As Austin nursing shortage grows, traveling nurses help fill gap

Nov 16, 2017
Seton Clinical Assistant Sarah Grover helps a patient in the ER at Dell Children Hospital on Monday, October 9, 2017. While on-staff employees account for the bulk of nurses at area facilities, providers often rely on experienced “traveling nurses” to cover gaps and provide certain specialty skills. RICARDO B. BRAZZIELL / AMERICAN-STATESMAN

It took months for Ashley Senatus to find her first nursing job, and she loved the colleagues and managers with whom she worked over the next three-plus years. She just couldn’t ignore her curiosity and sense of adventure.

So rather than settle into a nursing career in her hometown Miami, she signed on with Cross Country Staffing, one of the country’s largest staffing agencies for health care workers. This summer, she arrived for her first placement—at the Seton Medical Center Williamson in Round Rock.

“The next place that I go, I don’t know how it’s going to compare to Austin,” Senatus said. “I feel like every travel nurse should go there on their first trip.”

Senatus has returned to Florida for an assignment in Tallahassee, so she’s closer to her mother in Miami over the holidays. She’s already looking forward to seeing more of the country and working with different hospitals.

Such is life for a “traveling nurse,” the thousands of nurses in the United States who regularly travel from hospital to hospital, typically spending a few months at an assignment to help round out the corps of on-staff nurses at a health care facility.

Most of them help fill in for the cyclical ups and downs of hospital needs, migrating to help staff up for the flu season or filling in as providers expand their operations. But in Austin and other rapidly growing metro areas, they also help plug the gap between the supply of new nurses and a soaring number of job openings.

Over the next five years, college programs in the Austin metro area will graduate about 750 fewer registered nurses than regional health care providers will need, according to a recent analysis by EMSI, an economic and workforce data firm.

While local health care systems and colleges are working together to try to address the gap, more fundamental forces—from population growth to the aging Baby Boomers—could stretch it even further.

The outsized demand extends well beyond Austin. Among the 53 largest metro areas in the country, 33 will face a projected shortage of registered nurses in the next five years, according to EMSI.

The New York, Los Angeles and Houston metro areas will experience the largest shortfalls, a result of large populations and huge health care industries. Austin’s gap ranks 18th on the EMSI analysis.

The biggest oversupplies came in metro areas with large health-education communities and mature health care industries, including Chicago (5,651 more graduates than job openings), Phoenix (+5,514), Salt Lake City (+4,671) and Minneapolis-St. Paul (+3,349).

However, those four metro areas have shipped fewer than 250 registered nurses to Central Texas, according to an EMSI analysis of online job profiles. And fewer than 200 RNs who list Austin as home base came from Houston-area schools.

More often, registered and other specialty nurses emerge locally. But despite a significant increase of nursing graduates in recent years, the shortfall in Austin and around the country remains.

“There’s a lot of output,” said Joshua Wright, director of economic development at EMSI, “but there’s so much pent-up demand.”

Recruiting and training

The shortfall presents a key challenge for health care providers, but also a promising opportunity for low-wage workers and the educators and workforce-training organizations hoping to boost incomes in Central Texas.

Austin’s rapid growth has raised the cost of living and spurred a rapid increase in the health care industry. Yet while Austin’s cost of living outstrips other major Texas metros area, the industry remains smaller and, on average, offers lower nursing wages.

“It’s an expensive place to live,” said Yvonne VanDyke, chief nursing officer of the Seton Healthcare Family. “Yet we continue to be able to attract nurses. They don’t necessarily live downtown, but they come to work in Austin because of Austin, and they look for certain kinds of organizations to work for.”

Seton, for example, provides a residency program to bring in new graduates and help them gain experience, and they offer experienced nurses a fellowship program that helps them train for a new specialty, VanDyke said.

Hospital care is becoming especially acute, while other less-critical care is increasingly conducted in primary care offices, clinics and homes.

“As health care organizations expand their portfolio of service and their continuum of care, they will be hiring more nurses,” she said, “but they won’t necessarily be working in the halls of hospitals.”

Given the rise in demand — health care-related occupations are projected to be some of the fastest growing labor sectors over the next decade — area educators and workforce experts are racing to ramp up their programs.

The tightest bottleneck in Austin isn’t classroom space or college resources; it’s the availability of slots for hands-on clinical training. Nursing programs require that students work in live situations with real patients and there are only so many local spots to do that, said Pat Recek, health sciences dean at Austin Community College.

All of the area schools coordinate their clinical rotations through a common scheduling platform to help ensure students get the training they need. But it’s still limited.

“It’s not just that there’s a space and a facility,” Recek said, “but it has to be appropriate to that particular level of student and fit their objectives.”

So Austin Community College, like many other nursing programs, wants to incorporate more simulation to replace some of the direct patient care experience. The state Board of Nursing allows some flexibility for simulation, Recek said, and research suggests schools could replace roughly half the clinical experience with quality simulation and maintain the same outcomes.

