end of travel nursing

Travel nurses' gold rush is over. Now, some are joining other nurses in leaving the profession altogether.

Working as a travel nurse in the early days of the Covid pandemic was emotionally exhausting for Reese Brown — she was forced to leave her young daughter with her family as she moved from one gig to the next, and she watched too many of her intensive care patients die.

“It was a lot of loneliness,” Brown, 30, said. “I’m a single mom, I just wanted to have my daughter, her hugs, and see her face and not just through FaceTime.”

But the money was too good to say no. In July 2020, she had started earning $5,000 or more a week, almost triple her pre-pandemic pay. That was the year the money was so enticing that thousands of hospital staffers quit their jobs and hit the road as travel nurses as the pandemic raged. 

Two years later, the gold rush is over. Brown is home in Louisiana with her daughter and turning down work. The highest paid travel gigs she’s offered are $2,200 weekly, a rate that would have thrilled her pre-pandemic. But after two "traumatic" years of tending to Covid patients, she said, it doesn’t feel worth it.

“I think it’s disgusting because we went from being praised to literally, two years later, our rates dropped,” she said. “People are still sick, and people are still dying.”

The drop in pay doesn’t mean, however, that travel nurses are going to head back to staff jobs. The short-lived travel nurse boom was a temporary fix for a long-term decline in the profession that predates the pandemic. According to a report from McKinsey & Co., the United States may see a shortage of up to 450,000 registered nurses within three years barring aggressive action by health care providers and the government to recruit new people. Nurses are quitting, and hospitals are struggling to field enough staff to cover shifts. 

Nine nurses around the country, including Brown, told NBC News they are considering alternate career paths, studying for advanced degrees or exiting the profession altogether. 

“We’re burned out, tired nurses working for $2,200 a week,” Brown said. People are leaving the field, she said, “because there’s no point in staying in nursing if we’re expendable.”

$124.96 an hour

Travel nursing seems to have started as a profession, industry experts say, in the late 1970s in New Orleans, where hospitals needed to add temporary staff to care for sick tourists during Mardi Gras. In the 1980s and the 1990s, travel nurses were often covering for staff nurses who were on maternity leave, meaning that 13-week contracts become common. 

By 2000, over a hundred agencies provided travel contracts, a number that quadrupled by the end of the decade. It had become a lucrative business for the agencies, given the generous commissions that hospitals pay them.  A fee of 40 percent  on top of the nurse’s contracted salary is not unheard of, according to a spokesperson for the  American Health Care Association , which represents long-term care providers. 

Just before the pandemic, in January 2020, there were about 50,000 travel nurses in the U.S., or about 1.5 percent of the nation's registered nurses, according to Timothy Landhuis, vice president of research at Staffing Industry Analysts, an industry research firm. That pool doubled in size to at least 100,000 as Covid spread, and he says the actual number at the peak of the pandemic may have far exceeded that estimate.

By 2021, travel nurses were earning an average of $124.96 an hour, according to the research firm — three times the hourly rate of staff nurses, according to federal statistics. 

That year, according to the 2022 National Health Care Retention & RN Staffing Report from Nursing Solutions Inc., a nurse recruiting firm, the travel pay available to registered nurses contributed to 2.47% of them leaving hospital staff jobs.

But then, as the rate of deaths and hospitalizations from Covid waned, the demand for travel nurses fell hard, according to industry statistics, as did the pay.

Demand dropped 42 percent from January to July this year, according to Aya Healthcare, one of the largest staffing firms in the country. 

That doesn’t mean the travel nurses are going back to staff jobs.

Brown said she’s now thinking about leaving the nursing field altogether and has started her own business. Natalie Smith of Michigan, who became a travel nurse during the pandemic, says she intends to pursue an advanced degree in nursing but possibly outside of bedside nursing.

Pamela Esmond of northern Illinois, who also became a travel nurse during the pandemic, said she’ll keep working as a travel nurse, but only because she needs the money to retire by 65. She’s now 59. 

“The reality is they don’t pay staff nurses enough, and if they would pay staff nurses enough, we wouldn’t have this problem,” she said. “I would love to go back to staff nursing, but on my staff job, I would never be able to retire.” 

