A woman wearing a mask is seen in the foreground of a photo of the Maine Medical Center in Lewiston. The building is marble with tall, dark black windows.
A masked woman walks by Maine Medical Center's south entrance in Portland on Feb. 10, 2021. Credit: Troy R. Bennett / BDN

Last fall, with the delta variant overwhelming the Florida hospital where she worked, nurse and Maine native Laurie Solano did what thousands of others in her profession have done since the start of the pandemic: She took a short-term nursing job in a different part of the country.

Before the pandemic, hospitals typically hired so-called travel nurses using 13-week contracts  to fill temporary staffing holes. Because they required nurses to move across the country, often on short notice, they paid higher wages than a staff job.

But the steady, years-long grind of a deadly pandemic has driven away nurses from hospitals and long term care facilities, worsening what was already a national shortage, and driving up demand, and pay, for travel nurses like Solano. In recent months, travel nurses have earned $3,000 to $9,000 a week, many times what staff nurses typically earn. The pay has become so lucrative that staff nurses are quitting their staff jobs to make three to five times as much traveling — creating more empty positions, and further boosting the demand for travel nurses.

“It’s like a dog chasing its tail,” said John Gale, a rural health policy researcher at the University of Southern Maine.

Hospitals say the amount of money they have to pay to attract travel nurses is unsustainable over the long term. Lawmakers are exploring ways to limit or cap pay for travel nurses, and have directed their ire at the recruiting and placement agencies they believe are taking advantage of the pandemic. Health care policy experts wonder if having more nurses moving between facilities — and the learning curve that comes with it — could harm patient care. But for many nurses, the current situation represents a moment of reckoning for a health care industry that has underpaid them and undervalued them for too long.

The demand has even upended the very definition of the role, with some Maine hospitals reporting losing staff nurses to travel jobs down the road.

“I’m not sure we should even call them travelers since many are now leaving their Maine hospital and taking a job at another Maine hospital,” said Jeffrey Austin of the Maine Hospital Association. “That is something we really never saw before.”

Experts believe pay will fall as the latest COVID-19 wave and demand for nurses slide. But how far and how fast wages fall, and whether nurses will work for the same pay they made before are open questions that will have implications for the future of the profession and the American health care system.

Solano, 54, is from Lyman, Maine, but she had been working at Advent Health’s hospital in Altamonte Springs, Florida for four years in 2021. In September, conditions at the hospital were worse than ever, and in addition to her duty as a charge nurse overseeing nine other nurses, she was assigned four very sick patients, she said. Days later she also had to fill the role of nurse assistant on her floor.

She did that three nights in a row, then quit.

“It was the best decision I ever made,” Solano said.

She contacted a recruiter for travel nurses and applied for two positions. The very next day she had two offers, she said. She accepted a 13-week stint at the surgical oncology unit at Maine Medical Center in Portland, which paid her three times what she made in Florida with far fewer responsibilities. She recently completed her contract, and in a few weeks, she’s about to start another 13-week gig at the same hospital.

MaineHealth, the state’s largest hospital system, has doubled the number of travel nurses it typically uses, said spokesperson John Porter. The system employs more than 5,000 full- and part-time nurses and had 850 open registered nurse positions as of the end of January. Porter said the system has lost a “small percentage” of its nurses to traveling roles, but has kept on the majority of them in per-diem and part-time roles. This would seem to indicate that the nurses who left for travel jobs haven’t actually traveled that far from their hospitals, but Porter declined to elaborate.

There is no agency that tracks travel nurse placement in Maine. And many hospitals are reluctant to share information on how many they hire or how much they pay them.

The Northern Light hospital system employed about 3,000 registered nurses and contracted 150 travel nurses at the end of January, said spokesperson Suzanne Spruce.

“We have had people leave because they are offering astronomical amounts for travelers throughout the nation,” said Chris Laird, a critical care nurse at Northern Light Eastern Maine Medical Center in Bangor. “We’ve used travelers multiple times, normally, to help augment and cover different things, but it has taken on a life of its own.”

