3 health systems making a bet on internal travel programs

Amid the COVID-19 pandemic, U.S. hospitals and health systems have been tasked with addressing exacerbated clinician shortages. Many organizations turned to third-party staffing agencies and travelers to fill workforce gaps. Now some health systems are addressing their need for skilled clinicians through internal travel programs. 

Health systems with internal travel programs said they view the initiatives as an effective strategy and an opportunity to tackle staffing issues in house rather than through an outside agency.

"We need to make sure we have staffing available now, not just for COVID and ICU units but across the spectrum," E.J. Kuiper, CEO of Omaha, Neb.-based CHI Health, told Becker's in February. "Building out an internal [staffing program] makes sense on a number of different levels."

Here, Becker's dives deeper into the trend, including how internal travel programs are progressing and the details involved.  

Christus Health 

At Irving, Texas-based Christus Health, discussions about an internal travel program had been ongoing for years but came to the forefront during the pandemic. Texas used federal money during the pandemic to pay temporary healthcare workers. 

Christus saw an opportunity once the state began demobilizing temporary workers, according to Debi Pasley, MSN, RN, senior vice president and chief nurse executive for the Catholic, nonprofit organization, which has about 45,000 employees internationally.

"They had been provided to us for a period of time … and we said, 'Why would we want them to get away, especially those who seem consistent with our mission?'" Ms. Pasley said.  

Christus offered the program to temporary nurses who were slated to leave the health system, especially those in South Texas. Initially, about 96 nurses accepted the offer to stay with Christus, where they had been placed by the state. Of those 96 workers, some have left the program because they no longer want to travel, but others joined the program later, Ms. Pasley said. Christus anticipated that the total number of nurses and other workers, such as respiratory therapists, in its program will soon exceed 100.

"We're about to go over 100 in the number of people, and these are largely people who live close to some of our ministries," Ms. Pasley said. "So we believe we'll be able to maintain them over a longer period of time." 

Workers in the Christus program typically take 12-week assignments, though the assignments can be modified based on the needs of travel nurses and facilities. The health system pays the workers' travel fees, and those in the program have access to Christus benefits.   

Workers in the Christus program are paid an amount similar to what a person traveling for an external agency would receive, Ms. Pasley said.

"For the nurse, they don't get an advantage for going with an external agency, especially if they're already oriented and working with us," she said. "Our goal is to make the nurse whole. If they're willing to travel and be away from home, we want to make them whole if they do it for us versus for an external agency."

The pandemic has highlighted the gap between full-time workers' pay and lucrative temporary contracts. 

During the pandemic, hospitals and health systems have offered bonuses, increased wages and made other investments in employee retention for their staff workers. Still, the compensation gap between hospital-employed nurses and travel or agency nurses has continued.

As the amount external agencies are paying decreases, pay will fluctuate for those in the Christus internal program, Ms. Pasley said. 

Outside of pay, she said Christus offers workers in its internal program flexibility with scheduling.

"We have some people who adjust their schedules with their leader so they can have a better lifestyle," Ms. Pasley said. "We try to meet the needs of every clinician who comes to us, but we understand that's not always the case with our colleagues, our competitors, or they may not be able to have that flexibility. We're able to have a relationship with our traveling nurses such that it's more of a give and take."


Pittsburgh-based UPMC launched an internal travel program for its 40-hospital system in December.

John Galley, chief human resource officer at UPMC, told Becker's in January that the health system started the initiative not only to combat the nursing shortage — and attract nurses the health system has lost to outside travel agencies — but to address increased rates from outside travel agencies. 

Nurses and surgical techs who qualify for UPMC's program will earn $85 an hour and $63 an hour, respectively, in addition to a $2,880 stipend at the beginning of each six-week assignment.

Compensation for travel nurses at UPMC is still higher than full-time employees because the job comes with its own set of challenges. While full-time nurses get to know their facilities and have a more regular schedule, travel nurses are constantly on the move.

"They're going to have assignments for a few weeks at a time at a particular location, then we're going to pick them up and move them somewhere else, so they're going to be constantly traveling, living out of a suitcase, and that's what external travelers do, so we want to be just like the market, create roles like that and pay like that," Mr. Galley said. "I think our employees understand the difference between that kind of a lifestyle that goes along with the higher salary."

In a statement shared with Becker's on April 19, UPMC Chief Nurse Executive Holly Lorenz, DNP, RN, said the health system has brought 207 nurses into its travel program since the beginning of the year.

"We are delighted to see so many nurses joining our team who are new to UPMC, and we're especially thrilled to welcome back many nurses who left our team to work for external travel staff agencies and have rejoined us," Dr. Lorenz said. 

CHI Health

More recently, Omaha, Neb.-based CHI Health, part of Chicago-based CommonSpirit Health, launched an internal travel program in April for skilled clinicians in Iowa, Nebraska, Minnesota and North Dakota.

The CHI Health Midwest Internal Travel Program allows nurses, technicians, pharmacists and other workers to be full-time CHI Health employees, receiving full-time pay, a traveler rate, a stipend, vacation hours, insurance and a 401(k), the health system said.

Under the program, workers would travel within CHI Health's 28 hospitals with six- to 12-week assignments, based on where the need is greatest.

Timothy Plante, division vice president of patient care at CHI Health, said the program involves one level for people who prefer to work solely in hospitals in Nebraska and southwest Iowa and another for people willing to work at CHI Health hospitals in Minnesota and North Dakota, according to the Lincoln Journal Star.

He also said CHI Health can provide staff travel nurses the same pay they would get from an agency but without having to pay staffing agency fees, according to the newspaper.

As of April 20, CHI Health estimated more than 50 workers were in the program and about 60 others were in the application process. 

Long-term strategy

With CHI Health and other health systems creating internal travel programs, Ms. Pasley, of Christus, said the trend is here to stay. She said the reason is many organizations have a need for increased flexibility to meet the shortage of clinical professionals.

"I believe strategies like this will become commonplace … until we can boost the number of clinicians we need to care for our communities," Ms. Pasley said.

She also said Christus views its internal program as a long-term strategy. 

"We know that at some point — it may not be in the next 10 years, or it might be — but at some point we may not need the number of people traveling that we do today because numbers improve," she said. "At that point, we believe we can still maintain people on this [internal travel] team, maybe not at the same rates, but at a differential that would pay them for remaining flexible. We have hurricanes, too. We have to move nurses into areas where hurricanes hit or other natural disasters. We have a fair amount of experience with that, and we see that these are the people we could mobilize … I don't foresee dissolving [the program] in the foreseeable future." 

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