Hospital executives report high nursing vacancies, greater reliance on costly travel nurses

A physician in scrubs in a hospital hallway
COVID-19 has taken a bite out of hospitals' nursing staff, forcing many to hire travel nurses who command much higher pay rates than their peers, according to a new survey. (Getty/NanoStockk)

Hospitals are increasingly finding their hands tied on nurse staffing, reporting numerous position vacancies, heavy use of high-cost travel nurses and difficulties onboarding new nurses.

Thirty-six percent of hospital executives say they anticipate more than 25 openings this year compared to 17% in 2020, while 21% anticipated more than 50 opens and 11% predicted more than 100 open positions, according to a survey conducted by Avant Healthcare Professionals.

The nurse staffing firm collected responses for its annual poll from more than 100 hospital CEOs, chief nursing officers and human resources executives during January and February.

Compared to data collected by the firm during the two years prior, respondents said their organizations are anticipating a higher volume of nurse openings.

Seventy percent of the respondents reported losing anywhere from 5% to 30% of their staff as a direct result of COVID-19.

New graduates and internal recruitment are the primary strategies these organizations will employ to address those vacancies, although many fewer respondents said they were focusing on that second option in 2021 compared to the year prior (45% versus 70%).

Of note, 28% and 37% of respondents said they will be looking to improve pay packages and offer sign-on bonuses, respectively, to fill openings in the coming year. These proportions were generally in line with the years prior.

Bringing those new hires up to speed has also been more of a challenge during the COVID-19 pandemic.

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Seven in 10 of the survey’s respondents said the pandemic has impacted their ability to onboard new hires, while 63% said that it’s extended the orientation timeline for new nursing graduates. Others reported that the nurses they were hiring had less clinical experience, or that they needed to conduct orientation online or rush the process.

Adding to those difficulties are the higher payouts executives said they’ve been offering over the last year. Fifty-eight percent said they offered their staff additional COVID-19 hazard pay, and 56% said they offered bonuses. Respondents also said they were looking into strategies such as tuition reimbursements and contracts with international nurses to stave off staffing cost increases.

However, much of the focus when it came to pay rates revolved around the stark increase in demand for travel nurses that’s been reported over the past several months.

More than 90% of the executives said they were currently employing travel nurses in their organizations. Three-fifths of the respondents said they had hired between five and 20 travel nurses to specifically assist with the pandemic, while 11% said they’d hired more than 20.

Complicating the situation for organizations is that the new group of COVID-19 travel nurses are pulling in greater paychecks than their peers.

Here, a higher proportion of executives said they were offering non-COVID-19-specific travel nurses rates in the $65 to $75 range than they did for traveling COVID-19 staff (43% versus 23%). Rates within the higher $100 to $150 window were offered much more often to the traveling COVID-19 nurses (38% versus 11%).

The budding demand for travel nurses also affected hospitals’ present workforce, with 80% of the respondents noting they had lost some of their nurses to travel assignments for other hospitals.

“Costs for contract labor are not attainable, and national rates have greater impact on areas of the country where the cost of living and pay rates differ even more,” said an unnamed chief nursing offer quoted in the survey report.

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Avant’s report painted each of these findings in the light of broader reports from the International Council of Nurses, the National Bureau of Economic Research and others warning of an upcoming global nurse shortage.

Several respondents expressed concerns of a “great loss” of nurses to other careers in the future due to COVID-19 burnout and other factors. On the other hand, there have been recent reports of a bump in nursing school enrollment in spite of—or perhaps because of—the pandemic.

The rising costs of nursing labor and other COVID-19-driven stressors have led to some tension between hospitals and nursing groups in recent weeks.

Earlier this month, The Wall Street Journal reported a legal dispute between hospital operator Steward Health Care and San Diego-based Aya Healthcare. The former alleged price gouging and unlawful nursing assignment cancellations in a suit filed in March, while the latter countersued for more than $40 million it said is due in unpaid services.

This past weekend also saw a two-day strike of more than 150 nurses at South Lake Tahoe, California’s Barton Memorial Hospital. The labor demonstration was backed by the California Nurses Association, which said the hospital has experienced high nurse turnover in the past year due to poor working conditions and insufficient compensation.