About a month before the world turned upside down in 2020, Baylie Panzarello made a career move that would prove fortuitous.
Tired of waiting behind more experienced nurses to advance in her career, Panzarello gave up working as a staff nurse in Baton Rouge to give travel nursing a shot. Travel nurses, also known as agency or contract nurses, are registered nurses who can trek across the country to fill workforce needs. They typically earn higher rates than staffers.
Two years later — even after enduring the COVID-19 pandemic in ICUs from Baton Rouge to Boston — Panzarello doesn’t see herself going back to a staff job. The pay is too high to turn down.
From what Panzarello has seen, she’s not alone.
“Most nurses where I go now are all travel at this point,” said Panzarello, a 26-year-old nurse for a staffing agency called Aya Healthcare. She has worked in ICUs at Tulane Medical Center, Ochsner University Hospitals and Clinics in Lafayette, Woman’s Hospital and even a Boston facility.
“That is the case for Woman’s Hospital in their ICU right now,” she said. “I know that’s the case for Baton Rouge General as well, almost, at this point.”
The pandemic has created a conundrum for Louisiana’s nursing workforce. Health care leaders said nursing shortages were prevalent before the coronavirus, and hospitals turned to travel nurses in record numbers as patient populations skyrocketed.
The demand drove the hourly rates for travel nurses through the roof. As a result, the lucrative pay convinced some staff nurses to turn to agency life, further worsening the issue.
Health care leaders said they don’t expect the travel nurse usage to remain so inflated, but they’re still necessary in some cases, which is amplifying costs. They said long-term solutions are needed to address workforce gaps, like investing in training programs and nursing school faculty salaries.
But in the near term, both hospitals and nurses are left with a formidable question: say yes or no to travel nursing?
“We didn’t have enough nurses to manage all of the hospitalizations that were going on and the critical state that we found ourselves in early on in the pandemic,” said Karen Lyon, CEO of the Louisiana State Board of Nursing. “We had to have a lot of travel nurses come in — and they did.”
Money, money, money, money
Pinning down an average pay rate for travel nurses is challenging. It can vary based on market forces and privately owned hospitals aren’t required to divulge cost details.
Some Louisiana hospitals, however, did give The Advocate a proverbial peek behind the curtain.
Ed Halphen, vice president of human resources for Woman’s Hospital, said the typical rate was between $75 to $80 an hour for agency nurses before the pandemic. The Bureau of Labor Statistics estimates the hourly rate for nurses nationwide was $39.78 in 2021.
For some units, like the ICU, the agency rate has “almost doubled” in the last two years, Halphen said.
“At the time when they’re most needed, their prices are the highest,” he said.
Ochsner Health System President and CEO Warner Thomas has said rates were as high as $200 an hour. He also said Ochsner’s cost for temporary labor — which includes travel nurses — ballooned from $19 million in 2019 to roughly $160 million in 2021.
Baton Rouge General Health System paid $22 million for its labor workforce in 2021, a 16% jump from 2020. About $6.3 million of that was for contract labor, system officials said.
Edgardo Tenreiro, Baton Rouge General’s president and CEO, has said some experienced travel nurses across the country were making up to $250 an hour. That’s in addition to incentives paid to encourage staff nurses to take extra shifts.
“This is a nationwide issue. You’re just robbing Peter to pay Paul,” Tenreiro said. “You’re taking nurses out of Minnesota and bringing them here, and vice versa.”
Franciscan Missionaries of Our Lady Health System and LCMC Health declined to provide specific figures to The Advocate.
To combat the shortages and costs, the state Department of Health enlisted the Federal Emergency Management Agency to reimburse three nurse staffing agencies — SnapMedTech, AMI Expeditionary Healthcare and Safety Management — that provided extra labor.
Over two years, SnapMedTech billed nearly $428 million to the state for its travel nursing services, according to figures from the state Department of Health. Meanwhile, AMI and Safety Management sent invoices for $49.4 million and $7.6 million, respectively.
Dr. Joseph Kanter, the state’s health officer, said the FEMA program saved Louisiana’s hospitals from enacting crisis care, which would have forced providers to pick and choose who gets a bed.
“We got close,” he said. “We got way too close.”
‘It’s hard to turn that down’
Though COVID-19 hospitalizations are at their lowest point here since the pandemic began, the ripple effect can still be felt in Louisiana’s health care workforce.
