After a spike during the pandemic, region's hospitals turning away from travel nurses

GRAND FORKS — Christy Matlock was out of a job. Elective surgeries at the Memphis hospital where she was a circulator nurse halted at the start of the coronavirus pandemic.

Her husband was a stay-at-home parent to their children, and they were two months behind on their mortgage.

She had no choice but to join thousands of nurses jumping into travel nursing at the onslaught of the pandemic.

“They were begging for nurses to come up north because they were dropping like flies,” Matlock recalled. Her first stint as a travel nurse was in New Jersey. “The stuff in New York and New Jersey was wartime nursing. … When you saw nurses in the New York Times wearing trash bags? That was me.”

It was worth it, though. Matlock was earning about $4,000 a week, after taxes. It wasn’t close to the post-taxes $7,000 a week some travel nurses earned in New York City at the time, but it was significantly more than she made as a staff nurse before.

So, even though she was away from her husband and two children for months at a time, she continued to travel nurse. She worked in New Jersey, Milwaukee, Fargo and Memphis over the next couple years.

But the pay rates for travel nurses across the country have dropped in recent months due to hospitals prioritizing a return to higher staff nurse numbers. While the rates are higher than a staff position, it’s not worth it to continue traveling, Matlock said.

The pandemic bubble has burst, disrupting health care systems nationwide. The volume of patients remains high due to an aging population, delayed health care from the pandemic and remaining COVID cases.

Hospitals no longer can afford the high costs of travel nurses, choosing to focus on recruiting new nurses and retaining the staff they have left — many of whom retired or left the profession due to burnout from the pandemic, exacerbating the years-long nursing shortage.

Now, years later, Matlock is returning to a staff nurse position, like many who chose to travel during the pandemic. But this time, she’s moving her family to Fargo, where she’d worked on the oncology floor during the pandemic.

Matlock is taking a pay cut in return for a stable position at a hospital she loves and with coworkers she admires.

She was earning about $3,500 a week in Fargo, after taxes, while travel nursing. Now, she’ll be making about $2,500 every two weeks. But it’s worth it, she believes.

“I’m grateful for my job and the opportunity it provides my family to come to town and make a difference,” Matlock said. “It allows me to continue to do what I love, because for a while I considered quitting and finding a career that wouldn’t wear me down so badly.”

Sanford had about 400 travel nurses at the peak of the pandemic in Fargo. There are currently 200 in the city. Before the pandemic, Theresa Larson, vice president of nurses and clinical services at Sanford, estimates there were less than 20 travel nurses.

At Altru Health System in Grand Forks, the travel nurse peak was around 50 and is currently at 30, comprising about 2% of the system’s nursing budget.

Sanford hasn’t been able to return to normal because there’s still a high volume of patients to serve from North Dakota, South Dakota and Minnesota. Hospitals across the country are closing down beds because of the ongoing nursing shortage, Larson said, but Sanford has not had to do that.

The cost of regular staff at Sanford is about $30 million a year, Larson said. The cost of contract staff during the pandemic’s peak was $96 million.

“That’s not sustainable,” Larson said.

Most of the cost for travel nurses was paid for with the CARES Act. But now that the federally-funded money has dried up, hospitals have to take a hard look at what they can afford with their budget.

Travel nurses are meant to be a short-term solution, said Janice Hamscher, chief nursing officer at Altru. The Grand Forks-based health care system has set its rates “accordingly” to the national trend, she said, adding that the long term goal is for systems to hire their own nurses.

Sanford did not share its current travel nurse pay rate, either.

“We need to make sure we have the travelers needed to support the department but at a rate that we can support as an organization,” Larson said.

While money was important, being away from Matlock’s family was the hardest thing.

She would try FaceTiming home, but it wasn’t enough to keep the family together.

“My son told my husband, ‘She’s gone. She’s not going to come back,’ so he didn’t want to see me,” Matlock recalled. “He was only 4 years old. That broke my heart.”

Matlock continued to travel nurse after her stint in Fargo, returning to the Memphis area to be closer to family. But the hospital at which she contracted had too many travel nurses and not enough stable staff.

The result was chaos and left her stressed enough to raise her blood pressure to a concerning level.

She kept in contact with Fargo staff after leaving, and told them about her experience. They quickly offered her a job in Fargo, even offering her husband a position at Sanford as well so they could make enough income to support their family.

The staff position, while with less money, is better for her. She’ll even have a set schedule for the first time in her nursing career.

It’s unsustainable for hospitals to rely on travel nurses like they did during the pandemic, Matlock said. Not only does it cost too much, but it’s a difficult job to “hit the ground running” with only two days of orientation.

Travel nurses work best in small quantities, she said. Staff nurses are needed for consistency with patients and because it’s better overall for the nurses’ well-being.

It’s better for hospitals, too, Larson said.

In general, it takes about six months to a year for nurses to feel comfortable in a new position. That’s not feasible for travel nurses, whose contracts are only a few months at a time.

Many travel nurses at the height of the pandemic were also relatively young or new to the field, which added to the frustrating environment for nurses during the pandemic.

“There are lots of reasons to have your own badged staff,” Larson said. “We absolutely need the travel nurses, because they’re here to help us out. But if you look at the overall turnover, that inconsistency isn’t the best for patient care.”

To retain that consistency, hospitals are doing everything from offering incentives, changing the staff model or offering more flexible hours.

“You have to pull every lever,” Altru’s Hamscher said.

Staff nurses are more invested in the community and organization, Hamscher said, so it’s important to invest in them, too.

But to address the nursing shortage, North Dakota hospitals are looking at ways to entice people to join the nurse workforce.

Hospitals like Altru and Sanford still rely on North Dakota colleges for new graduates, but Larson said she’s hoping to see programs grow to meet the standards and needs of the hospitals. While there hasn’t exactly been a reduction in students, she said, the clinical requirements have increased and schools are working to add programs to properly train students.

But those students won’t graduate for another few years. Even then, nursing students account for maybe 100 employee hires a year at Sanford, Larson said.

To address the immediate need, Sanford is planning to hire 400 international nurses over the next couple years. The nurses will be on three-year contracts at the health care system, which will help stabilize the nursing workforce, Larson said.

About 300 international nurses have been hired so far, but only 25 have started and moved to Fargo with their families. It can take months to move the new hire and their family to North Dakota.

Nurses will come from 21 countries, including the Philippines, Nigeria and the United Kingdom. Some spouses have also been hired in other roles at Sanford or will join the state’s workforce elsewhere.

The demand for nurses will increase as the region’s population ages and grows. To meet that demand, health care systems are expecting they'll need to be creative on how to wean themselves off travel nurses, widen the new recruit pipeline and retain experienced nurses.

“The nursing profession isn’t easy, and when we look at what the pandemic has done to nurses and all of health care, I think people are still in there trying to figure out how to make it work,” Larson said. “We have amazing employees at Sanford who want to make sure we’re here to support our community. All the work we’re going to do going forward is going to meet that goal to the best of our ability, knowing that the world just looks a lot different today than before.”