By Markian Hawryluk & Rae Ellen Bichell

In March, Claire Tripeny was watching her dream job fall apart. She'd been working as an intensive care nurse at St. Anthony Hospital in Lakewood, Colorado, and loved it, despite the mediocre pay typical for the region. But when Covid-19 hit, that calculation changed.

She remembers her employers telling her and her colleagues to "suck it up" as they struggled to care for six patients each and patched their protective gear with tape until it fully fell apart. The $800 or so a week she took home no longer felt worth it.

"I was not sleeping and having the most anxiety in my life," Tripeny said. "I'm like, 'I'm going to go where my skills are needed and I can be guaranteed that I have the protection I need.'"

In April, she packed her bags for a two-month contract in New Jersey, then a Covid-19 hot spot, as part of what she called a "mass exodus" of nurses leaving the suburban Denver hospital to become traveling nurses. Her new pay? About $5,200 a week, and with a contract that required adequate protective gear.

Months later, the offerings — and the stakes — are even higher for nurses willing to move. In Sioux Falls, South Dakota, nurses can make more than $6,200 a week. A recent posting for a job in Fargo, North Dakota, offered more than $8,000 a week. Some can get as much as $10,000.

Early in the pandemic, hospitals were competing for ventilators, Covid-19 tests and personal protective equipment. Now, sites across the country are competing for nurses. The fall surge in Covid-19 cases has turned hospital staffing into a sort of national bidding war, with hospitals willing to pay exorbitant wages to secure the nurses they need. That threatens to shift the supply of nurses toward more affluent areas, leaving rural and urban public hospitals short-staffed as the pandemic worsens and some hospitals unable to care for critically ill patients.

"That is a huge threat," said Angelina Salazar, CEO of the Western Healthcare Alliance, a consortium of 29 small hospitals in rural Colorado and Utah. "There's no way rural hospitals can afford to pay that kind of salary."

Surge capacity

Hospitals have long relied on traveling nurses to fill gaps in staffing without committing to long-term hiring. Early in the pandemic, doctors and nurses traveled from unaffected areas to hot spots like California, Washington state and New York to help with regional surges. But now, with virtually every part of the country experiencing surges — infecting medical professionals in the process — the competition for the finite number of available nurses is becoming more intense.

"We all thought, 'Well, when it's Colorado's turn, we'll draw on the same resources. We'll call our surrounding states, and they'll send help,'" said Julie Lonborg, a spokesperson for the Colorado Hospital Association. "Now it's a national outbreak. It's not just one or two spots, as it was in the spring. It's really significant across the country, which means everybody is looking for those resources."

In North Dakota, Tessa Johnson said she's getting multiple messages a day on LinkedIn from headhunters. Johnson, president of the North Dakota Nurses Association, said the pandemic appears to be hastening a brain drain of nurses there. She suspects more nurses may choose to leave or retire early after Gov. Doug Burgum told health care workers to stay on the job even if they've tested positive for Covid-19.

All four of Utah's major health care systems have seen nurses leave for traveling nurse positions, said Jordan Sorenson, a project manager for the Utah Hospital Association.

"Nurses quit, join traveling nursing companies and go work for a different hospital down the street, making two to three times the rate," he said. "So it's really a kind of a rob-Peter-to-pay-Paul staffing situation."

Hospitals not only pay the higher salaries offered to traveling nurses but also pay a commission to the traveling nurse agency, Sorenson said. Utah hospitals are trying to avoid hiring away nurses from other hospitals within the state. Hiring from a neighboring state like Colorado, however, could mean Colorado hospitals would poach from Utah.

"In the wake of the current spike in Covid hospitalizations, calling the labor market for registered nurses 'cutthroat' is an understatement," said Adam Seth Litwin, an associate professor of industrial and labor relations at Cornell University. "Even if the health care sector can somehow find more beds, it cannot just go out and buy more front-line caregivers."

