Some 60 million people across the country's rural areas rely on small local hospitals for medical care. But as the delta variant rages on, the hospitals that provided a lifeline to these communities now find themselves drained of the resources that sustained them: nurses.
A boom in demand for travel nurses, who work short stints at hospitals around the country to fill high-demand positions, has exacerbated a longtime staffing issue, with rural nurses enticed away by salaries that can be almost 10 times what they made in their hometown.
Nurses at rural hospitals are paid an average of $70,000 a year or just over $1,200 a week, according to hiring website ZipRecruiter. But some staffing agencies such as Nomad Health are offering travel nurse positions with a $5,044 a week salary. White Glove Placement, another nursing staffing agency, offers placements that pay anywhere between $5,800 and $5,900 a week. Health care hiring site Vivian lists several travel nurse assignments that pay up to $9,562 a week.
Covid was uniquely suited to take advantage of every fracture in the rural hospital workforce and widen it significantly.
"If you lose one or two nurses, that makes a difference," said Audrey Snyder, president of the advocacy group Rural Nurse Organization and a faculty member at the University of North Carolina Greensboro School of Nursing. “These hospitals are small hospitals and they don't have a large nurse workforce.”
Years of low patient volume, a high number of uninsured patients, along with government-funded insurance payers, led to a record number of rural hospital closures last year, according to the Cecil G. Sheps Center for Health Services Research.
Dozens of rural hospitals filed for bankruptcy last year, including Eastern Niagara Hospital in Lockport, New York, Faith Community Health System in Jacksboro, Texas, and Pinnacle Healthcare System hospitals in Kansas and Missouri. Another 216 rural hospitals are currently at high risk of closure, said Brock Slabach, chief operations officer with National Rural Health Association.
“The rural hospital workforce has always been a challenge,” Slabach said. “What Covid was uniquely suited to do was take advantage of every fracture and widen it significantly and make it even harder to cope with demands being placed on them.”
Most of the demand is not even directly related to Covid patients, said Susan Salka, CEO of AMN Healthcare Services Inc., on an earnings call last month. Rather, it is "leaves of absence, clinician fatigue, normal patient volumes rising and operating room backlog. Our clients are telling us that this is unlikely to change anytime soon,” she said.
While the surge in popularity of travel nursing has deepened the country’s nursing shortage, it has been a boon for staffing agencies. AMN Healthcare Services Inc., a San Diego-based medical staffing agency, reported a 41 percent increase in revenue from the same time last year. Its travel nurse staffing business alone grew by 37 percent, it reported.
Cross Country Healthcare CEO Kevin Clark told investors in an earnings call last month that travel nurse orders across the staffing agency’s clients increased by nearly 50 percent over the course of the second quarter. Revenue for its travel nurse business rose by 58 percent, he said.
“We are coming out of the pandemic with, I think, flying colors,” he said. “First time travelers are up significantly this year. That trend continued through the second quarter.”
Many nurses are turning to travel nursing in large part because of pay, but also the opportunity to hone their skills and advance their careers, said Nicole Rouhana, director of the graduate nursing program at the Decker School of Nursing at Binghamton University. Nurses in rural areas are considered jacks of all trades, she said. One night they could be working the emergency room and another night they could be assisting with a birth.
“[Travel nursing] is more popular right now and I think it’s partially because we're also a mobile society and there is some attractiveness in going to Southern California and working six weeks and going to the northeast and working in the summer,” she said.
Rouhana, along with other nursing programs and clinics, have rolled out new fellowships and short-term educational experiences for nurses to learn new skills in a rural hospital setting, in hopes that they continue to serve the community. Some state programs will forgive college debt for nurses who spend a certain number of years working in rural hospitals. At the same time, health care companies are offering bonuses. Unity Health in Newport, Arkansas, increased its signing bonus to $15,000 for new bedside nurses. Monument Health in Rapid City, Iowa, is offering experienced nurses up to $40,000, in order to fill several ICU and operating room nurse positions.
But smaller rural hospitals cannot afford to pay nurses a competitive salary, said Shannon Cannon, a professor with Texas Tech University School of Nursing. The counties where rural hospitals are located sometimes have only a couple of thousand residents, which means taxes are lower, she said.
“If you live in a community in rural west Texas with 1,500 to 2,000 people, trying to find a nurse still within that community is hard,” she said. “They get lured away to go to larger cities because the pay is better and there are more attractions, especially for young nurses.”
Patricia Gonzales Meserole, 50, has worked in healthcare in the rural city of Washington, Iowa for over 8 years, currently making about $30 an hour as a nurse. She says she’s been spoiled by the quiet and small town culture of the town. But now she’s on the hunt for a travel nurse position that will give her the hospital experience she craves from a well-resourced institution and provide the salary she needs to stabilize her finances.
“It hurts my heart to tell my boss she’s going to have to replace me, because its hard to find people right now,” she said. “But this is my opportunity to use those skills and make this level of money. My goal is to pay off debt and loans and build a future, because I can’t do that right now.”