Sept. 23, 2022

The World of Travel Nursing With Rex Hartman| Episode 54

The World of Travel Nursing With Rex Hartman| Episode 54

In Episode 54 of The Healthcare Leadership Experience Jim Cagliostro is joined by Rex Hartman, Travel Nurse specializing in ICU, IR, Cath Lab, and Vascular Access, to discuss the reality of life as a Travel Nurse and the impact of the nursing...

In Episode 54 of The Healthcare Leadership Experience Jim Cagliostro is joined by Rex Hartman, Travel Nurse specializing in ICU, IR, Cath Lab, and Vascular Access, to discuss the reality of life as a Travel Nurse and the impact of the nursing shortage.  


Episode Introduction  


The shortage of nurses in healthcare was exacerbated by Covid.  In this episode, Jim Cagliostro, VIE’s Clinical Operations Performance Improvement Expert, interviewed Rex Hartman, to explore the factors that fueled his decisions to become a Travel Nurse. The conversation was wide and varied, covering topics including the impact of an aging nursing population on healthcare, why nursing is no longer a priority for young people, and the benefits and risks to hospitals of hiring traveling staff.  


Show Topics  


  • Working in ICU through Covid-19 
  • The decision to become a Travel Nurse 
  • The retiring Baby Boomer generation affects the nursing shortage 
  • Why young people are turning away from nursing as a career option 
  • How hospitals benefit from Travel Nurses 
  • The health systems providing their own in-house travel staff 
  • Potential risks of hiring traveling nurses 


Main Topics 

06:24 Working in ICU through COVID-19  


Rex shared the reality of working in ICU during a pandemic.  


‘’When COVID-19 hit, about a month in in South Florida, when we started seeing cases, out of nowhere, my hospital administration came to me and said, "Oh, by the way, starting tomorrow, you're going back full-time to the ICU to take full assignments." That was just a little bit of a shock. It would be as if anyone working in a clinical area all of a sudden said, "You're going back to another clinical area without any forewarning or discussion." ……For about a month and a half, ICU was full. Everyone was freaking out a little bit. If we can all remember back those two years ago, the PPE shortage and all the other types of mask shortages where we started re-wearing PPE and everything like that, we clinically started to do things that we knew were no-nos and boo-boos, but a lot of things happened across the nation where infectious disease protocols that had been set up and established for over that decade that I've been in healthcare, well, now we're re-wearing and sanitizing our PPE because there's a shortage, and I can't help but wonder how much of that created other issues for our population.’’ 



07:45 The decision to become a Travel Nurse 

Rex said that variety and compensation were two key factors in his decision to become a Travel Nurse.  


‘’And from that period of time, if you're working in full-time ICU or somewhere in the hospital, even if you're in ancillary services, you're in surgical services, departments are getting shut down. Workflow is being stopped. And then you hear the travelers coming in by the droves. You see them, and they're like, "Hey, where are you from?" Maybe you've never met... I had never really met or worked with travel nurses until they came to the ICU. And they started to tell me, "This is what I do. This is how I work. This is how I structure my entire life." And man, if that didn't sound, first of all, a whole lot more interesting, as far as the variety of labor you can get into, the different clinical areas you can travel to and different hospitals, different regions if you're into that, but also we can't underscore enough: there was crazy amounts of money being thrown around for travel nurses in 2020. And I'm not saying that I'm not a loyal person to my community, but if you want to pay me to do the same job about four or five times more, I'm hard-pressed to say no, especially if I know I'm not breaking any laws to get it.’’ 



11:39 The retiring Baby Boomer generation affects the nursing shortage 

Rex commented that the large numbers of nurses retiring will hit the healthcare sector hard in two ways.   

‘’A couple of additional factors that you didn't mention is that we have an aged nurse population, and this isn't just in nursing. This actually spans, I think, almost every major industry in the nation right now. As the Baby Boomer generation retires, multiple people have not only noted, but shown, that the birth rate in most industrialized countries are declining. So there's an immediate discrepancy between the consumers of healthcare and the providers of healthcare, and that's going to be fully realized when most of the Baby Boomers reach that 75-85 age window. And a lot of them are still working right now, but they're in their last few years, and many of them preemptively retired due to COVID. So we had a huge retirement and we have a coming retirement of all of these Baby Boomer aged nurses who were the primary teachers of people like myself, experienced seasoned nurses. They were a career nurse. They were there 30 years, or plus, even, some might say. And that can't be overstated, that when you have such a high proportion of your employees in that age category, ready to move on, it's going to hit really hard. And not only that; they're immediately turning the coin and they're going to be consumer of healthcare. So they're retiring and immediately, within the next five, ten years, they're going to be needing some type of nursing or healthcare situation.’’ 



13:07 Why young people are turning away from nursing as a career option 

Rex said social media and other industries mean that talented people can make money easily without considering nursing.  