Litwin said he's glad to see the labor market reward essential workers — disproportionately women and people of color — with higher wages. Under normal circumstances, allowing markets to determine where people will work and for what pay is ideal.

"On the other hand, we are not operating under normal circumstances," he said. "In the midst of a severe public health crisis, I worry that the individual incentives facing hospitals on the one side and individual RNs on the other conflict sharply with the needs of society as whole."

Some hospitals are exploring ways to overcome staffing challenges without blowing the budget. That could include changing nurse-to-patient ratios, although that would likely affect patient care. In Utah, the hospital association has talked with the state Board of Nursing about allowing nursing students in their final year of training to be certified early.

Demand in Rocky Mountain states

Meanwhile, business is booming for companies centered on health care staffing, such as Wanderly and Krucial Staffing.

"When Covid first started and New York was an epicenter, we at Wanderly kind of looked at it and said, 'OK, this is our time to shine,'" said David Deane, senior vice president of Wanderly, a website that allows health care professionals to compare offers from various agencies. "'This is our time to help nurses get to these destinations as fast as possible. And help recruiters get those nurses.'"

Deane said the company has doubled its staff since the pandemic started. Demand is surging — with Rocky Mountain states appearing in up to 20 times as many job postings as in January. And more people are meeting that demand.

In 2018, according to data from a national survey, about 31,000 traveling nurses worked nationwide. Now, Deane estimated, there are at least 50,000 traveling nurses. Deane, who calls traveling nurses "superheroes," suspects a lot of them are postoperative nurses who were laid off when their hospitals stopped performing elective surgery during the first lockdowns.

Competition for nurses, especially those with ICU experience, is stiff. After all, a hospital in South Dakota isn't competing just with facilities in other states.

"We've sent nurses to Aruba, the Bahamas and Curacao, because they've needed help with Covid," Deane said. "You're going down there, you're making $5,000 a week and all your expenses are paid, right? Who's not going to say yes?"

Krucial Staffing specializes in sending health care workers to disaster locations, using military-style logistics. It filled hotels and rented dozens of buses to get nurses to hot spots in New York and Texas. CEO Brian Cleary said that, since the pandemic started, the company has grown its administrative staff from 12 to more than 200.

"Right now we're at our highest volume we've been," said Cleary, who said that over Halloween weekend alone, about 1,000 nurses joined the roster of "reservists."

With a base rate of $95 an hour, he said, some nurses working overtime end up coming away with $10,000 a week, although there are downsides, such as that the gig doesn't come with health insurance and that it's an unstable, boom-and-bust market.

Hidden costs

Amber Hazard, who lives in Texas, started as a traveling ICU nurse before the pandemic and said eye-catching sums like that come with a hidden fee, paid in sanity.

"How your soul is affected by this is nothing you can put a price on," she said.

She remembers walking into the break room in a hospital in the Bronx at a high-paying job caring for Covid-19 patients during New York's first wave and seeing a sign on the wall about how the usual staff nurses were on strike.

"It said, you know: 'We're not doing this. This is not safe,'" Hazard said. "And it wasn't safe. But somebody had to do it."

The highlight of her stint there was placing a wedding ring back on the finger of a recovered patient. But Hazard said she secured far more body bags than rings on patients.

Tripeny, the traveling nurse who left Colorado, is now working in Kentucky with heart surgery patients. When that contract wraps up, she said, she might dive back into Covid-19 care.

Earlier, in New Jersey, she was scarred by the times she couldn't give people the care they needed, not to mention the times she would take a deceased patient off a ventilator, staring down the damage the virus can do as she removed tubes filled with blackened blood from lungs.

She has to pay for mental health therapy out of pocket now, unlike when she was on staff at a hospital. But as a so-called traveler, she knows each gig will be over in a matter of weeks.

At the end of each week in New Jersey, she said, "I would just look at my paycheck and be like, 'OK. This is OK. I can do this.'"