On the Road Again: Travel Nursing in Oregon

by Henry Fields

October 17, 2017

What if every few months you could pack your bags and move to a new job, one that welcomed you with open arms?

One season, you’re in Florida, serving a community that desperately needs your skills and spending your down time exploring the coast. After a few months, you’re off to Oregon to both do good and hike the Cascades on extended weekends off.

Depending on your personality, the flexibility may sound like a dream, or the lack of stability might sound like a nightmare. But it’s real life for a travel nurse, or “traveler,” a small but growing subsection of registered nurses (RNs) in the United States.

Although travelers often have an adventurous mindset, the career path is open to any RN with a few years’ experience, especially those in high-demand specialties. This unique arrangement can benefit nurses, healthcare facilities, and local communities alike.

What Is Travel Nursing?

Historically, travel nurses were used to cover planned leaves of absence, such as maternity leave, or short-term increases in the number of patients. Travelers are increasingly used in a variety of settings, including covering hard-to-fill vacancies in particular specialties.
Travel nurses are employed by a staffing agency, which contracts with health care facilities to provide RN coverage for short periods of time. The typical assignment is 13 weeks, but can be shorter or longer depending on the facility’s needs or if the parties agree to an extension. The staffing agency usually helps the traveler locate housing, and can reimburse some travel and licensing costs. They also vet the candidates’ skills and specialties, reducing the administrative burden on healthcare facilities. This arrangement allows travelers to work in areas far from home, and allows healthcare facilities short-term, stable contracts to meet workforce needs.

Nearly all travel nurses in Oregon work in hospitals and health systems. According to The Demand for Nursing Professionals in Oregon, a report from the Oregon Center for Nursing (OCN), nearly 75 percent of hospitals and health systems surveyed reported using travelers in 2015, in contrast with less than 10 percent of all other kinds of facilities.

A Rolling Stone Gathers No Data

Nationwide, the number of travelers is increasing, although good data on the field is hard to come by. No agency or organization keeps steady statistics on the number of travelers, but there are a few things we can say about the occupation.

The number of working travelers fluctuates with the economy and has increased during the recovery. The Professional Association for Nurse Travelers reports that as of 2011 (the most recent data available), there were more than 15,000 travelers working in the U.S., down from a peak of 30,000 before the recession.

Since the end of the recession, demand for travel nurses has rebounded: Kaiser Health News reported that the demand for travel nurses has grown by more than 10 percent a year or more in recent years in conjunction with recent increasing demand for nurses overall.

We can get a ballpark estimate of how many travelers work in Oregon by using some unpublished data gathered by OCN. In the last three years, there were 850 RNs with an active Oregon nursing license who worked in Oregon and lived outside the state certified to practice in the state using licensure they received in another state.

This number includes travel nurses coming from out of state, the largest numbers of which come from nearby states like California, Washington, Idaho, and Arizona, as well as states like Texas and Florida. This estimate captures some non-travelers, such as nurses practicing telemedicine in Oregon across state lines, and fails to capture in-state travelers (such as a Portland-based nurse who works in Ontario or Roseburg).

Based on this data, an estimated 500 to 1,200 travel nurses likely worked in Oregon over the past three years, with fluctuations based on economic conditions and health policy changes. Travelers were a small part of the 33,421 RNs employed in the state in 2014 according to Oregon Employment Department data.

Meeting Oregon’s Healthcare Workforce Needs

As the unemployment rate has declined and a large cohort of nurses in the baby boomer generation nears retirement age, healthcare facilities find it more difficult to fulfill their workforce needs.
There are varying perspectives on how severe a “nursing shortage” the country will face in coming years, but some facts are clear. Demand for RNs is increasing as the population ages and greater health insurance enrollment drives demand for health services.

Our state is projected to have some specific challenges in meeting the demand for healthcare workers. According to the >United States Registered Nurse Workforce Report Card and Shortage Forecast, Oregon is projected to lose ground in its ability to meet RN demand over the period of 2009 to 2030, dropping from a “C” to a “D” grade.

Workforce gaps also tend to be higher in certain regions of the state. The Health Professional Shortage Areas (HPSA) in Oregon, which the Department of Health and Human Services uses to determine eligibility for programs to incentivize providers to work in high-need areas, designates only a few areas of Oregon as non-priority areas.

Although travelers make up only a small portion of RNs, workforce demands in the short term may drive some health care facilities to make greater use of travelers.

How One Oregon Hospital System Uses Travelers

To get a local perspective on the use of travelers in a hospital setting, I spoke with Marie Stehmer, Senior Director of Human Resources for PeaceHealth Oregon. PeaceHealth uses travelers in its hospitals throughout Lane County in patterns similar to other hospitals across the nation, with greater usage in high-need units such as Labor and Delivery, Intensive Care Units, Operating Rooms, Telemetry and Emergency Departments.

