The Big Business Behind Travel Nursing
During the Covid-19 pandemic, demand for nurses—already understaffed—surged to even higher levels, and travel nurses deployed to fill the gaps.
As the first wave of Covid-19 hit the United States, Jen, a 53-year-old nurse struggling to pay her bills, received an intriguing message. “THE TIME HAS COME TO DEPLOY AT INCREDIBLY HIGH RATES,” read the mass text from Krucial Staffing, sent to nurses nationwide in March 2020 and forwarded to Jen by a colleague.
Jen (a pseudonym used to protect her from retaliation from employers) could barely believe the wages promised by the Kansas-based healthcare staffing firm. As part of its massive recruitment drive during the first wave of Covid-19, Krucial was paying $10,000 a week to nurses willing to travel — or “deploy,” in the company’s lingo — to the frontlines in New York City.
“FLEXIBILITY IS KEY,” it continued. “EMERGENCY STAFFING IS NOT FOR EVERYONE.” Travel nurses would have to be ready to deploy with a few days’ notice. Once on assignment, nurses would work 14 to 21 days straight in overwhelmed hospitals with the potential, but no guarantee, to renew their contracts.
Jen already worked 60-hour weeks as a wound care nurse at a Maryland rehabilitation center. The pay there, at $38 an hour, wasn’t bad, but her expenses were overwhelming. Jen was the provider for her two teen nieces and had taken in her adult son, who was recovering from severe meningitis, all while trying to pay off her own medical debt.
So Jen put in her notice at the rehab center and called Krucial, hoping the company would send her to New York immediately. She called the company line repeatedly, and on March 28, 2020, a Krucial recruiter picked up and offered Jen an assignment in New Orleans. The job would pay $95 an hour — two-and-a-half times her previous rate.
“It was like winning the lottery,” Jen says.
Drawn by high pay and the chance to help save lives, tens of thousands of healthcare professionals have served short-term stints as travel nurses during the pandemic, pouring into areas with Covid-19 surges to shore up local hospital systems. Many, like Jen, left full-time jobs to work gigs with staffing firms like Krucial.
While some travel nurses extol the freedom of the lifestyle, others caution that, while they’re paid far more than gig workers who pack boxes or deliver groceries, they face many of the same problems — including corporate employers who treat workers as expendable.
Arriving in New Orleans in March 2020, just 24 hours after receiving her assignment, Jen steeled herself for long hours at a convention center functioning as a Covid-19 field hospital. But she didn’t anticipate that she would end up being “demobilized” — another industry term — after complaining about sexual harassment she alleges was rampant at the hotel where the nurses were lodged. Jen alleges Krucial has since effectively blacklisted her, barring her from future work with the company. Other nurses told In These Times they were sent home early by Krucial after speaking up about poor accommodations or working conditions on assignments — a form of retaliation the nurses say is rampant across the travel nursing industry.
In interviews with In These Times, as well as in more than a dozen state and federal lawsuits filed during the pandemic, travel nurses have alleged workplace violations and retaliation by some of the industry’s fastest-growing private staffing agencies. Meanwhile, the staffing agencies that served as a stopgap in the early days of the pandemic now look like more permanent healthcare fixtures, as longterm understaffing in hospitals gives way to bidding wars for short-term help.
The exceptional pay for travel nurses is possible, at least in part, because of federal relief dollars funneled to staffing agencies during the pandemic. Using funding from the Federal Emergency Management Agency (FEMA), states are paying out hundreds of millions to bring in additional medical personnel during Covid-19 surges — a boon for companies like Krucial and SnapNurse, an Atlanta-based startup that boasted a more than 9,000% growth in revenue in 2020. Other healthcare staffing agencies have been recipients of federal Paycheck Protection Program loans intended for small businesses to keep employees on payroll.
Nurses’ advocates say this approach is unsustainable. In a September 2021 letter to the U.S. Department of Health and Human Services, the American Nurses Association called for federal action to address the “national nurse staffing crisis” and offer additional pay and support to nurses toiling under untenable stress.
“We are seeing examples throughout the country of nurses leaving their communities for the higher compensation offered by travel nurse agencies,” the letter reads. “This only serves to further local staffing strains, often in the most underserved communities.”
The traveling nurse profession is not new. Throughout the 20th 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.”
For Tiffany, a registered nurse of five years, travel nursing started out as an adventure. But it’s worn on her during the pandemic. Travel assignments can be unreliable, she says, with nurses showing up for a contract only to learn they are no longer needed.
In October 2021, Tiffany traveled to New Orleans on an assignment with SnapNurse, whose virtual platform provides facilities with nurses on demand. When she arrived at the hotel where she was supposed to be “on-boarded,” the company’s representatives were nowhere to be found.
“What is going [on] with SnapNurse in Louisiana right now?” Tiffany wrote to her SnapNurse recruiter in text messages shared with In These Times, adding that her rental car alone cost $230 a day.
“I do not know why it has been so difficult to onboard and I wish I did,” the recruiter replied. “It is extremely frustrating for me as well.”
After two days of waiting, Tiffany says she left empty-handed. “[SnapNurse] just left me stranded with a bunch of other nurses,” she says. “Nobody makes a big deal out of it because we’re used to being abused.”
