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'A bidding war': Kansas, Missouri hospitals fighting for travel nurses as beds fill up

Kansas City Star logo Kansas City Star 10/27/2021 Jonathan Shorman, Daniel Desrochers, and Jeanne Kuang, The Kansas City Star
a person standing next to a car: Mercy nurses work to collect samples from patients at a coronavirus testing center outside the Mercy Virtual Care Center in Chesterfield, Mo., on Saturday, March 14, 2020. © Robert Cohen/St. Louis Post-Dispatch/TNS Mercy nurses work to collect samples from patients at a coronavirus testing center outside the Mercy Virtual Care Center in Chesterfield, Mo., on Saturday, March 14, 2020.

The shifts are often long, the locations unfamiliar. No family or friends may be nearby.

But the demand for travel nurses has skyrocketed as the COVID-19 case surge spawned by the delta variant is crushing hospitals across the United States.

At a moment when the number of nurses at a facility may determine how many patients can be treated, advertised positions in Kansas and Missouri top $5,600 a week. Some nurses have heard of assignments paying five figures weekly.

Hospitals in Kansas and Missouri — and numerous other states — are all scuffling to hire travel nurses, also called contract nurses. The intense competition for a limited pool of workers has led Kansas Gov. Laura Kelly to publicly fret that the facilities will be out bid. Missouri Gov. Mike Parson has promised to provide hospitals with millions in financial aid, but it's unclear how much of a difference it will make.

"Many of us get emails or telephone calls looking for travel nurses," said Kelly Sommers, director of the Kansas State Nurses Association. "And they pay per week three times as much as a nurse who is working in Kansas in a specific job."

The travel positions are so lucrative that when nurses join the field, traveling can be a "great opportunity" if they don't have ties to their local community, Sommers said. "And you can't fault them for wanting to take advantage of this opportunity."

Kansas and Missouri hospitals were collectively seeking to fill more than 1,700 open positions through travel nurses as of Monday, according to data from Aya Healthcare, a leading travel nursing agency, Kansas had 407 open positions and Missouri had 1,350.

Hospitalizations have been rising in both states since late June or early July. Kansas hospitals reported nearly 800 COVID-19 patients last week; Missouri had nearly 2,500 patients. The patient counts haven't been this high in either state since January.

Missouri has just 19% of its inpatient beds remaining, according to the Missouri Department of Health and Senior Services. Kansas has at least 39%, according to the Kansas Hospital Association. Still, 14 Kansas hospitals — roughly 14% of facilities in the state — reported last week that critical staffing shortages are anticipated.

Not only are beds filling up, but many of those patients need extraordinary levels of attention, exacerbating staffing challenges. COVID-19 patients often require intense, round-the-clock care that limits the number of bed each nurse can safely cover.

Staffing shortfalls, combined with growing patient loads, are causing more hospitals to turn to travel nurses in an attempt to fill the gap.

And the price keeps going up.

"There's nothing any hospital...can do to keep our staff from moving over to agency, because they're offering some of these folks really, pretty nice salaries and hourly wages if they'll move over," said Truman Medical Centers CEO Charlie Shields. "That's hard to compete with."

'Bidding war' feared

Before the delta wave, the travel nursing market was returning to its pre-pandemic dynamics, said Sophia Morris, vice president of account management at Aya. Travel offered a way to experience a different hospital, live somewhere attractive or get closer to family. Those reasons were beginning to resurface.

But the variant is once again refocusing travel on hotspots where hospitals are struggling to care for a flood of patients. Roughly 180 clinicians — which include nurses and other positions — booked through Aya are currently working at hospitals in Kansas. In Missouri, the company is providing about 940 at the moment.

The true number of traveling staff working in the two states is almost certainly higher because Aya is just one of several agencies trying to place nurses.

Pay packages run $1,000 a week to upwards of $5,000, Morris said. Hospitals in areas with extreme outbreaks, such as Texas, Florida and areas of California. are often starting at $3,000 a week and going as high as $6,000

Morris listed a number of factors that could be contributing to the higher rates, including delta as well as the decision by many hospitals to continue many elective surgeries it suspended earlier in the pandemic.

"We are seeing rates that are higher in some areas and fairly standard in other places," Morris said.

And there are anecdotal reports of sky-high weekly rates. Heidi Lucas, director of the Missouri Nurses Association, said in an email that some assignments pay $10,000 a week.

Kelly has voiced worry that Kansas hospitals can't compete in luring travel staff. At a news conference Friday to draw attention to rising patient numbers, the governor compared the situation to the first few months of the pandemic, when states fought over limited masks, ventilators and other supplies.

