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What We Can Learn from Nurse Mobility
By Richard Watson, MD
Richard Watson, MD is the co-founder of Motient of Greenwood Village, CO.
I’ve always been envious of our nursing credentialing and licensing system. I’m not easily given to professional jealousy, but over the years, I’ve worked through the process of becoming credentialed in three states and six hospitals. The mere thought of the effort required is enough to dissuade one from changing locales. Nurses, however, have compact licensing agreements, and a good two-thirds of the states accept licensing across state lines. This is a great idea, and it’s long overdue for the physician credentialing process.
When I applied for licensure in Alaska, I was warned about the protracted time frame. I had long dreamed of working in the remote areas of the state, and I assumed that since the need for healthcare access was significant, the credentialing process would be easy. Au contraire, my friend! Evidently, there is a whole cohort of medical professionals with difficult pasts who expect Alaska will be an easy reentry point into the profession. In any case, the length of time between communications led to an almost nine-month process. In the mean time, my nursing colleagues were freely moving and working from state to state.
During the nascent stages of COVID, nurse mobility became an absolute necessity. While the news reported on the explosion of coastal cases, the rest of the country remained almost free of contagion, yet people were deeply hesitant to seek urgent and emergent care. Emergency room and EMS volumes plummeted, and hospitals experienced record low capacity.
Because of the great disparity in COVID prevalence, hospitals on the coasts were struggling with staffing crises, while most other states were laying off staff. Compact licensing agreements allowed nurses to step in to fill urgent needs in the system. The number of travel nurses expanded rapidly, rising by 40% in 2021. As cases spread nationwide, the need for staff became much more uniform. Now, with nursing attrition rates at an all-time high and nursing staffing levels at an all-time low, agency nursing has moved into position as the primary broker of nursing resources.
To add fuel to the fire, the massive influx of COVID relief funds has only multiplied the problem. Nurses are readily being poached from one state to another—and often back to locations closer to their home base—at several times their original salary. No one could fault nurses for capitalizing on this unique circumstance, and there is a longstanding, valid argument that nursing salaries have lagged far behind even salaries for medical professionals who have no patient contact whatsoever. But where is this really headed?
Surely hospitals are doing the math, calculating the percentage of agency nurses they’re using versus their incoming revenues for floor and ICU beds; presumably, they’re tracking how the influx of agency nursing is impacting overall costs and revenues. Or maybe not. In this artificial world of COVID dollars, where the gates are open and entry is relatively easy, the actual fallout of these short-term relief programs is poorly calculated.
Agency nursing is set to expand by another 40% in 2022. Some healthcare organizations have called for the FTC to examine these practices and policies, but the rate of expansion far outstrips the analysis. Some have called for a moratorium on agency nursing, as well as for a centralized staffing commission and other bureaucratic solutions. But honestly, once the COVID dollars are closed, the revenue incentives for the high staffing costs will be gone. To my mind, three points stand out in this quagmire:
- Nurses are one of the most important components of our healthcare system. Without a doubt, nurses are those in closest proximity to patients experiencing a health crisis. We must provide them with an environment that fosters the genuine compassion and agile intelligence we will all need at our bedside at some point.
- We must begin to understand that every problem in healthcare—from the minor to the pandemic-sized—doesn’t necessarily benefit from sweeping edicts and centralized solutions. The COVID story is rife with examples of unintended consequences.
- Our government agencies must stop throwing money at everything that seems difficult in healthcare. Shoring up a dysfunctional system with an influx of ready cash just solidifies that dysfunction. The difficulty of a strong central regulatory system is the lack of knowledge about what constitutes real solutions at a regional level.
We are rapidly moving toward the time where we will need to rebuild a healthcare system that is begging for renovation. Much of what is good about our healthcare is the direct result of the nurses and other frontline professionals who compassionately care for others. We need to take advantage of these seminal moments to strip away the obstacles for those who are doing that irreplaceable work, so that it becomes easier for them to follow their calling within a sustainable system.