In August 2020, NBC Miami reported on travel nurses who likewise said they had been recruited by SnapNurse to work in southern Florida, only to have their contracts canceled upon arrival and to return home without compensation.
SnapNurse started in 2017 to staff facilities that perform elective surgeries, according to a profile in the Atlanta Business Chronicle. Such procedures were rare during the pandemic, but founder Cherie Kloss saw an opportunity to staff hospitals stretched to the breaking point. A former reality TV producer and contract anesthetist, Kloss told the Chronicle that she hopes to see her company become the “Amazon of health-care staffing.”
Meanwhile, SnapNurse and its parent company, SnapMedTech, are facing at least four separate class-action complaints — three in California and one in Georgia — from nurses who allege the company failed to properly compensate them for wages earned or expenses incurred on Covid-19 travel assignments.
SnapNurse did not respond to requests for comment. The company has denied the claims in three of the pending suits and has yet to respond in the fourth.
In a LinkedIn message to In These Times, Kloss said that complaints from nurses were rare. “Our nurses have been able to change their financial lives and pay off debt, buy a house, send kids to college, and thank us all the time for the opportunities we give them,” she wrote.
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.
On an assignment in Waco, Texas, in 2021, registered nurse Ryan Speaker says he also experienced retaliation from Krucial. Speaker shared a video (which went viral) of healthcare workers confronting managers about their accommodations— which, according to the workers, were littered with needles and infested with rats and bedbugs.
Speaker says that, immediately afterward, his contract was cut short. According to Speaker, the nurses had originally been told they would be on assignment in Austin, Texas, but were transferred to Waco at the last minute, where they were moved into a budget motel.
“Our jobs are hard,” Speaker tells In These Times. “You bring all that stress home with you, and then you still can’t relieve any of that stress, because you’re worried … you’re gonna take home bedbugs to your family, or you’re waking up with bites all over you.
Catherine Derenoncourt alleges she was barred from additional work with Krucial after pushing for improved contact tracing and testing on an assignment in early 2020.
While working at a hospital in Texas, Derenoncourt says she was floated to a non-Covid-19 floor where, to her shock, a patient with a fever had been admitted. She says she pushed for the patient to be tested for Covid-19, and when the test came back positive, asked to be swabbed herself. After a mandatory seven-day self-quarantine, Derenoncourt tested negative for Covid-19. Regardless, Derenoncourt says, “The hospital asked that I not return to the floor.”
After that assignment, Derenoncourt says she has been assigned Krucial contracts three times, each canceled at the last minute.
“As soon as they give me the assignment, someone will call back and say, ‘Oh, no, you can no longer work for Krucial — you are ‘DNR’ [do not return] in our system,’” Derenoncourt says. “They don’t want you to create trouble for the contract. And I understand business, but it’s not always about the money… I have a human being in that bed.”
In a lawsuit filed April 2020, three nurses who deployed to New York City with Krucial claim the company fired them after they complained about being asked to perform roles outside the bounds of their medical training. The suit, which is pending in federal district court, alleges that the company is “profiteering from the crisis.” Krucial has denied the claims in court.
Krucial did not respond to a request for comment and directed In These Times to contact BCFS. A BCFS spokesperson replied to say the company was unaware of the allegations and directed In These Times to contact Krucial.
“The safety and well-being of deployed personnel during any emergency response is paramount,” the BCFS spokesperson noted in their email.
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.”
Before the pandemic, more than 10% of frontline healthcare workers suffered from post-traumatic stress disorder (PTSD) — figures that have likely jumped since 2020. A study presented at the American Psychiatric Association that surveyed Turkish healthcare workers found that nearly half of non-physicians working in the healthcare setting during the pandemic had PTSD.
Derenoncourt, who has spent nearly two years in hospitals overwhelmed with Covid-19 patients, knows she will be haunted by her work long after the pandemic. She recalls the scene of disarray that greeted her at a long-term care facility in New Jersey in early 2020, where an outbreak of Covid-19 was spreading among patients and staff.
“Everyone on staff was out sick,” Derenoncourt says. One patient, who had tested positive for Covid-19, appeared to have been left unattended. “I washed her from head to toe … and she looked at me and said, ‘Can I please have a hug?’”
Derenoncourt didn’t have the heart to refuse.
The patient was dead by the next morning.
“I cannot get that lady out of my head,” Derenoncourt says.
Over the pandemic, Derenoncourt has seen many more patients die. “We have to wrap them up ourselves, so I became an expert in removing all kinds of tubing and cleaning them before I can wrap them and put them in that bag,” she says. To limit the spread of Covid-19, hospitals rarely grant non-patients access to the facility — so after cleaning and wrapping their bodies, Derenoncourt wheels them outside to be collected by funerary services and family members.
Despite the challenges, Derenoncourt says she can’t afford to leave travel nursing. “To continue and to be able to provide for my kids and myself,” she explains, “I had to go back to the bedside.”
Between assignments, Derenoncourt stays with her son in Camilla, a small town in southern Georgia. She had planned to hang out there for a few months in late fall 2021 — a vacation that would span the holiday season.
But her break came to an abrupt end in mid-November. An agency reached out offering back-to-back assignments.
Alice Herman is a 2020-2021 Leonard C. Goodman Institute for Investigative Reporting Fellow with In These Times.