Some nurses, particularly those close to retirement age, have left the profession because of burnout. Others chose the profitable life of travel nursing.
“Can you imagine being offered $200 an hour and a $5,000 sign-on bonus?” Lyon said. “It’s hard to turn that down no matter what.”
Panzarello, the travel nurse, said her contracts offer flexibility that a staff job can’t. Her terms can last from four weeks to 12 weeks and can be extended — or ended — if she wants.
“You can just go. You can just up and leave,” she said. “You don’t have to stay. You don’t have that luxury with staff nursing.”
But the gig isn’t all sunshine and roses.
Introducing travel nurses can cause friction on a hospital unit, Lyon said, because they’re paid more and aren’t as familiar with the unit’s culture, policies and procedures.
“To bring in a stranger, whether they’re making $25 more (an hour) than you are or whether they’re making the same salary, can be very difficult to quickly incorporate them into that culture because they are outsiders,” she said.
The pandemic also produced another unintended effect: “boomerang nurses,” as described by Missy Sparks, Ochsner’s vice president of talent management. Those are nurses who left for travel gigs but have returned to staff jobs.
“We welcome them back home,” Sparks said. “Some have said, ‘Hey, I’m going to go do this for six months because if I can make in six months what I might be able to make in a year or two years and I can leverage that to pay off my college tuition, it seems like a good choice for me and my family.’”
But the return of those nurses can “cause a lot of emotional distress to the nurses who stayed, who felt like they were loyal to their hospitals and their organizations,” Lyon said.
Panzarello acknowledged the tension. However, the pros of travel nursing still outweigh the cons, she said. The contracts are typically short enough to endure the stress.
She’d still be in the game if she could. She and her husband are expecting a baby in July, which has put her traveling on pause.
“It’s very lucrative right now. It’s almost not even a reflection on the way the hospitals are running on this point," she said. "Why wouldn’t you choose to go make what you can make in a year at Baton Rouge General, make in six months somewhere else?”
The long-term view
Louisiana health care leaders expect the use of travel nurses to plummet as pandemic hospitalizations, hopefully, stay low. But the workforce shortages are still there.
At the end of 2020, 17% of RNs working and living in Louisiana — 9,331 of them — were planning on leaving their current position, according to the Louisiana State Board of Nursing’s latest annual report. The two biggest departure reasons were retirements and pay.
“I do understand that we will continue to have at least a short-term, five-year or so, specifically nursing shortage,” said Tina Schaffer, vice president of human resources for Our Lady of the Lake Regional Medical Center. “I think organizations are doing things to partner appropriately to be able to take care of their patients.”
Hospital officials said they’re participating in workforce training and scholarship programs to recruit and retain workers. Kanter, the state health officer, said nurses “deserve to make more as a base salary” and vouched for loan repayment programs to offset student debt.
But the hospitals all face an uphill battle to wrestle more graduates out of the state’s nursing schools.
Though Louisiana’s nursing schools have produced an average of 1,996 graduates annually for the last five years, they’ve also turned away an average of 1,400 qualified applicants each year in that same time frame, according to the state board’s annual report. The primary reason is a lack of qualified faculty, driven mostly by salaries that lag behind the national average.
The average salary for a Louisiana nursing school professor was $86,958 in 2020. Meanwhile, the American Association of Colleges of Nursing says the national average for nursing school professors was $118,967.
Tenreiro, of Baton Rouge General, called the faculty and applicant quandary a “red tape issue.”
He said nurses need a master’s degree to teach, but he argued that nurses don’t need a master’s to succeed in a clinical setting. He also called for the state nursing board to loosen its rules so licensed practical nurses — which provide more routine patient care — can take on more responsibility.
“The system is incapable of reacting to the reality — incapable, and perhaps unwilling, to react accordingly,” Tenreiro said. “It’s a huge problem.”
Lyon, however, argued that patients in 2022 are sicker and need a higher level of care driven by “critical thinking and intellectual capital” that comes with a degree in registered nursing.
She added that it’s more practical for nurses to pursue an advanced practice degree to become a nurse practitioner, which offers more money and opportunity than a teaching job.
“You’ve got to find ways and methods to improve faculty salaries in order to make nursing education as attractive as clinical practice is,” Lyon said.