Washington hospitals have spent the past month enduring the largest wave yet of COVID-19 cases, and the surge is prompting health care worker unions to issue renewed calls for hospitals to take additional steps to combat burnout, retain existing caregivers and maintain their overall staff levels.
In a joint press release last week, three unions representing Washington health care workers — SEIU Healthcare 1199NW, UFCW 21 and the Washington State Nurses Association — said hospitals are “on the brink of a crisis” and needed “immediate and impactful action to retain and attract critical workers.”
“Instead of fighting over a supply of nurses, we need to be looking at how to retain the nurses that are there, build up staffing and decent working conditions,” said Washington State Nurses Association Executive Director David Keepnews.
Union officials and local nurses said the widespread use of “traveler” nurses — temporary contractors supplied by staffing agencies — has been a particular source of frustration in recent months, because the tight labor market has pushed up contract pay rates. Sign-on bonuses for new staff nurses are also becoming much larger and more common, Keepnews said.
The problem with those approaches is that permanent staff nurses feel left behind when they find themselves doing the same work for less pay, said Sarah Collins, an ICU nurse at PeaceHealth Southwest Medical Center.
The health care workforce is struggling with burnout after 18 months of pandemic operating conditions, she said, and the pay disparities amplify the problem, prompting nurses to either walk away from the job or become travelers themselves — creating more staffing gaps at the hospitals they leave behind.
“It’s kind of this vicious cycle,” Collins said. “I don’t see how it’s going to end well.”
Beth Zborowski, senior vice president of membership and communications at the Washington State Hospital Association, acknowledged the traveler pay disparities but pushed back on the broader claims about retention efforts.
Hospitals have offered multiple incentives to retain existing workers throughout the pandemic, she said, and they’ve been working to broaden the education pipeline to bring new nurses and other health care workers into the industry. Hospitals statewide have also been working collectively to balance the stream of incoming patients and make sure no one location gets overloaded during the current wave.
But there isn’t a quick or easy solution, she said, because the whole health care industry was already suffering from a chronic nursing staff shortage long before COVID-19 arrived — and the current case surge has substantially exceeded even the worst weeks of last winter’s wave.
“The health care and hospital system is still very stressed, and our employees are still having to do some awfully hard work,” she said.
Burnout, pay concerns
A nurse named Lauren, who asked that her last name not be used, worked at PeaceHealth Southwest until earlier this month when she quit to become a traveling nurse. She described a heavy psychological toll inflicted by the sheer number of patient deaths, particularly in the past month.
“It’s ICU — you’re used to people dying,” she said, “but the only reason we had room for patients is that so many of them were dying.”
Nurses are constantly pulled in too many directions at once, she said, because critically ill patients require near-constant supervision to make sure they remain stable. Nurses are traditionally assigned to those sorts of patients at a one-to-one ratio, but the ratio at present tends to be two to one, Collins and Lauren both said.
In an environment where teams of nurses increasingly have to rely on each other for moment-to-moment support as they jump between patients, the high turnover rate adds to the pressure and stress on the permanent staff.
Traveler nurses are equally qualified, Lauren said, but every hospital has its own procedures and familiarity among the nursing staff, and it takes time for newcomers to fully assimilate, she said — which makes the pay disparities harder to ignore.
“You’re sitting next to someone who’s making three times as much as you are, and you’re the resource for them — this is a new hospital for them,” she said.
The situation is tough at every hospital, and Collins and Lauren both said the nurses who quit to become travelers aren’t expecting the work environment to be any less stressful or demanding wherever they land.
“It’s the pay,” Collins said. “It might be just as morally distressing in terms of COVID elsewhere, but elsewhere might pay me more.”
Lauren commended PeaceHealth for offering counseling for employees and said the managers directly in charge of her unit have been supportive and understanding. She expressed regret at the thought of leaving her coworkers and moving to an unfamiliar work environment, but she said ultimately the pay disparities made it so that “going to work feels financially unreasonable.”
PeaceHealth Chief Nursing Officer Holley Tyler said in a statement that the hospital has worked to recruit and hire nurses throughout the pandemic in addition to bringing in travelers.
Staff nurses have been given expanded paid sick time, an emergency fund to help with living costs and enhanced compensation for picking up additional shifts, she said. The hospital’s board of directors also provided financial awards to all caregivers last year.
“Our priority is to always provide safe, quality patient care,” she said. “We extend our deep gratitude to our nurses during this pandemic, and we will continue to ensure we remain adequately staffed so our nurses continue to want to practice here.”
The traveler nurse pay disparity is a significant problem nationwide, according to Chelene Whiteaker, senior vice president of government affairs at the Washington State Hospital Association. Whiteaker, Collins and Keepnews all said it has become common to see travelers making two or three times the pay rate of their permanent staff colleagues.
Some Washington hospitals have been trying to offer retention bonuses for permanent staff, Whiteaker said, but it’s impossible to match current traveler rates dollar for dollar.
“That would bankrupt hospitals — literally,” she said.
The hospitals are looking for a solution at the federal level to place an upper limit on traveler contract rates, Whiteaker said, and want to see the U.S. attorney general step in to look at what she called “price gouging” by the staffing agencies that supply traveler nurses.
“The reason I say it needs to be national (is) because if one state takes action, the travelers just won’t come to that state,” she said.
Keepnews acknowledged the retention bonus efforts but said they were “not that widespread” among hospitals statewide, and not enough to address the disparities caused by travelers and other “short-term solutions.” The ultimate goal needs to be to achieve and maintain safe staffing levels at hospitals statewide, he said, and “we’re clearly not there yet.”