"Right now, we're sort of in the same situation," Kelly said, adding that "we've got states like Texas and Florida paying a fortune — twice what we pay contract nurses. So we're going to end up in a bidding war with other states."

Kelly said her administration is looking at what it can do, but didn't offer any details.

The Kansas Hospital Association has floated several options, including additional funding to offset the cost to retain and recruit staff. The money, which would presumably go toward pay and benefits for staff, would help "keep these burned out staff members across our communities retained," said Cindy Samuelson, an association spokeswoman.

Additional measures proposed by KHA include helping small, sometimes rural, hospitals keep acutely ill patients in their facilities. This could involve more extensive consultations between doctors at larger hospitals that have handled many COVID patients and those at smaller facilities with less experience.

KHA has also discussed finding ways to refer more rural patients transferred to large hospitals back to their small community hospitals after they improve, as well as providing flexibility around licensing to make sure professionals coming from out-of-state can begin working quickly.

In a letter Wednesday, Kansas House Speaker Ron Ryckman, an Olathe Republican, urged Kelly to act on a "serious shortage of nurses" in hospitals. He raised the possibility of using federal COVID funds for sign-on bonuses, overtime pay and other incentives.

Missouri providing aid

The current delta wave has been especially trying for nurses, after a period of relative calm that sparked hopes that the worst of the pandemic was in the past. The vast majority of those currently hospitalized are also unvaccinated, frustrating nurses who know the crisis could have been prevented.

"They go through mad, sad, quiet," said Carol Perry, chief nursing officer at Stormont Vail Health in Topeka. "I have nurses that say, 'I came to work tonight and both of my patients died.'"

Shawnee County, home to Topeka, declared an emergency over COVID-19 last week, with local officials warning hospitals are being pushed to the limit. "Our hospital is full," Stormont Vail CEO Robert Kenagy said in an online update Monday.

Stormont Vail is not currently using travel nurses, Perry said. Instead, for the past four years the hospital has brought in international nurses. The number fluctuates between 20 and 40, she said.

"They stay in our organization. They don't come and go. They are part of this culture, they are part of the organization," Perry said.

But for other hospitals, travel nurses are simply a reality.

"We're all facing a registered nurse shortage in this country," said Betty Jo Rocchio, senior vice president and chief nursing officer at Mercy, which operates hospitals and clinics in Missouri, Kansas, Oklahoma and Arkansas.

Parson on Aug. 11 announced Missouri is providing $15 million to boost hospital staffing. The smallest hospitals, those with up to 25 beds, can receive up to $50,000. At the high end, hospitals with 401 beds or more are eligible for up to $200,000.

"We've consistently heard from our health care partners that staffing is one of the biggest challenges we continue to face," Parson said at the time.

But there's uncertainty about how far the money will go. Relative to their bedspace, small hospitals will get more aid, about $2,000 per bed for small facilities compared to less than $500 for the biggest.

Mercy, for instance, is paying up to $200 an hour for travel nurses, according to Rocchio. That's $8,000 a week for five, 8-hour shifts, though in practice longer shifts are common.

Rocchio emphasized that she's appreciative of the money and said everything helps, but downplayed its likely impact.

"No, it's not going to scratch the surface of the additional labor force that we're gonna have to hire," she said. "These RNs, you can see the rate that we're paying them right now, it's going to add up pretty quickly."

The travel nursing industry has gotten "out of control" and should be rethought, said Patricia Pittman, director of the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University. While the system has its advantages, it's unfair to hospitals with fewer resources, many in rural and underserved areas, she said.

"It's just sort of exacerbating the inequities in terms of resources across the country," Pittman said.

Hospitals that hire travel nurses also risk making staff nurses feel devalued because of the massive pay gaps, Pittman warned. Ultimately, she contends, working conditions are at the heart of the nursing shortage. Pay needs to improve, but nurses must also have hospital leadership that listen to them.

"Producing more bodies that are just going to wash through this leaky bucket is not really the solution," Pittman said. "The solution is rethinking how nurses work."

Shields, the Truman Medical Centers CEO, said the hospital will "absolutely" apply for funding and said it will help. But simply devoting more money to the problem won't solve it, he contends.

"The underlying problem that I think everybody is facing, though, is it's not even a financial issue at the root cause of this. There's just an extreme workforce shortage right now," Shields said. "So, you know, at some point, while the money is helpful, it doesn't fix the bigger problem which is you just can't find these people."

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