‘’Beyond that, and this is just going back to 2016: when I entered nursing, the state of social media and opportunities for income, or let's say not even social media, but opportunities for, let's say, influencer-category income were little to none. That has actually changed. If you're a young person coming out of high school, looking at college or tech school or whatever across the panel, you actually stand a pretty good chance to find a way to earn money without going to nursing school or going to get any type of college degree, if you wanted to directly go into business. Or if you wanted to try to support yourself on YouTube by customizing trucks, to give an example, there's such a higher level of stratification in the last six to eight years of how people can earn money, and the problem is... I'll use it for an example. If I had the opportunity to work for Walmart now, what the hospital was paying for a PCA, I would have worked at Walmart, but the hospital was paying more. And I think this is one of the factors that comes into the shortage. The shortage that's coming up is because there are other industries that young people can get into that can outpace both growth and income than nursing income. It's good in a way, because you have a portion of people who won't chase the money, but then it's bad in a way, because it's hard to get new talent: people who might be really good nurses, but now they're somewhere else.’’ 


16:39 How hospitals benefit from Travel Nurses 

Rex commented that Travel Nurses bring significant experience to a position, but prices are beginning to fall.   


‘’ Where the traveler comes in, they've been there, they've done that, hopefully, and they will just pop right into the situation as an experienced person, and with very little updating, be able to function, maybe while you bring someone else, a new hire, up to speed for three months. A typical traveler contract is 13 weeks, which is three months in change. That's the ideal situation in which a hospital system uses a traveler. Where we're at now, people have left the industry, they're retiring, and healthcare needs are in general growing. So where we're at now, we have this limbo where there's thousands.... I think every major agency advertises that there's 18,000 to 21,000 open spots in the country. And while that doesn't sound like that many as far as a profession, remember there are very few people who are willing to travel as a nurse. We're grounded. We have families. Not everyone's willing like I am to pick up the family and hop over the country for three months. So because of that, you run into a price war. And with COVID, when there was federal money pouring in to assist with COVID emergency stuff, it wasn't that big of a deal for hospitals. But now that that's gone, the hospitals are eating the bill. So prices are coming down, which they have to, but now we're working into, how do I meet my continual short-staffing need with experienced people?’’ 


18:20 The health systems providing their own in-house travel staff 

Rex highlighted the healthcare organizations investing in their own agencies to provide traveling staff. 


’There's HCA, which is also known as HealthTrust, and I know of a couple other examples, which I can't necessarily completely demonstrate this, but many people are buying agencies. By people, I mean hospital systems are buying agencies to staff themselves, and they are paying the people who are agency workers a higher wage, like a traveler would make. And they will even sometimes contract them at a higher rate than their normal staff, but not such a high rate as maybe an outside traveler would make. And they will use these staffing agencies to shore up their semi-long-term needs, if I can make that a term. 

So it's a tactic that people are employing, and there are many people who are travelers like myself, that hospitals, they no longer really heavily enforce that radius rule. If you're not familiar with that, it's rules that facilities set that you can't travel within a certain distance, but what they will say... They need the staff members, right? They will say, "Well, we'll give a local person a slightly lower rate than we would give an away person." So I don't know if that's discouraging enough to get people to come back to work full-time, but those are a couple tactics that hospitals are using to try to shore up their semi-long-term needs for experienced staffing.’’  



25:28 Potential risks of hiring traveling nurses  

Rex highlighted potential risks hospitals face when working with Travel Nurses 

‘’You asked me, have I seen anything that's a risk or liability? Absolutely, and most of it was actually during 2020 and 2021 when I was working in ICU more as a traveler versus procedural work. ... You have to judge them based on who they are, how they do what they do. But I, coming into the situation, have this very moral and personal burden to do my best for every person I possibly can. Not everyone's like that, and many people are potentially accidentally overdosing their patients or maybe not assessing them correctly. And then before the hospital system could ever catch wise, their two-to-four-week contract is already up. They've made their thousands and they're off to the wind. Does this introduce liability? Yes, it definitely does. And how do hospitals vet that? Well, there's legislation being kicked around in various states about capping pay for travelers, which I don't think is the right way. But I think, let's say for the compact licensed nurses, adopting educational standards or standards of practice beyond state lines might be the answer: that people have some type of overseeing standard of practice or authority. ‘’ 



Connect with Jim Cagliostro on LinkedIn 


You’ll Also Hear: 


The effect of the staffing shortage that’s grown since Covid. 92% of respondents to a survey carried out in September 2021 said the pandemic depleted nursing numbers, 66% are considering leaving altogether due to Covid-19. 


Rex’s career experience, via Patient Care Associate to ICU during the pandemic, and his transition to a full-time Travel Nurse. ‘’I enjoy taking care of people so that’s why I’ve stayed in healthcare.’’ 


A change in family life: How working as a Travel Nurse gives Rex more flexibility and family time, ‘’I was working four days a week, 10-hour shifts, and then picking up another fifth day every single week and then picking up additional on-call time to make up for all the income.’’ 


Why the nursing shortage isn’t just about numbers, it’s about finding the right type of people, and why continually raising salaries isn’t a viable long-term solution to the shortage, ‘’….then everybody’s healthcare price goes up coupled in with that.’’ 


The benefits and disadvantages of a career as a Travel Nurse, ‘’I'm perfectly okay accepting the fact that I'm not going to get X, Y, Z health benefits, retirement benefit from the employer, because I'm getting the money. And I'm trying to do what's responsible: pay off my debts, save up money, invest money for the future.’’ 



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