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caption: Donavan Pepin, 22, an organizer with SEIU, leads a chant as nurses and caregivers strike on Tuesday, January 28, 2019, outside of the Swedish Ballard Campus along NW Market Street in Seattle.
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Donavan Pepin, 22, an organizer with SEIU, leads a chant as nurses and caregivers strike on Tuesday, January 28, 2019, outside of the Swedish Ballard Campus along NW Market Street in Seattle.
Credit: KUOW Photo/Megan Farmer

Washington nurses call for better pay as more colleagues turn to traveling work

Hospital staffing shortages across Washington state have some nurses wondering if they should trade staff positions for traveling work. While travel contracts don't guarantee better hours or fewer patients, they do often come with higher pay.

And that comes at a steep cost to hospitals, as well as the professionals who choose not to hit the road.

"When somebody comes on as a traveler — and you know they are getting paid two, three times more than you, and you have more knowledge of that institution — of course, it's a little upsetting. But it's not the traveler's fault," says Jane Hopkins, a registered nurse and president of the local nurses union SEIU Healthcare 1199NW. "This is literally hospitals under-paying healthcare workers, under-paying nurses to a point where it's better to be traveling than actually work in the hospital. And that's not acceptable."

According to the Puget Sound Business Journal, as of July, travel nurses in Washington were making about 20% more each week compared with last year. Their average weekly pay was up to about $3,210, which is about 8% higher than the national average, the Business Journal reports. In Seattle, travel nurses may find gigs for as much as $5,200 a week.

Rural hospitals have struggled even more with staffing shortages, so nurses may find better pay even outside of major metropolitan areas. The Business Journal notes higher-than-average salaries can be found in places like Omak in the foothills of the Okanogan Highlands or Elma in Grays Harbor County — cities with populations of fewer than 5,000 people, according to the 2020 Census.

Chelene Whiteaker, vice president of governmental affairs for the Washington State Hospital Association, says the pandemic exacerbated a pre-existing nurse shortage across the country. That meant more demand for traveling nurses, which led to "rates of pay in travel nursing that have never been seen in the industry before — triple, quadrupling of those wages."

If this sounds unsustainable, it is.

Hopkins says these pay disparities and staffing imbalances aren't sustainable. And hospitals agree on on this.

"They know there's a crisis," Hopkins says of hospital administrators. "But we all have different perspectives of what the solution should be."

The union argues the hospitals would retain more staff nurses if they paid them more.

Whiteaker says that's an oversimplification of a more complex issue.

"Hospitals cannot pay the rates to all nurses that the travelers are making," she argues.

In any case, the demand for traveling nurses remains high. Of the roughly 30,000 nurses employed in Washington hospitals, Whiteaker says about 6,000 are travelers.

"Our hospitals would love to cancel those traveling contracts. Yet there are people in hospital beds that need care, and who will take care of them?" she says. "We need to have adequate staffing levels in our state... so we can't just cancel the the traveling contracts right now."

Hopkins sympathizes. She understands the need, having seen for herself the pressure medical professionals at all levels are currently under.

But without incentives to staff at one hospital, she worries younger nurses, in particular, are increasingly interested in traveling gigs.

"There are TikTok videos about how traveling is the new generation of nursing," she says. "Even new nurses are starting off as travelers, which is even harder for them because they really need to be in a hospital where they can get a lot more experience."

That in turn could affect the quality of care being provided, she adds.

"I do believe quality of care is going down...because they are learning on the job," Hopkins says. "This is a problem that we — all hospitals and unions and our members — have to really discuss."

Hopkins and Whiteaker spoke with KUOW about what solutions there may be, from the union and hospitals' perspectives, respectively.

These interviews were recorded separately. They have been edited for clarity.

We know many hospitals in Washington state and across the country are looking for help, especially rural hospitals. But they're also saying the increase in the number of traveling nurses is costing them money they can't really spare. That might affect their ability to pay staff nurses more. Is that a fair assessment?

Jane Hopkins: That's true, and I sympathize with that. But again, there's always been a solution. We've been telling hospitals they've got to staff better, they have to pay better. There was already a shortage of nurses before Covid-19. And there's people leaving the profession, not even traveling, leaving the profession, because it got too hard. They're not being respected and paid for the work that they do. Hospitals have got to understand that, although people love this work, they also have to think about families. How can I live the American dream? And they [hospital administrators] know there's a crisis. But you know, we all have different perspectives of what the solution should be.

Chelene Whiteaker: We disagree with the notion that we're going to be able to pay our way out of this. Hospitals are already providing wage increases. We agree that traveling nurses — this phenomenon — is a problem. We completely agree with the unions on that. Where we disagree is we are providing wage increases to nurses. Hospitals lost a billion dollars in quarter one, and 40% of that was from traveling nurses. So, it shows you what type of impact that cost has on our industry.

The union also says that hiring traveling nurses, ultimately, costs more than it would to raise nurses pay. Is that fair or accurate?

Whiteaker: We need to take a step back and look at the problem. The pandemic created a demand that was felt nationally. So, travelers in this context are meant to be kind of a stopgap. You're going to have too many patients. You don't have enough staff. You need to bring in traveling nursing for a short period of time. What has happened, though, is those wages have increased. Pay rates for traveling nurses have increased to such levels, hospitals are unable to pay that for all nurses.

Here's an example: The rate of traveling nurses in our state doubled from 2021 to 2022. That was a $300 million impact to hospitals just in quarter one. So it's too simple of a solution to say that we should just pay the rates of traveling nurses. That does not actually work in terms of the way health care is financed. Hospitals have not had a rate increase from Medicaid in 20 years, Medicare gave hospitals a 4% rate increase this year.

Unlike other industries, hospitals can't just raise their prices.

What do you think the solution is?

Whiteaker: There are several solutions. Congress could actually look into this issue. It's happening not just in Washington state — it's all over the country. We'd like to see congressional action [to prevent price gouging]. At a state level, we could look at other incentives to to attract nurses to work in hospitals, like student loan repayment. Overall, we're going to need a Medicaid rate increase. And we're going to need help from the state with getting patients out of the hospital that no longer need to be there.

The other piece is the Legislature debated a nurse-to-patient ratio bill [which Hopkins and unions supported]. We think that if the Legislature enacted that type of of law, one, hospitals would be forced to cut beds, because you couldn't staff to the levels of the bill. And two, it would create an artificial demand for travelers again, because you can't staff to those ratios. So the solution the unions are putting forward on ratios just runs counter to what we all decided was a problem, which are the traveling agency costs.

Hopkins: Most people want stability, and I really do believe that if hospitals paid better, people would not want to travel. That's the key. Hospitals have to pay better. Everybody wants to give the best care possible, and it's harder when you're going from one place to the other, because you have to learn new things every time you do that. Just as you're getting used to it, then you move again. So, hospitals have got to pay people to stay.

What are you going to do? What are you going to do to make sure there's more people to do this work? It's a huge dilemma.

[Hospitals] continue to pay people way less than what their travel counterparts are getting, who they're working right next to and teaching new skills to — somebody who is making $2,000 to $3,000 a week when a traveler is making $5,000 to $10,000. That's not comparable. Why would people not want to go travel?

Producer John O'Brien contributed to this report.