This is an article I wrote for a journalism class. Though I didn’t end up successfully publishing it, I wanted to post it here. Writing this was a great educational experience, and I could not have done it without the gracious help of many healthcare providers. To everyone who shared their story with me, I am so grateful.
Before COVID-19, travel nurse Brooke Gozdiff says there were three types of travel nurses: “the young and fun, the empty-nesters with motor homes, and the diverters.” But now? Now, it is “Anybody and everybody,” she says. ” If I’m going to work short-staffed in a shitty job and have a crummy work-culture and work-life balance, why wouldn’t I do it greater than one hour away and make a ton more money?”
Brooke and her husband James Gozdiff both began travel nursing in 2014, a couple of years before they met. Brooke left her position as a floor nurse at Mayo in Rochester, Minnesota, and James left his job as an ICU staff nurse in Idaho. Since then, they’ve leveraged travel nursing to fit around their lifestyle rather than mold their lives around their career. And they understand a part of travel nursing that the general public doesn’t: nurses don’t need to travel far to receive travel pay. The Gozdiffs are part of a growing number of people reaping the benefits of travel nursing without much travel.
The boom in travel nursing didn’t take a rocket scientist to predict. According to a study conducted in 2015 by Montana State University healthcare economists, almost 40% of nurses were older than fifty. So they were well on their way to retirement by the time the first group of patients presented with shortness of breath and fever in Wuhan, China in December of 2019.
Initially, hospital censuses decreased as people who would ordinarily seek treatment stayed home. And staffing was stable, with some nurses even able to take advantage of the Family Medical Leave Act (FMLA) to protect their families during the hospital mask shortages of 2020.
Jennifer Higgins, Chief Nursing Officer at Lee Health located in Southwest Florida, explains that when the initial shock of a global pandemic wore off, Lee Health was bombarded with volumes of patients they had never seen before. And these weren’t your stay-a-night-for-observation kind of patients. These were your, holy-crap-she’s-gonna-crash, in need of an ICU bed, kind of patients. Higgins says that while they expanded their ICUs, they didn’t have the ICU-trained nurses they needed to run the units.
They needed more nurses, but so did every other hospital. Desperate, hospitals began offering increased salaries to lure in travel nurses. According to Indeed.com, a job search engine, the average salary for travel nurses in 2021 was $113,600, whereas the average registered nurse made around $80,500. Not only were hospitals paying their travel nurses more, but this pay was structured differently than that of the staff nurses.
Brooke Gozdiff explains that travel nurses receive two different kinds of income: their paycheck and their tax-free stipend. The tax-free stipend covers the secondary living expenses that the nurses accrue while traveling. This money is, just like it sounds, not taxed. So when travel nurses negotiate their salaries, they want their paycheck to be as low as possible, lumping as much money as they are allowed into their tax-free stipend.
But not just anyone can take advantage of the tax-free stipend. According to the IRS, if a nurse needs to sleep and rest outside of his or her tax home between shifts, he or she can qualify for the tax-free stipend. Joseph Conte, a tax-certified public accountant for travel nurses, says that a tax home is typically where a person accrues their income. But because travel nurses frequently move around, their tax home is often where their permanent home is located. Per IRS rules, the nurse must also continue to pay bills on their permanent home and visit it at least once per year, as the tax-free stipend is meant to cover duplicate living expenses.
Conte explains that often companies simplify matters by using a specific mileage rule to determine whether or not their employee can take advantage of the tax-free stipend. The Gozdiffs are familiar with “the 50-mile rule”: the nurse needs to live more than 50 miles from the hospital where they are travel nursing. Conte confirms that the 50-mile rule is not an IRS rule, and he points out that by IRS standards, nurses could live even closer than 50 miles to the hospital if they need to stop to sleep at a spot away from their tax home.
Conte says the volume of nurses taking advantage of local travel assignments has increased significantly over the past two years. This short-distance travel is known as local travel nursing, and it gives the nurses the best of both worlds.
