you don't hire the travel nurses or the agency nurses then you have open slots and you're not fully staffed, and your permanent nurses have to do way more or pick up extra shifts. Having that additional individual there who is also a nurse can help ease the load from your regular permanent staff," she said. "The flipside is your regular staff knows the traveling nurses are getting paid so much more because as an RN we're getting offers every day that are double and triple what we make at our permanent facility. That's well-known. I think there are pluses and minuses to both, and I think most nurses realize that."

Easing resentment among existing staff

Amid the benefits to bringing in travel workers, both CNOs also acknowledged the need to address the needs and concerns of their existing staff.

One approach Dr. Jamarik recommended is being transparent about the organization's staffing plans.

"It's undeniable to say that COVID has taken a toll on the healthcare industry overall, all the things they say about people leaving from burnout to retiring early, those things are all true. That is happening. And where we find ourselves is a space where we have more vacancy than we normally would across the country and a struggle to bring people in fast enough," Dr. Jamarik said.

"At the end of the day, what my workforce here needs to know is that I have a plan that includes how we are going to retain the nurses we have, but also to attract, recruit and hire additional nurses to get us in a space where we aren't so reliant on travelers. I think that has to be visible, communicated, and people need to see progress in that within your workforce."

Roper St. Francis has other practices to mitigate resentment among staff as well.

The system will not bring in a travel worker who lives within a certain radius of the system to prevent Roper St. Francis staff from working beside their next-door neighbor, who might be doing the same job but making more money.

Also, if a worker leaves Roper St. Francis to go travel (after being employed with the system for a certain amount of time), the system will not bring them back as travel worker.

"There's a threshold," Dr. Jamarik explained. "We don't accept contracts for people who have been employed with us for at least a year. That's another fundamental principle that's really important to our team members and I think has gone a long way to mitigate bad feelings for our team."

At Scotland County Hospital, Ms. Guffey said travel nurses are treated like regular staff regarding their assignments and responsibilities, which can help in terms of the morale of existing staff. 

"I think for the most part, we've been very lucky with the agency staff we've hired. They've gotten along very well with the rest of our staff and made things easier. I think our regular staff has also realized without those agency staff our lives would be worse because we would have to turn away patients potentially," she said.

Additionally, the hospital raised permanent nursing staff salary to try to compete with the amount travel nurses are making. The pay bump took effect in September and was based on salary comparison data for Missouri hospitals from the Missouri Hospital Association. Staff nurse pay was brought well above the average for the association comparison, according to Ms. Guffey.

"It's nowhere near what you would make as an agency nurse, but we did try to increase our nurses more to show them we realize the tremendous stress everyone's in and the tremendous amount of work everyone's being asked to do," she said.

Another effort Scotland County Hospital made to ease any resentment among hospital staff was to involve front-line staff in the decision about whether to use agency nurses.

"We had a discussion with all the nurses about whether we should offer double time to current staff and have them picking up extra shifts, with expectation they would pick them up to fill gaps," Ms. Guffey explained. "We were able to make that decision [to bring in travel nurses] as a group. I also think it helped that they had ownership in that decision from a morale standpoint."

Overall, though, Dr. Jamarik noted that organizations don't typically make a higher number of travelers a part of their long-term staffing plan. Therefore, she encouraged healthcare leaders to provide an atmosphere where staff members, including nurses, can grow both professionally and personally and want to stay.


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