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What are the current travel staffing trends? Insiders weigh in on what's hot and what's not.

Need a nurse to fill a long-term staffing vacancy quickly? Join other nurse leaders who, in the past 10 years, have increasingly used travel staffing agencies to fill facility staffing requirements. The travel nurse industry is now a multimillion-dollar enterprise, largely due to the convenience and costeffectiveness offered by travel nurses.

Why travel works

Donna Ramey, RN, director of nursing at RN Network, Boca Raton, Fla., believes the growing flexibility of travel nurses enables their agencies to provide appropriate workers upon client requests.

"Nurses have more flexibility. They may have had to stay at a position they weren't happy with because the opportunities weren't there to gain a new position," she says. "I think that travel is easier now. Twenty years ago the typical traveler was a single person, maybe traveling with a friend. You'd be a staff nurse for 4 or 5 years and then you'd become a traveler. Now you see more nurses with 20 years of experience with kids out of the house. They're free to leave home, and many also have spouses with jobs that can work out of the home."

That's not to say that some difficulties don't arise. According to Ramey, it's becoming common for hospitals to request more nurses on short notice. "Hospitals, because of their budgets, will wait until the last minute to decide to use a traveler," she says. "But then they want the nurse to start working for them tomorrow." This time shortage causes a problem, not only with finding a nurse who's ready to pack up and leave at a moment's notice, but also with licensing.

"In some states it's easy to get your license," notes Ramey. "In other states it can take 4 to 6 weeks to obtain a license. So if the hospital's telling us they need a nurse next week, and that nurse isn't already licensed in that state, there's no way we're going to be able to get the nurse ready in time."

In high demand

Travel nursing is undoubtedly a popular occupation and a popular staffing solution. In the past several years, however, the travel industry has seen its share of ups and downs. Joseph A. Boshart, president and chief executive officer of staffing company Cross Country Healthcare, Boca Raton, Fla., has watched the demand for travel nurses rise and fall.

"Over the past 10 years I'd say the demand for travel nurses has increased significantly," he says. "The share of nursing positions throughout the hospital industry has increased and maybe even doubled since the mid-1990s. But in the past 2 years, we've seen a reversal of that trend."

Boshart believes the reversal is related to the country's economic slowdown, which likely forced nurses to go from secondary earners to primary earners to meet their families' needs. "The hospitals have had more success and a greater willingness on the part of the nurses to fill shifts, at wages that don't disrupt the hospital's wage structure. So the hospital's going to need less third-party outsourced labor to fill the patient-care needs of that facility."

Further, facility recruitment and retention officers have been working harder to attract permanent staff members, taking measures such as raising wages or creating nontraditional full-time positions to provide nurses with more schedule flexibility. Administrators at Cross Country Healthcare have seen a drop in the rate at which hospitals renew nurses for backto-back contracts, due in part to hospitals' recruiting success. In addition, Boshart estimates that wages increased by anywhere from 6% to 14% nationally in 2003, a move that puts staffing companies at a disadvantage. Conversely, his company's rates haven't increased at the same level.

The fundamental Issue

The nursing shortage is a serious concern in the health care community. According to Boshart, some of its causes aren't frequently discussed. He believes that in the short term, there are enough nurses in the workforce, and they've agreed to work more hours at the wages hospitals are willing to pay. In addition, hospitals doing more with less resources create stopgap measures by increasing the number of patients for which individual nurses are responsible. To Boshart, a look at the demographic makeup of the nursing field explains the shortage problems.

"You have an aging population that will demand more in-hospital patient care," he says. "A parallel demographic is that nurses as a group are aging more rapidly than the overall population. When you look at the percentage of nurses under 30 in 1998 as opposed to 1980, it has declined by approximately 41%. In the overall labor population, the percentage of workers under the age of 30 has declined by only 1%. You have a disproportionately aging nursing profession at a time when the demand for nursing services is likely to increase dramatically."

As the economy begins to right itself and the nursing population ages, more holes will begin to appear in hospital staffs, says Boshart. The enforcement of California's new nurse-to-patient staffing ratios is already beginning to force a rise in the demand for travel nurses. That demand is only likely to increase in the future.

"Asking nurses to work overtime has filled the gap in bedside coverage," he notes. "But in addition to California, a number of states have passed or are considering legislation that prescribes the maximum amount of time a nurse can work in a 24-hour period, thereby taking the overtime option off the table for hospital employers. Legislative initiatives have begun to narrow the tools that hospitals have at their disposal to deal with the shortage of nurses."

Boshart believes the travel industry has moved from an environment that was supply constrained (reliant on who was able to recruit the most nurses) to one that's demand constrained (reliant on whether you have the most positions available).

"This is 180 degrees different than it was 2 years ago," he says. "We believe this is a temporary condition for the market, and ultimately, given the demographics as they play out, it will return to a supply constrained market. But the dynamics of this business are very different than they were for the 5 years leading up to 2002."

As the health care industry continues to evolve, no doubt the travel staffing industry will change alongside it.

About the author

Lauren Green is an author and freelance health care writer in Perkasie, Pa.