Hospitals’ “exploding” labor costs haven’t impacted the quality of care patients are receiving, but it has changed the cost of care, said Steven Michaud, president of the Maine Hospital Association. One medium-sized Maine hospital has added $1 million per month in costs for travel nurses, an increase he called “staggering.”

“We believe the last quarter of last year and first quarter of this year will show us sustaining losses worse than anytime in the pandemic,” Michaud said. “Our job post-pandemic will be to solve our labor shortage problems and fast.”

Some lawmakers are beginning to target nurse pay. Minnesota and Massachusetts already have caps, although they have increased during the pandemic. A Pennsylvania lawmaker has proposed a plan to cap pay for nurses working at nursing homes and other long term care facilities.

However, any state-level solution is hampered by the desperate national need for nurses, who  will likely take assignments where the pay is highest. That’s why some hospital groups and lawmakers have called for federal action.

On Jan. 24, a bipartisan group of 195 U.S. House members, including Reps. Jared Golden and Chellie Pingree, called on the executive branch to probe whether the agencies that recruit and place nurses are exploiting the pandemic by gouging prices to boost profits. Without citing any specifics, the letter charged that some travel agencies take “40 percent or more” of the prices they charge hospitals.

But many travel nurses believe that any effort to cap nurse pay is unfair.

“I really feel like if they try to cap it, a lot of nurses will go on strike. It’s not going to be good,” Solano said.

While hospitals call the current situation unsustainable, some nurses have wondered if the current high pay is evidence that hospitals have been underpaying them all along. And while there has been a shortage at hospitals for many years, the country’s largest nursing union has argued that there are plenty of registered nurses, but poor working conditions have driven them from the bedside.

“If hospitals protected nurses with safe working conditions and safe staffing rather than pushing nurses to do more and more with less and less, we could keep more nurses at the bedside,” National Nurses United said in a December 2021 report on nursing staffing issues.

Meanwhile, some experts see the high pay as a sign of a healthy labor market.

“The market is actually working quite well, in some ways, in the sense that there is a lack of supply,” said Bianca Frogner, a professor at the Washington University School of Medicine and director of the university’s Center for Health Workforce Studies. “So you pay higher wages to attract new workers.”

But the dependence on the agencies that place travel nurses has left some hospital administrators frustrated. “This is the result of COVID, but also of the result of these agencies driving up the price,”Lisa Landry, Human Resources Director at Redington-Fairview General Hospital in Skowhegan, said.

There are hundreds of staffing agencies specializing in travel nursing and several startups trying to get into the industry. While the vast majority are privately owned, two of the largest agencies are publicly traded. Their financial disclosures give a glimpse into just how profitable placing travel nurses has become since the start of the pandemic.

AMN Healthcare nearly tripled its profits from $24 million in the third quarter of 2020 to $76 million in the same period in 2021. Cross Country Healthcare, which provides staffing services for MaineHealth, made $26 million in profit in the third quarter of 2021 after running more than a million dollars in the red in the same quarter in 2020.

Cross Country Healthcare has actually shrunk its profit margins on individual nurse placements during the pandemic, said executive vice president William Burns. And the company provides staffing services to hospital systems like Maine Health as a managed service, meaning hospitals pay a contracted price, not for individual nurse placements.

There has been so much money to be made in recruiting and placing nurses, that nurses themselves have started getting in on the action.

Anthony Colón, a nurse at St. Mary’s hospital in Lewiston, served as a travel nurse early in his career. He started and runs a private Facebook group for nurses to trade tips and ask for advice on the travel experience.

Despite working during the pandemic as a behavioral health nurse, Colón has managed to turn his expertise into a burgeoning business. He has connected nurses with reputable travel placement agencies he trusts and has earned between $500 and $1,500 per referral, he said.  

“There is just unlimited need,” Colón said.