The higher costs of bringing in short-term nurses was especially necessary during the pandemic. But Maine’s hospitals continue to struggle with those costs just to meet the ongoing labor shortage.
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As a travel nurse, Bailey Orvis has been all over, from her beginnings in North Dakota to New Hampshire and Maine. She has finally settled in as a per diem nurse at MaineHealth Maine Medical Center Biddeford and a part-time nurse in New Hampshire.
But back in March 2020, Orvis was a newly graduated nurse. She earned her nursing license and immediately went to work for an intensive care unit in Bismarck, N.D.
“I did that for 10 months and that was very difficult,” says Orvis. “I moved to New England and started working in the emergency department.”
Orvis’s journey is not unusual.
Travel nurses are registered nurses who take on short-term roles at hospitals, clinics and other health care facilities, going where they’re needed. Traditionally, they have been employed by independent staffing agencies rather than the hospitals themselves.
Demand for travel nurses exploded during the pandemic, sending hospitals and health care systems into a frenzy of recruiting.
Even before COVID-19, health care leaders warned that hospitals face a severe nursing shortage. The repeated surges in the pandemic made the situation dire, in part because of nurse burnout, stress, exhaustion, trauma and lack of support.
Although travel nurses have helped Maine hospitals, the industry has created challenges for health care systems, especially rural hospitals. The higher cost of bringing in short-term workers could have been justified during the pandemic. Maine’s hospitals struggle with the higher costs of labor while coping with the ongoing nursing shortage.
Maine’s nursing shortage
After the continual demands of the pandemic, some nurses in Maine stepped aside and took a break from nursing, according to Deanna Orfanidis, the chief nursing officer at Franklin Memorial.
“It was very unprecedented in regards to patients and all the requirements related to isolation,” says Orfanidis. “It was in that factor that the nurses chose to step away. There was a percentage of nurses and other employees that, when we moved to our mandated vaccination, people chose not to continue employment because of not wanting to receive the vaccination.
“Primarily what increased was the demand in our community, which then required us to bring travel nurses in,” she says.
Franklin Memorial’s parent system, MaineHealth, was able to mobilize through its nursing agency to get nurses in Maine and throughout the system, Orfanidis says. The challenge for the hospital was the cost of care. The amount more than doubled due to demand.
According to published reports by the American Hospital Association, hospitals spent about 4.7% of their nurse labor expenses on travel nurses in January 2019, while in January 2022, that average reached 38.6%.
“Typically, a nurse that costs, let’s say, $100 would cost $250 that puts added pressure on organizations related to cost,” says Orfanidis.
When Orfanidis started at MaineHealth at the end of the pandemic in December 2022, she saw a high number of travel nurses. She has been working on reducing travel and has reduced the number by more than 50%.
While the demand for nurses in Maine and across the country has never been greater, MaineHealth is working to provide help to their nurses with a scholarship program.
“We help and support nurses that are in the school program and on the backend support them with regards to a three year commitment,” says Orfanidis. “This is for our own employees and we call it an RN Pathway Scholarship Program, which has been a really nice recruitment strategy and retention strategy to help and support those RNs.
“In terms of our nursing assistant, we have an apprentice program,” she continues. “We help and support them by paying for their education and training and then on the back end, they guarantee an interview for the organization and we bring folks in that way.”
The hospital has also been working on its nursing leadership team. They have introduced engagement tactics and recognition, such as the Daisy Award, which is an international national recognition for care team members.
“The nursing leadership team at Franklin Memorial called folks who may have resigned their positions during the pandemic of what I call a boomerang program, you know, ‘come back work for us,’ and we are a small community. [We] really just have that conversation that we want them to come back. That definitely was successful with helping and supporting [recruiting],” says Orfanidis.
What it's like to be a travel nurse
Since moving to New England, Orvis has worked in five different emergency departments in Maine and New Hampshire.
Once she got enough experience as an ER nurse, she saw all the needs at different hospitals. With the money that travel nurses were making, she also saw that she could travel locally as a nurse.
“We were still caring for COVID-19 patients, but it wasn’t during the peak of the pandemic,” says Orvis. “It was definitely dying down, but still, there was a big need for nurses. I would say that post-COVID is when they need the help. It was good money and I took the opportunity.”
When Orvis decided that this was the career path she wanted to take, there were several steps to getting started.
She began looking for a nursing agency that would help recruit her to different hospitals, and from there she got matched with a recruiter that asked her what her job preferences were and then matched her to a job.
Those looking to travel as nurses have to make sure they have a license to work elsewhere. Around 40 states in the U.S. use compact licenses, which allow nurses to work anywhere with a single state license.
Travel nurses often take three-month contracts, but can work up to six months to a year in one hospital if the hospital agrees to another contract and needs more help.
However, once Orvis got hired, she found that housing was the most challenging part.
“[Housing is] one of the difficulties and hassles with travel nursing, which is why I am no longer a travel nurse,” says Orvis. “The process is really difficult and you are pretty much on your own in regards to finding housing.”
Once you get matched with a travel position, it’s up to you to find housing and figure out your commute.
Training as a travel nurse is a different process than that of a typical hospital nurse. Travel nurses must have two years of experience before starting an assignment. Most of the time, travel nurses get one day of orientation and then hit the ground running while still learning the ways of the hospital. That's unlike a typical staff nurse, who gets weeks to months of training.
“I’ve had a couple of assignments where I have had to just hit the ground running with no orientation,” says Orvis.
A travel nurse is just as busy as a staff nurse, Orvis says. There is definitely a need for nurses. There are days when she would just have to hustle because the hospital didn’t have any other help.
“Oftentimes, there were only travel nurses working on a unit,” she says. “That could be difficult because if you don’t have a staff nurse as a resource, you have to figure things out on your own. If you don’t have anyone to ask questions or refer to, ‘you guys are just running the unit by yourself.’ It’s intense in that regard.”
A travel nurse has to be resourceful.
“We always figured it out. A nurse is a nurse is a nurse — so you just know what you are doing and can be a nurse anywhere. You just have to work with the resources you have and be open and flexible to hospital resources that they may or may not have. Because every facility is different.”