By Robert Longyear
The last three years have been a tumultuous time for hospitals, healthcare organizations, and other employers of registered nurse (RN) labor, especially travel, contingent nurses. Outsized demand for RN labor to cover hospitals beds filled with Covid-19 admissions led to significant rate increases. On the labor force side, the coupling of absences due to sickness, nurse burn out, the increased availability of virtual work, and an existing well-documented general shortage of RN labor has led to a tightening of RN supply—further elevating hourly RN labor rates.
Figure one, shows travel nurse total hourly compensation from January 2022 through March 2023. According to Wanderly data, January 2022 was the peak of the market over the last three years with a steady decline into the summer of 2022. After that significant 1H 2022 decline, rates have stabilized for the first time in three years going into fall and winter 2022. These rates are still significantly elevated from pre-2020 rates prior to the rapid emergence of Covid-19. 2023 has ushered in continued reductions in rates for travel RNs with a ~13% decline in total hourly compensation for RN contingent labor.
Figure 1: Travel RN Median Loaded Hourly Pay (Jan 2022 to March 2023)
Source: Wanderly Data; Loaded Hourly Pay is total nurse received compensation inclusive of stipends and housing allowances reduced to an hourly equivalent.
Looking to the Future
Projecting travel RN rates is a difficult task with so many macro variables at play. Projections must take into account patient services demand, inpatient census projections, seasonality, and key public health indicators (e.g., Covid-19). Whereas on the supply side, projections must take into account labor trends, nurse sentiment, nurse labor market entry by new clinicians, trends in alternative non-acute work opportunities for RNs, and geographic variability. Thus, it is difficult to provide, with sufficient accuracy, a vision for the future. However, it is possible to provide some idea of direction and key considerations.
The rate pattern over the last three years has correlated tightly—very tightly--with Covid-19 incidence rates and hospitalizations. This correlation has remained strong even over the past 6 months (Figure 2). This is likely to still be the best leading indicator for health systems looking to monitor future rate trends in the contingent labor markets. The emergence of a new highly virulent variant or other significant uptick in Covid-19 numbers would likely result in a subsequent increase in contingent labor rates.
Figure 2: Weekly Trends in Number of Covid-19 Cases in the United States Reported to CDC
Source: Centers for Disease Control and Prevention
Importantly, the reduction in labor rates may also correspond with nurses seeking permanent positions. Recent surveys have indicated that many travel nurses may be open to permanent roles again now that the rate gap between contingent labor and full-time labor has begun to close—ERI data suggests average RN pay is $48.22. During the peak of Covid-19, the gap was so large many facilities reported permanent nurses leaving for travel assignments paying as much as double or triple their full-time hourly compensation. However, with the rise of virtual care models and other work-from-home opportunities, permanent roles for RNs may look less like a traditional bedside role—reducing the potential supply of labor for acute care facilities.
Burnout will also continue to play a role in determining the post-pandemic crisis era of healthcare staffing. Nurses who are disinterested in returning to the bedside environment, likely a significant percentage based on the burn-out rates, will also constrain the supply of RNs leading to continue elevated rates for travel RNs.
Technology’s Increasingly Important Role
Data and insights are going to become increasingly important for hospitals and health systems looking to effectively manage contingent labor costs. While rates are declining, most likely due to a reduction in demand due to Covid-19, supply side factors are still uncertain. Rates are likely to remain elevated significantly from 2019 numbers and thus the implementation of cost mitigation strategies will become increasingly important for CFOs and health system executives.
Many healthcare executives have turned to technology via vendor-neutral vendor management systems (VMS) to leverage a competitive market-based approach to cost control. These systems allow hospitals and health systems to accept and manage competitive bids on jobs from a variety of traditional healthcare staffing vendors.
But, taking things a step beyond just VMS approaches, some health systems have adopted data and analytics platforms to closely analyze the trends in nurse pay rates to acquire nurse labor more quickly and cost-effectively. Combining vendor neutral VMS systems with an effective data analytics approach on the labor market side is allowing HR leaders insight into the former staffing Agency pricing “black box.”
Prior to the adoption of these technology systems, hospitals were at the mercy of agencies to set the prices for contingent healthcare labor, but with these technologies some hospitals are gaining a competitive advantage in the market and realizing significant cost savings. Ultimately, as markets mature, technology plays an increasingly important role in allowing purchasers to better understand and control contingent labor costs.
Today, our nation’s health systems need to embrace labor “where it’s at”, offering greater flexibility to clinical and non-clinical professions and thinking outside the box on models of staffing.