Traveling Nurses Give Temporary Medical Relief

Unable to fill all their permanent nursing staff openings, California hospitals are tapping into a new source: traveling nurses.

Commonly called “travelers,” the nurses pack their supplies and scrubs and move from city to city, hospital to hospital, every few months. Many are young, single and driven by a desire to see the country or to sample different hospitals, while others are older and simply looking for a change.

Hospital administrators say temporary staffing is a stopgap solution that helps while they recruit and train permanent nurses. But the solution is not ideal, administrators say, because the traveling nurses often cost more than staffers and their stints are too short.

Many hospitals, however, do not have a choice.

“We will beg, borrow and steal wherever we can find nurses because we are on the precipice of a dangerous situation in hospitals without them,” said Jim Lott, executive vice president of the Healthcare Assn. of Southern California, a hospital trade group. “We need the nurses, so we have to [pay], and are paying, premium

prices for them.”

Those costs--paid to the agencies that employ traveling nurses--include benefits, housing and moving expenses. Although traveling nurses can cost 30% more than staff nurses or those hired day-to-day from a nurse registry, they commit to working at least 13 weeks, making the cost worthwhile, hospitals say.

Jennifer Zitt, a 25-year-old Illinois native, is one of 35 traveling nurses at Kaiser Permanente Los Angeles Medical Center. Zitt was attracted to travel nursing last June by the paid travel and the opportunity to work at different hospitals.

“Everywhere you go, nursing is different,” said Zitt, who spent six months in San Diego before moving to Los Angeles. “I am bettering myself as a nurse by the experience I am gaining. But if you can’t handle change, travel nursing is not the way to go.”

There are disadvantages, Zitt and other traveling nurses say. They don’t receive any paid sick or vacation time; can be let go based on need; and are often given the toughest patients and the least desirable shifts.

“We’re here to fill a need,” said 32-year-old traveling nurse Dawn Simms. “We’re not part of the group.”

Simms, who has worked at four hospitals in as many years, said her salary increased dramatically when she left a permanent position in Maryland to join the ranks of travel nursing.

“But now I’m kind of stuck,” said Simms, who works for San-Diego based American Mobile Nurses and has a 3-year-old son. “Nobody is paying this much. I can’t take a pay cut to go somewhere else.”

Though some travel-nurse companies started during the shortages of the 1980s, several new agencies have opened in the last few years. Company officials estimate that there are at least 50 agencies nationwide that provide temporary staffing to hospitals.

Agency heads say their business is at an all-time high. A recent survey by Staffing Industry Analysts Inc. reported that temporary medical staffing increased by 16% in 2000 and is expected to grow 21% this year. And as baby boomers age and more nurses retire, even more temporary nurses will be needed.

Lott said 90% of the 180 hospitals in the Healthcare Assn. use traveling nurses, compared to 10% a decade ago. Within the last week, Lakewood-based Medical Resource Network contracted with 10 new hospitals, bringing its number to 507 across the country.

“We are in such demand it’s unbelievable,” said Sally Suarez, a registered nurse who started Medical Resource Network five years ago.

Agencies recruit nurses on the Internet, at nursing schools and through trade journals. The agencies interview and screen their candidates and usually require a professional license and a year of acute-care experience.

Despite the screening, many hospitals are cautious. Jane Olson, director of nursing administration at USC University Hospital, said she works only with agencies she trusts to ensure the quality of the nurses.

“You have to be careful,” she said. “You don’t really know who you are getting.”

The California Nurses Assn. says travel nursing is eroding the quality of the profession, undermining patient care and placing a greater burden on full-time staff nurses. Permanent nurses are already overworked and are now responsible for training and supervising the travelers, said Hedy Dumpel, chief director of nursing practice for the association.

Dumpel said traveling nurses also lack loyalty to the profession, and sometimes serve as scabs during strikes.

“Travelers come and go,” she said. “The majority of traveling nurses take the money and run. There is no commitment to patient advocacy or to improving standards of care.”

Travel nurses argue that they are very committed to their patients, but simply want to avoid hospital politics. They also point out that many renew their contracts and stay at the same hospitals for a year or more.

Beth Beil, 42, started traveling as a nurse nearly five years ago when her children left for college. Since then, she has worked in Florida, Maryland, Oregon and California.

During the 12 years she spent as a staff nurse in Maryland before traveling, Beil said she served on committees, fought for better patient ratios and organized other nurses. Then she got fed up with the bureaucracy.

“I’d had enough of that,” said Beil, who now works as a traveler at St. John’s Hospital and Health Center in Santa Monica. “I feel like I’m bailing out on [other nurses], because I’m just floating from place to place, but there is not the stress and worry I used to have.”

On a recent morning at Kaiser, Simms--wearing bright green scrubs--administered IV antibiotics to one patient and pain medication to another whose body was rejecting a kidney transplant. Down the hall, Zitt tended to 73-year-old Billy Austin, recovering from a heart bypass operation.

Zitt, who has blond spiky hair and lavender nail polish, checked her patient’s lungs and helped him do breathing exercises. “Am I gonna live?” asked Austin, smiling widely. “Yeah, I think so, at least for the next 20 minutes or so,” Zitt teased back.

Then she asked Austin about his family, to make sure somebody would be at home to take care of him when he left the hospital. Even though her jobs are temporary, Zitt said she is still a counselor, an advocate and a friend to her patients.

Kaiser Permanente’s director of hospital operations, Larry Kidd, said traveling nurses also fill spots while staffers are on vacation or leave. All Kaiser travelers attend several days of orientation to learn hospital policies and procedures.

Providence St. Joseph Medical Center in Burbank uses traveling nurses as a recruiting tool. About 30 of the 800 nurses at St. Joseph are travelers, and several travelers have been hired on as staff in past years.

“We would prefer to have out permanent staff,” said Lynn Bracci, director of patient care support. “But if you can’t get that, the travelers are just about the next best thing. It would be hard to say we would ever be able to do without them.”