“We’re not headed to 50 percent right now,” she said, “but one of the things we are doing is moving towards trying to have a more systematic way of using simulation.”

The next phase of ACC’s Highland Center campus will include a large, high-fidelity simulation program. In the meantime, the school has started rolling out another program designed to help nurses with two-year degrees get their bachelor’s degrees.

Research shows that a higher share of nurses with four-year degrees raises the quality of care in a hospital, and heath care accreditation organizations are now encouraging providers to increase the share of nurses with bachelor’s degrees. At Seton, 72 percent of nurses hold at least a four-year degree, and officials said they hope to hit 80 percent across all specialties by 2020.

But even at their most successful, these efforts can do only so much to offset the demographic and economic forces that have caused the nursing shortage.

Growing — and growing older

The aging of the country’s — and the region’s — Baby Boomer population has whipsawed health care providers, raising the need for more health care resources even as many experienced nurses approach retirement.

Austin remains a young metro area on the whole, with more than half the population younger than 35 years old. But health care and other officials also note the region’s emerging “silver tsunami.” The number of Austin-area residents 60 years old or above jumped to 15.3 percent last year from 10.8 percent a decade earlier, according to Census data.

“As Baby Boomer nurses retire, we’re really at the cusp of what could be the most significant shortage this country has every realized, particularly for certain specialties,” VanDyke said. “Pretty much every nursing executive would tell you they have some plan in place to make sure they have a supply of nurses to work in the operating room.”

The sheer speed of Austin’s growth packs a second punch, as population-dependent industries like health care typically lag behind the primary economic drivers of growth. These industries typically receive delayed “secondary signals” about supply and demand, said Guy Berger, an economist for LinkedIn, the business networking site.

“So you’ll have these patterns where cities that are doing poorly end up with stranded workers in secondary industries,” Berger said.

Or, he said, you’ll have fast-growing metro areas such as Austin, where you have a longer-lasting talent shortage in secondary industries.

“The full adjustment can take … a really exceptionally long time — over years or decades — until everything is back in equilibrium,” Berger said.

Travelers fill the gaps

Traveling nurses have been around for decades, but they’ve become more common over the years. Initially, they emerged as fill-ins for hospitals who had to cover for nurses who, for example, went on maternity leave.

Now, most work for large agencies, such as Cross Country Staffing, who forge relationships with various health care providers and can move people around the country as needed.

So when snowbirds flock to Florida over the winter, so to traveling nurses. When Mardi Gras temporarily ups the demand on hospital care in New Orleans, travelers temporarily help handle the influx. And when a shortage of a particular skill arises, travelers fill in the gaps.

“We do use them some to fill particular gaps,” said Lynn Vance, Seton’s senior director for nursing resources. “Operating room nurses is a shortage nationally, and we’ve used some.”

Seton keeps a pool of local part-time and temporary nurses it can tap to handle the usual ebbs and flows of patient traffic. But many hospitals lean more heavily on travelers, particularly in rural parts of the country, Vance and VanDyke noted.

“Fortunately, these (staffing) companies know organizations are looking for high quality nurses, so they screen them well,” VanDyke said.

But the industry is changing, said Liz Seaman, chief nursing officer at Cross Country. The reduction in open heart surgeries in favor of catheterizations, for example, means more demand for catheter lab nurses. The growing use of robotics in the operating room requires a different set of nursing skills to assist.

Cross Country has about 6,000 professionals on contract across virtually all specialties and in all 50 states, Seaman said, and it has its own in-house training services to prepare for the changing needs.

All told, it has relationships with more than 4,000 facilities around the country—from the MinuteClinic in CVS pharmacies to Seton’s Austin-area hospitals.

“We’ve had this relationship for 14 years now, and looking at what’s happened to Seton through the years has been amazing,” Seaman said. “It was just five hospitals back then, now it’s 10. We’ve gone from periods of only 20 to 30 nurses at a time, to 200 to 300 nurses at a time because of expanding hospitals” or replacements needed while on-staff nurses learn new electronic medical records software.

Travelers typically get competitive wages, but they usually don’t pay for housing and, in some cases, get a per diem for other costs. When it all adds up, they tend to be more expensive than full- or part-time staff.

Still, they provide highly qualified professionals to fill the needs of hospitals in Central Texas and around the country. And, given the allure of the higher compensation and a chance to travel around the country, there’s a steady supply.

“At the end of the day, nursing is a very challenging profession,” Seaman said. “It’s hard work, whether a permanent staff member or a traveler.”

Like any staffer, they work weekends and holidays. They’re on call. They don’t get any special treatment on scheduling.

“That doesn’t change when you’re a traveler,” she said. “But obviously sitting on the beach in Hawaii on your days off is nice.”