Travel Nurses: Healthcare’s Favorite Scapegoats

The Allure of Travel Nursing: Freedom, Flexibility, Autonomy

Sarah Gaines, MSN, RNC-OB, has a travel nursing origin story that’s all too common. After her father died unexpectedly and she was reeling with grief, her PTO request was denied. She was forced to report to her hospital nursing job the very next day after his funeral. At that moment, she realized her staff job would never treat her humanely or fairly, and she needed to take her career into her own hands. She took a leap of faith and accepted a travel nursing position in Dallas, Texas. 

What began as a temporary endeavor became a thriving travel nursing career, which later inspired her to start her own business, the Six Figure Travel Nurse, where she taught other staff nurses how to break into the industry: 

“When I started, no one knew about travel nursing. It wasn’t a well-known option, even amongst nurses. After I started travel nursing in 2015, I realized that it provided a level of flexibility, financial reward, and freedom that staff nursing never would. And I haven’t looked back since,” Gaines says. 

While that may sound glamorous to most nurses slogging away in underresourced, grueling hospital positions, there is a reason why travel nurses are so well paid.

Travel Nursing Misconceptions

The reality of travel nursing and the many challenges accompanying that lifestyle are rarely mentioned in the media. Instead, travel nurses’ total compensation–including the amount paid to the agency–is usually the only focus. 

And on paper, their wages can sound extravagant. During the worst peaks of the Covid-19 pandemic, some travelers were paid up to $10,000 per week for special arrangements called crisis contracts. 

Figures like these have hospitals all over the U.S. crying poverty and begging politicians to cap travel nurse pay. According to these executives, travel nursing has directly contributed to the greater nursing shortage. But dig a little deeper, and you’ll see the numbers aren’t what they seem. 

Understanding Travel Nursing Math

When you look at the media coverage of travel nursing over the last five years, you’ll notice that travel nursing pay is always reported as a single hourly wage. This makes sense for most professions, but according to industry experts, it does not tell the whole story of their unique compensation arrangements with the hospitals they work for. 

Sarah Gaines, an experienced travel nurse and coach for other travel nurses, has strong feelings about the slander of travel nurses, something she feels is deeply hypocritical. 

“We live in a capitalist system where pricing is determined by supply and demand. Yet, nursing is the only profession where nurses’ skills and experience are being heavily scrutinized and their salaries attacked. My brother, who is a truck driver, experienced the same types of incentives and made $10,000 a week during Covid too, but I don’t see politicians trying to cap his pay,” Gaines says. 

According to Gaines, executives and industry lobbyist groups intentionally mislead the public by omitting crucial details about travel nursing pay and contracts to paint them as greedy. Let’s take a look at travel nursing math.

Travel nurses are paid an hourly wage like most other hospital employees. Still, their pay is actually quite low, typically $20 to $25 hourly, according to Gaines—roughly half of the average RN salary in 2023. They also receive a tax-free stipend to cover the cost of lodging and meals, which makes up the majority of their compensation.

According to the IRS, contract workers like travel nurses must maintain a home base and prove they have duplicated expenses to receive those tax-free stipends. Crucially, nonprofit hospitals, which make up almost 60 percent of all hospitals in the U.S., can write off all expenses—including payroll and stipends paid to temporary workers—from their taxes each year.

Stagnate Nursing Pay & Festering Safety Issues

According to Love, nursing wages in America have been stagnating for years. This, combined with poor working conditions that include routine and unaddressed violence against nurses and unsafe staffing ratios, has led to the current state of nursing—something the media has deemed the “Nurse Shortage,” but what’s more accurately described as a “Nurse Retention Crisis.” 

Love strongly disputed the idea that travel nursing as an industry has meaningfully contributed to the nursing shortage. Instead, she believes the poor treatment of nurses over many decades has resulted in this current crisis.

For example, nursing salaries rose an average of 1.67 percent each year between 2011 and 2020—far lower than the average. For all of these reasons, Love says nurses simply are not willing to work in unsafe conditions and put their licenses on the line any longer. Hospitals have been aware of this fact for decades but have chosen not to address it. 

For most, travel nursing simply makes the physical, mental, and emotional toll that nurses endure at least financially worthwhile. And according to Love, the actual cost that hospitals paid to travel nurses during the pandemic has been exaggerated anyway. 

“The average hospital in the U.S. in 2019 had about 4 percent of their nursing staff made up of travel nurses. By the height of the pandemic in 2021, many were averaging 20 percent. Yet, the average labor cost across most hospital operating budgets during that time only increased by 19 percent. While the cost of other essentials like drugs and supply chain increased by 30 percent and 40 percent. So they’re blaming a lot of the costs on nursing when they were tremendous costs going to other things as well,” Love says.  

Exact prices notwithstanding, it’s crucial to note that many hospitals did not spend their own money on travel nurses throughout the pandemic because the CARES ACT dedicated $100 billion to reimburse hospitals for pandemic health-related expenses, including temporary staffing. 

So, while the exact cost that individual hospitals paid to staff their units throughout the worst of the Covid-19 pandemic varies, it’s clear the associated costs have been overestimated. In addition, the life-saving heroism travel nurses exhibited in the face of the biggest global health crisis in a generation was intentionally minimized. 

Curiously, with all this fervent discussion about the fairness of ballooning wages, one line in the healthcare operating budget that hasn’t received much attention during this period is hospital executive pay.

The Ultimate Healthcare Hypocrisy: Hospital Executive Pay

The hypocrisy of high-paid hospital executives and industry leaders attacking the wages of frontline healthcare workers has not gone unnoticed. A recent report titled Hospital Executive Compensation: A Decade of Growing Wage Inequity Across Nonprofit Hospitals examined top executive pay and key outcome data in North Carolina, and what they found was sobering. 

According to the report, throughout the pandemic, while many nurses were laid off and had their benefits and raises suspended, hospital executives in nonprofit hospitals in North Carolina “…enriched themselves while fueling a crisis of healthcare affordability.” In addition, the report concluded that executive pay does contribute meaningfully to patient safety or the mission of nonprofit hospitals. 

According to the report: 

• North Carolina’s nine largest nonprofit healthcare systems paid executives $1.75 billion from 2021 to 2021
• Almost 20 percent of that amount ($308.8 million) was given to only a few CEOs
• Executive pay did not meaningfully correlate with patient safety outcomes 

North Carolina is not unique. Hospital executives across the country have continued to receive massive salaries and bonuses throughout the pandemic, despite claims of terrible work conditions and continuous nurse strikes in some cases due to intentional short staffing that maximized profits.