“We hire travelers when we have positions open for whatever reason that are difficult to fill, as a stop-gap measure,” Stehmer says. Acute staffing needs can arise during big projects, periods of increased retirements, or short-term events like construction leading to the addition of new beds. For example, during PeaceHealth’s 2016 transition to a new electronic health records system, travel nurses were used to cover the gap caused by the substantial on- and off-the-job training of medical staff to learn the new system.

While there can be an additional cost to travelers in comparison with permanent workers, they can also decrease some financial and nonfinancial costs. Without the flexibility provided by travel nurses, healthcare facilities may end up overworking permanent staff or relying on excessive overtime. “Nursing is hard work,” says Stehmer, and “staff need time to rest and decompress” in order to do their best work and not get burnt out.

Although they bring many benefits, from Stehmer’s perspective, travelers primarily meet a short-term need. Over the long term, hospitals prefer to take approaches that build the permanent workforce, such as hiring and supporting local cohorts of new graduates. They also use internal float pools to manage needs across units. Still, PeaceHealth has had some success bringing travelers into full-time positions, and considers travel nursing one of many ways to introduce potential long-term hires to the system.

Stehmer emphasized that keys to successful travel nurse placements are a good attitude, flexibility, and attention to patient needs. Also, Stehmer says travelers need to have an “understanding of the culture and organization of the place they’re going to. All hospitals are measured on patient experience, so it’s important that every interaction pay close attention to customer service and excellent patient care.”

Although it takes discipline to develop these abilities in the context of short-term assignments, being a highly effective travel nurse and an RN at a traditional position rely on many of the same skills: customer service, attention to detail, and being willing to come to work every day motivated to improve health.

What Motivates a Travel Nurse?

No two travelers have the same motivation and background, but I wanted to know more about what drives some in the profession to do what they do.

Johnathan Hopper, a travel nurse working in Oregon, spoke with me about his experience. Hopper hails from Springfield, Missouri, and worked as a traveler at a number of locations in the Minneapolis metro area before taking a position in the Emergency Department at PeaceHealth Sacred Heart Medical Center at Riverbend in Springfield (Oregon, this time).  

Some travelers are motivated by adventure, others by economic opportunity, he says. The chance to explore a career in a part of the country with higher pay or a more supportive work environment is a draw even for those who don’t love living out of a suitcase. Hopper puts himself more in the second category. He was able to upgrade from a local market where he was making little more as an RN than what he made at a job prior to graduating from college.

He quickly found that the benefits weren’t only financial: he also got access to unique learning opportunities. “I was able to work in teaching hospitals where I saw new research put into practice,” Hopper says. He can “take and share that knowledge with the staff at a rural hospital” on his next rotation.

According to Hopper, it’s important for travel nurses to consider the less glamorous aspects of the job. It takes time to adjust to the local community and learn regional or institutional differences in practice. Travelers have to be ready to spend money on the unexpected, like a car breakdown or high local housing costs.

Those interested in the career also need to be realistic about the risks of separation and isolation. Travelers far from home or who schedule back-to-back rotations without breaks need to consider how their work will affect their relationships. Far away friends and family will still need your attention, and you theirs. “You’re gonna miss your momma,” as Hopper puts it.  

Despite the downsides, Hopper was enjoying his time as a traveler. He took a travel position in Oregon not intending to stay long – he wanted to be closer to family in California, and had heard that RiverBend was a traveler-friendly hospital.

But once he got here, he “just fell in love.”

Part of it was the environment – he loved being close to the coast and mountains. But Hopper was also impressed by the culture of the hospital, where he saw that management supported their staff, there were good nurse-to-patient ratios and compensation was competitive. He saw stronger complementary services, such as support for patients with mental health issues, than he had in facilities where he had worked previously.

After four months in the Emergency Department, Hopper accepted a permanent position in nursing administration at RiverBend.

Hopper says he’s happy to be settling down in Oregon, and appreciates the perspective that working in a range of facilities gave him. He says those varied experiences allowed him to appreciate what was attractive about the culture at PeaceHealth.

Hopper’s experience shows that an advantage of traveling is giving RNs a chance to explore a career in the state they might not have considered. In this case, for the hospital, nurse and local community, the short-term position worked out to long-term benefit.

Travel Nursing – Looking Forward

For those interested in starting a career in travel nursing, the future looks bright, as it does for RNs in general. The Employment Department projects the number of RNs in Oregon will grow by 14.8 percent by 2024. An aging workforce will open new opportunities for younger nurses: the National Council of State Boards of Nursing reported in 2015 that 50 percent of RNs are age 50 or older. Especially during periods of short-term demand, travel nurses will be an important piece of the growing RN workforce.

While we don’t know exactly how travelers will be represented in the future nursing workforce, there will continue to be opportunities in underserved regions and specialties for flexible and motivated RNs. For those with the skills, traveling can be an exciting part of an already rewarding career.

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