New Hampshire - March 2022

Page 10 • New Hampshire Nursing News March, April, May 2022
The trauma of traveling nurses —
a tug between supply and demand
Roberta Baker, The Laconia Daily Sun
Jan 17, 2022 | Updated Jan 17, 2022
LACONIA — Gerie Pingol, 53, was trained as
mechanical engineer in the Philippines, his native
country. But when his degree and experience didn’t
translate to a career in the U.S, he tapped an inner talent
and an abiding interest: his love of people — especially
elders in need of care, empathy and patience.
“As a Filipino, it’s normal for us to take care of
older people, and normal for us to take care of our
grandparents,” said Pingol, a green card holder who did
an about-face from manufacturing.
For the last six years, Pingol has worked as a licensed
practical nurse, or LPN, on staff at Belknap County
Nursing Home — a job he never envisioned, but
has discovered fulfillment in — including during the
turbulence of COVID-19.
“At Belknap County Nursing Home, the residents are
very nice so it was easy to change my career,” he said.
“Working at the nursing home is like my second home.”
To the patients, Pingol is a blessing. To BCNH, he
is a godsend — a dependable staff caregiver during
unprecedented times: the pandemic never actually
passes, but ebbs temporarily, only to return around the
corridor with vigor or a variant.
Skills and heart aren’t the only value Pignol and stalwart
nurses bring in these times. As the pandemic wears
on, burnout and disillusionment run high, along with
temptations to travel or work elsewhere for higher pay.
Health care facilities in New Hampshire and nationwide
are grappling with ways to attract and retain nurses at
all levels. Solutions range from boosting wages to workstudy
agreements, subsidizing education, and improving
benefits.
In the simmering emergency that COVID-19 spawned,
coupled with an exodus of retiring nurses and others
lured by easier jobs or less stress in related careers,
traveling nurses have emerged as a lifesaver and last
resort for facilities plagued by chronic staff shortages.
But the use of exorbitantly paid transients is a doubleedged
sword, according to health care administrators
and staff.
“We love traveling nurses,” said Mike DellaVecchia,
now a staff nurse in emergency room at Huggins
Hospital in Wolfeboro. Without them, over-worked
nurses would endure longer shifts and weeks without
a break, he said. But “paying rental doctors and rental
nurses is not sustainable. The traveling nurses aren’t
making all the money. It’s the big agencies,” said
DellaVecchia, who worked as traveling nurse between
Florida and New England for 18 years. He said he
makes more money now, especially with overtime,
because travelers have periods without pay between
assignments.
It's a thorny issue. Traveling nurses enable facilities to
keep beds open, and occasionally admit new patients.
But they can cost two to three times what a staff nurse
is paid, and their contracts usually expire after 90 to
180 days, requiring replacements, or an extension of
their contract. When staff nurses leave, some return
to their original employers for temporary assignments
that pay double what they previously earned. Hourly
rates become a matter of supply and demand, and they
fluctuate. Staffing agencies collect hefty fees and one
of the first questions they ask health care administrators
whose backs are against the wall: How much are you
willing to pay?
The pandemic ushered in bidding wars, not unlike
those in real estate – and a whole new level of financial
precariousness.
“The cost of travelers is enormous,” said Pam DiNapoli,
executive director of the New Hampshire Nurses
Association. “And they don’t have to come from out of
state. They can come from Catholic Medical Center,
going to Elliot Hospital” in Manchester. “We need to
incentivize people to stay at their home organizations.”
Traveling LNAs, LPNs and RNs from staffing agencies
have always cost much more to hire, but COVID-19
dissolved any invisible, fragile ceiling that may have
existed before. The cost of traveling nurses has vaulted
120% since the pandemic started, said DiNapoli. That
translates to one traveling nurse for the price of two
to three staff nurses — sometimes four. This is bad
economics especially for nursing homes that depend
on the state’s Medicaid reimbursements, which don’t
come close to covering the actual costs of caring for
chronically ill and elderly patients, most of whom have
run through their life savings. At county-owned nursing
homes, the percentage of patients on Medicaid is 75.9%
— 80 to 85% at BCNH, when the facility is full.
Hospitals are also hard hit, and strapped to compete
with the rates of travelers.
Price gouging in a free market that is not free
DiNapoli said the rationale is, "If I’m going to work this
hard, I want to be compensated." Some traveling nurses
make $125 an hour compared to staff members who
have stayed and are making $50 or less plus benefits,
with more experience at the job.
One large out-of-state staffing agency, which books
traveling nurses nationally through its website, allows
facilities to press a button to automatically outbid what
another facility is offering elsewhere in the country.
Nurses who travel are typically not grounded by family
commitments, or bound to a facility by health insurance,
retirement benefits or workplace culture, or by loyalty
to patients or co-workers. Some have their housing and
travel expenses paid through tax-free vouchers.
When they arrive on a new turf, sometimes with less
training and experience, their presence can dampen
morale among loyal staff. They require on-site training,
just like any newbie.
Most staff members are happy to do some mentoring,
but over the long haul, it can be demoralizing to train
someone who is making a lot more money and is less
prepared to hit the ground running.
“It can cause a lot of friction where you work,” said Di
Napoli. “It’s become a national issue. We have a lot of
conversations about what this is doing for quality of care.
You have inexperienced nurses coming into a setting
they don’t know, taking care of the sickest of the sick.”
Then there’s staff attrition. Some nurses are lured away
by what amounts to a gold-rush size paycheck for
temporary commitments in the high-stress, high-risk
work environment of the pandemic.
Agencies are taking advantage of a free market that is not
actually free, but tied to fixed rates of reimbursement,
health care experts say.
Ethics vs. economics
“Some people are calling to say it’s an ethical issue
because people are charging so much,” said DiNapoli.
“It’s a form of price gouging. They’re taking advantage of
the times.”
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Brendan Williams, president of the New Hampshire
Health Care Association, which represents 58 nursing
homes, nine assisted living facilities and five continuing
care retirement communities, said traveling nurses have
become the solution du jour where there a few if any
alternatives. In long term care, “It’s absolutely essential
because we don’t have other options. Even though
facilities have raised wages, none of that matters if you
can’t find licensed professionals in your community. In
order to cover your shift, you have to go with staffing
agencies. It’s predatory pricing. They play a lot of
games,” he said.
County nursing homes in the southern tier of the state
were quoted $50 an hour for a traveling nurse assistant,
or LNA, whose rate in New Hampshire typically varies
between $14 and $18 an hour. “You tack on $20 if you
have COVID in the facility,” said Williams.
Some agencies book nurses with more than one
provider, which prompts a last-minute price war with
hospitals and nursing homes bidding against each other,
said Williams. "It’s really a marketplace of desperation at
this point. And it’s unsustainable.”
“Staff leave and return to your building as a traveler for
an out of state staffing agency. It’s like we’re swirling
down the drain and there’s no end in sight. Medicaid
doesn’t cover normal nursing costs, let alone traveling
nurses,” said Williams. “You have no choice other than
utilizing pirates. You’ve got to cover your shifts.”