The Big Business Behind Travel Nursing

The traveling nurse profession is not new. Throughout the 20^th century, doctors and nurses with the U.S. Public Health Service have been dispatched to disease outbreaks and natural disasters. But the first private travel nurse agency wasn’t established until 1978, the brainchild of a temp agency executive who saw an opportunity to meet seasonal demand for healthcare in New Orleans during Mardi Gras, according to the Professional Association of Nurse Travelers.

Healthcare staffing, a $24 billion industry that also includes temporary medical doctors, dentists and other specialists, has expanded during the past three decades in tandem with the overall growth of the temp industry. During the pandemic, the travel nurse sector expanded by 40%, according to the trade group Staffing Industry Analysts.

One estimate, from healthcare staffing firm SimpliFi, suggests travel nurses now account for 8 – 10% of the overall U.S. nursing workforce, up from 3 – 4% before the pandemic. Travel nurses may often make twice as much as those on staff in hospitals, even when they perform the same work.

But the high-paying jobs come at the cost of job security and personal stability, as nurses leave their families behind to travel from hotspot to hotspot.

“You’re constantly shifting your life around the entire country, not able to stay still or create a foundation,” says Tiffany (also a pseudonym), who has worked in 17 hospitals since 2020. ​“I’ve been separated from the person I used to be.”

In October 2021, SnapNurse announced a deal to deploy hundreds of medical personnel to Alaska. The positions are publicly funded through FEMA, but the state awarded more than $100 million in contracts to private agencies to bring nurses in amidst a Covid-19 surge.

So-called crisis contracts, funded through FEMA, are a major source of the premium pay on offer for travel nurses.

In March 2020, the state of Louisiana awarded Texas-based BCFS Health and Human Services a $145 million contract to manage field hospitals set up for Covid-19 patients, according to state records. Krucial subcontracts with BCFS, supplying some of the nurses on assignments like this one.

When Jen arrived in New Orleans in March 2020, she was surprised to learn she and the rest of the nurses would report not to Krucial, which had recruited them, but to BCFS. The non-profit emergency management organization also operates a detention center for unaccompanied migrant children arriving on the U.S. – Mexico border.

BCSF staff onsite ​“controlled everything we did,” Jen says. ​“You were told what to do and when to do it, and that’s it.” When they weren’t working, nurses were to remain in their hotel rooms at all times, while managers came and went at will.

In the hotel, Jen says women in her cohort began to feel uncomfortable when male coworkers and BCFS managers cornered them for unwanted conversations and to solicit dates. In one instance, Jen alleges one colleague sent sexually explicit images to another nurse without the nurse’s consent.

“We had very young nurses there,” Jen says. ​“It’s so unfair to put these women in this crazy situation.”

On June 2, 2020, Jen called her supervisor, a Krucial representative onsite in New Orleans, to report her concerns. She says she described the unwanted advances from managers, as well as a rumor that the men onsite had been placing bets on which women they could sleep with. She told the representative that she was worried that added stress in an already high-stakes situation could create an unsafe work environment for female nurses.

Jen had been perturbed by the atmosphere at the hotel, but she was even more shocked by what she says came next. In emails to Krucial and BCFS obtained by In These Times, Jen alleges the Krucial representative dismissed her concerns and told her to ​“just keep her legs closed.”

Then, later that night, Jen says a different Krucial representative called to tell her that her contract had been terminated early. When she confronted management at a team meeting the following morning, Jen says she was told she had violated company policy by taking an unpermitted smoke break outside the hotel. Regardless of the allegation, Jen says the rule was not enforced for anyone else; she had clearly been singled out. She left New Orleans.

A month later, in July 2020, Krucial assigned Jen a new job —this time in Texas, where the agency was again providing staff through a state contract awarded to BCFS.

“Five minutes after I give them all my information and I’m set and I’m in, I get an email,” Jen says. Sent from a Krucial representative and shared with In These Times, the email reads: ​“Because of things that happened in New Orleans, you are not allowed to go on assignments for Krucial Staffing. PLEASE DO NOT TRAVEL TO TEXAS.”

Jen says that email put her out of work for months, and that she did not secure a contract with another agency until the end of September 2020.

With no end to Covid-19 and staffing shortages, states are continuing to turn to travel nurses to fill healthcare gaps. In September 2021, Alabama Gov. Kay Ivey announced she would use $12 million of the state’s federal relief funding to hire more temporary healthcare workers.

That can have a demoralizing effect on nurses staffing local hospitals, who ​“are working next to a travel nurse who makes three times the money,” one Alabama nurse told WBRC News.

Hospitals are blaming the private agencies for exploiting the crisis and exacerbating understaffing. In a September 2021 letter to the state attorney general, the California Hospital Association, which represents more than 400 hospitals and healthcare systems in the state, called for an investigation into possible price-gouging by private healthcare staffing agencies.

But nursing researchers and unions are emphatic that understaffing was a problem long before the pandemic — and point to hospitals and healthcare facilities as the primary culprits.

While ​“hospitals are concerned with how much they’re spending on agency nurses,” according to Karen Lasater, an assistant professor of nursing at the University of Pennsylvania, ​“that wouldn’t need to be the case if [hospitals] were doing right by their core nursing staff.” In a December 2019 survey of nurses in New York, Lasater found that about half reported burnout, and one in four said they planned to leave the profession within the year — even before the pandemic hit.

National Nurses United, which represents more than 175,000 members nationwide, argues that staffing shortages can be chalked up largely to poor working conditions — caused, in part, by intentional understaffing. To underscore the point, the union cites a 2017 U.S. Department of Health and Human Services report showing that most states have plenty of qualified nurses—more than they have open nursing positions. In other words, they argue, the understaffing is largely a manufactured issue.

Throughout the pandemic, healthcare facilities have continued to lay off workers. Morning Consult, a data intelligence company, found that in addition to the 18% of healthcare workers who quit during the pandemic, an additional 12% had been laid off. At Henry Mayo Newhall Hospital in Valencia, Calif., workers protested when 35 nurses were laid off in June 2020.

“They could have helped treat the Covid patients,” says Nerissa Black, a nurse who works in the telemetry unit at Henry Mayo. ​“By the time winter came and we had the surge, we were so short-staffed. And we had been warning our administration.”