When Cat Piper started her career as a registered nurse in Massachusetts, she wasn’t sure where she wanted to work. So, she decided to try out different hospitals, working as a “travel nurse.” It wasn’t long before the arrival of COVID-19.

“The original intent was just to kind of sample the wares. ... I went to a few different places to find where I wanted to be staff,” said Piper. “And then, since the pandemic hit, rates have increased astronomically, and I've stayed in it, really, for money to try to buy a house.”

Travel nurses were once seen as a way to fill staffing shortages or assist in times of increased need, like flu season, and because they are urgently needed, they traditionally make more money than staff nurses. But during the pandemic, hospitals have increasingly relied on travel nurses to fill the gaps. As a result, travel nurses have seen a massive pandemic jump in pay, causing resentment among staff nurses and what many see as unsustainable burden to budgets.

Nursing shortages existed well before the pandemic and have reached “an all-time high” across the country, according to the American Hospital Association. Burnout, low morale and low pay have contributed to an exodus of nurses from the field, and now demand for travel nurses is outstripping the supply.

In a recent assessment of pandemic-related challenges facing hospitals, the American Hospital Association said hospitals have been forced to turn to more staffing with travel nurses in the face of critical staffing shortages and accused contract labor firms of charging “exorbitant prices” during the nursing shortage. They also said high labor costs threaten care by "pushing many hospitals closer to their financial brink."

Patricia Pittman, a professor of health policy and management at the School of Public Health at George Washington University, has called travel nurses “a double-edged sword” — helpful in times of high need but an “excuse” for hospitals not to focus on staffing issues. And she blames short-sighted policies by hospitals that have viewed nurses “as a cost that could be cut when times were tough,” she told GBH News. In the first wave of the pandemic, for instance, Pittman said many hospitals laid off or furloughed nurses in units where elective surgeries were suspended.

“So now, when staffing agencies raised their prices and began paying nurses so much more than they earn in the regular jobs, it has been a shock to hospitals,” said Pittman, who's hopeful the high pay for travel nurses forces hospitals to reconsider pay and retention of staff nurses.

Working as a travel nurse typically lured those early in their career who wanted to see new parts of the country and enjoy adventure while earning a good living. The ability to travel, try out different facilities and even “avoid hospital politics” are still draws, according to Steve Curtin, CEO of "The Gypsy Nurse," a website dedicated to travel nursing. But given the pandemic challenges of working in healthcare, money is what’s driving most travel nursing now.

“Prior to the pandemic, the rates were normally higher, but not as high as they are now — the last two years — because of the pandemic,” Curtin said. “In many cases, they have doubled or tripled what they were, what they previously were.”

Pay varies widely depending on experience and geography, making precise numbers difficult to pin down. But data from Indeed indicates that travel nurses are now making on average more than 30% more than staff nurses — a figure that even falls short of what industry experts say now and excludes sign-on bonuses, insurance and housing and meal stipends.

"I feel like having people come in and having the hospital be willing to pay double or triple what their staff are making is kind of a slap in the face to their staff."
Cat Piper, travel nurse with Boston Medical Center

Piper, who works in the medical intensive care unit at Boston Medical Center, said prior to the pandemic she worked as a staff nurse in Worcester and made a third of what she makes now. She said colleagues have paid off school loans and cars with their travel nurse salaries.

“They’re coming in to make their money and go,” said Piper. “For a lot of people it's life-changing money.”

As an in-state traveler, Piper said she doesn’t get the stipends that a typical travel nurse would get, but she gets good health benefits and a match for her retirement plan. And given shortages, there’s been a rise in those like Piper who don’t have to travel very far to get to their next contract.

“Now we’re finding as people are traveling and leaving one hospital and going down the street and traveling at the next hospital for two to three times the salary,” said Dan Nadworny, director of emergency and critical care at Beth Israel Deaconess Hospital in Milton.

Nadworny also heads the Massachusetts Emergency Nursing Association, which represents 1,100 emergency nurses across the state. He said that, even before the pandemic, there was a need to increase the rate nurses are being paid. Now the pay differences have made for tension among nursing staff.

“For staff to sit there and know you’re working with somebody the same pace or maybe even teaching somebody how to do something and they’re able to only be here for 13 weeks is hard,” Nadworny said.

A group of people, several who have pro-nurse protest signs, hold their hands up to draw attention as a vehicle drives by.
Low staff-to-patient ratios sent nurses at St. Vincents Hospital on strike for nearly 10 months. In this file photo, more than 300 people in front of St. Vincents Hospital as union nurses announce a strike in Worcester, MA on March 7, 2021.
Matthew J. Lee Boston Globe via Getty Images

Local and national data show high levels of vacancies for staff nursing positions, which in turn has driven up demand and openings for travel nurses. The latest nationwide survey of nurse staffing found hospitals face a nearly 10% vacancy rate. The latest data from Aya Healthcare, a national travel nurse staffing agency, shows there are currently 20% more open travel nursing jobs than there were one year ago in Massachusetts: roughly 700 positions in the state out of 35,000 nationally.

A 2021 national survey of nurses by the healthcare job marketplace Vivian found that 40% of new nurses were considering leaving the profession, and cited "decline in morale, increase in stress and general dissatisfaction with pay." The current challenge in the nursing workforce is "a widespread, national problem without a solution until supply-demand equilibrium is achieved," according to a recent report from the Organization of Nurse Leaders, a five-state membership organization that includes Massachusetts.

“The stress levels are probably some of the highest I've ever seen in my career,” Nadworny said.

To retain more nurses, the Organization of Nurse Leaders as well as nursing unions are calling for increased staffing to reduce nurse to patient ratios, more flexibility and growth opportunities and help to manage burnout and stress.

On Curtin's website, there’s talk about the staffing shortages and pay disparities, according to Curtin. But like everywhere in nursing, stress is a big topic for travel nurses as well.

“There are certainly some concerns in the travel nursing population around mental health, self-care, those sorts of things. The travel nurses have been really on the frontlines of the pandemic for the past two years, and it's taking its toll,” said Curtin.

And because travel nurses lack seniority, they're the first to be shuffled around to new units — a source of stress for any nurse, said Piper. Still she's grateful for the high pay, though its a subject she avoids on the job unless she gets approached by staff who are considering travel nursing.

“I've had a lot of people, a lot of staff members ask me about my travel agency, ask me about my recruiter, and then I'll be open and honest,” said Piper. “But it's not something that I openly talk about otherwise, just because I feel like that harbors negative feelings.”

For her part, Piper admits the current pay disparities often make her “feel guilty.”

“It's a stressful job,” said Piper, “and I feel like having people come in and having the hospital be willing to pay double or triple what their staff are making is kind of a slap in the face to their staff.”