The Gozdiffs are among the increasing number of local travel nurses. While they initially traveled across the country for job opportunities, they are now traveling close to home. Brooke explains their journey with travel nursing in her rapid-fire speech pattern while their one-year-old son naps. Back in her young and fun travel nurse days, Brooke met James, also a travel nurse, at a hospital in Puyallup, Washington. After that, they were inseparable, working together in Arizona, Nebraska, Maine, and Alaska. James proposed in Minnesota, and they married in Oregon.
Before COVID-19 hit, Brooke explains they couldn’t be too picky about placement for travel positions. But now she says, “Every hospital everywhere is hiring travel nurses because every hospital is short. The career is now nurse-driven vs. hospital-driven. You get to pick and choose. You lay out your demands and expect them to be met.” James ballparks that the average travel nurse rakes in $4,000 per week, while staff nurses bring home around $1500. So it is no surprise when he says, “The draw for everybody for travel is just the pay.”
But sometimes, money isn’t everything. After having a baby, the Gozdiffs wanted to be closer to family, so they settled down in Duluth, MN, where they took a break from travel nursing. James took a staff position as a nurse supervisor at Essentia Health. It was there that he watched as nurses from Duluth left their staff positions to cash in on travel positions 154 miles south in Minneapolis, MN. And sure enough, guess who showed up to fill the travel positions now open at Essentia Health in Duluth?
None other than the Minneapolis nurses.
Back at Lee Health, ICU nurse supervisor Betsy Groendyke confirms that the same trend is occurring. Many of their travel nurses come from Tampa, FL, and drive two hours south for their shifts. During COVID-19, her unit doubled the number of travel nurses they were utilizing. When the Delta wave hit, she says, “There were multiple shifts where every nurse had three vented COVID patients. When you have vented ICU patients on multiple drips, you want a two to one [patient to nurse] staffing ratio. And actually, we’ve read things where the best practice for these proning patients [patients who are on a ventilator and need to be positioned lying on their stomachs] is a one-to-one ratio. Well, that wasn’t even a remote option.” Beyond the logistics, they faced an emotional impact. Groendyke recalls a weekend when her ICU lost fifteen patients, “If that doesn’t impact you, then you don’t have a heart.”
And while nurses are used to shouldering the emotional burden, Higgins says, “Many nurses began to evaluate whether they wanted to continue in the profession, be exposed, and have their families exposed to this new variant that was very unknown.” She watched as nurses retired early or left the field of nursing entirely.
Higgins estimates that Lee Health brought on 350-400 travel nurses in 2021, compared to the seventy seasonal travel nurses they typically bring on from November to April when there is a seasonal population increase. She admits, “Most organizations are not going to be able to sustain a model like this. The only reason we were able to is because of the [high] volume [of patients] that offset that cost. But in the long run, long term, it’s not going to be the solution. We are going to have to figure out ways to make sure we keep our core people.”
One way Lee Health is doing this is by offering bonuses and extra shift incentive pay to their staff nurses. They also started bringing in a different food truck each day to prevent cafeteria food burnout and giving $5 gift cards to the hospital coffee shop to recognize staff members for a job well done.
Higgins thinks, “the market will settle down a little bit, but I think there will always be an increased pool of people that are willing to take the risk of being a travel nurse- taking advantage of the money aspect of it.”
Others are not so optimistic. Julia, a nurse who left Lee Health to travel two hours north, and requests to only be identified by her first name, says, “A lot of nurses are tired of being staff. We’ve set ourselves up for, at least, a few years of a complete disaster when it comes to staffing, even if the pandemic ends.”
Now back in Oregon, Brooke Gozdiff drives just over 50 miles away from their home in Keizer to work as a travel nurse. She makes triple what she would if she worked as a staff nurse in Keizer, Oregon. She supports the family on a single income, while James takes care of their one-year-old son and his mom, who was recently diagnosed with stage IV lung cancer. Travel nursing provides her and James with flexibility, adventure, and a cash flow that few other careers could provide.
But the Gozdiffs believe that travel nursing should be the exception, not the rule. James says, “I hope that people come back to the hospital systems because having a core staff that is highly qualified and highly trained and has worked together for years is ideal. The hospital and the unit run so much better when they don’t have a high percentage of travelers. Healthcare is better when you have a high number of staff.”