The coronavirus exacerbated issues that were already driving health care workers out of their professions, Landhuis said. “A nursing shortage was on the horizon before the pandemic,” he said.

According to this year’s Nursing Solutions staffing report, nurses are exiting the bedside at “an alarming rate” because of rising patient ratios, and their own fatigue and burnout. The average hospital has turned over 100.5% of its workforce in the past five years, according to the report, and the annual turnover rate has now hit 25.9%, exceeding every previous survey. 

There are now more than 203,000 open registered nurse positions nationwide, more than twice the number just before the pandemic in January 2020, according to Aya Healthcare.

An obvious short-term solution would be to keep using travel nurses. Even with salaries falling, however, the cost of hiring them is punishing.

LaNelle Weems, executive director of Mississippi Hospital Association’s Center for Quality and Workforce, said hospitals can’t keep spending like they did during the peak of the pandemic.

“Hospitals cannot sustain paying these exorbitant labor costs,” Weems said. “One nuance that I want to make sure you understand is that  what a travel agency charges the hospitals  is not what is paid to the nurse.”

Ultimately, it’s the patients who will suffer from the shortage of nurses, whether they are staff or gig workers. 

“Each patient added to a hospital nurse’s workload is associated with a 7%-12% increase in hospital mortality,” said Linda Aiken, founding director of the University of Pennsylvania’s Center for Health Outcomes and Policy Research.

Nurses across the country told NBC News that they chose the profession because they cared about patient safety and wanted to be at the bedside in the first line of care. 

“People say it’s burnout but it’s not,” Esmond said about why nurses are quitting. “It’s the moral injury of watching patients not being taken care of on a day-to-day basis. You just can’t take it anymore.”

Jean Lee is an associate reporter with NBC News’ Social Newsgathering team in Los Angeles. She previously reported for the NBC News consumer investigative unit.

Trusted Health Blog

Transition Back from Crisis: The Future For Travel Nurses After COVID-19

The COVID-19 pandemic has impacted and continues to impact everyone worldwide. It’s no surprise that healthcare systems and travel nurses still are being impacted and experiencing significant changes. But how has the pandemic changed the world of travel nursing? Let’s discuss the state of travel nursing during the pandemic, the future of travel nursing , and ways to transition for travel nurses.

The State of Travel Nursing During COVID-19

Travel nursing has always been a high-in-demand field. During the pandemic, the state of travel nursing changed worldwide. Let’s explore how the pandemic affected the state of travel nursing.

Demand For Travel Nurses

The demand for travel nursing during the COVID-19 pandemic exploded. The average hours that travel nurses worked increased to over 23% in January 2022 . This number reflects the total number of travel nursing hours worked as a percentage worked by nurses in hospitals. This is a tremendous increase compared to less than 4% hours pre-pandemic numbers.

Hospitals were experiencing and continue to experience nursing shortages due to a variety of reasons. Reasons include staff nurses contracting COVID-19, patients needing a higher acuity of care, or a lack of safe nurse-to-patient ratios. Also, a large number of staff nurses left their full-time jobs. Staff nurses were seeking higher wages, scheduling flexibility, and the opportunity to travel, all of which travel nursing offers .

Changes to Safety Protocols

Safety protocols have also changed during the pandemic. Nurses have always needed to wear personal protective equipment (PPE). Pre-pandemic, PPE most of the time included only surgical masks and gloves. However, since COVID-19 is an airborne illness , this changed PPE and safety protocols worldwide. Travel nurses now additionally wear surgical gowns and N-95 masks or respirators , which protect against airborne droplets.

Sick leave protocols changed because of the pandemic as well. If nurses were experiencing any flu-like symptoms or had a mild headache, they called out sick. This is because COVID-19 symptoms present differently in everyone. Nurses were required to receive a negative COVID-19 PCR test before returning to work. These return-to-work protocols are still changing and vary per healthcare system.

In addition to COVID-19 testing, hospitals have been more lenient on sick time for nurses. Before the pandemic, it was more often than not that travel nurses worked when they were sick. Now, it has become more accepted that it’s ok to not go to work when you are sick-even if it’s not with COVID-19.

👉 Read more: Trusted Benefits

Changes in Pay and Incentives

Travel nurses made approximately $1,673 per week before the COVID-19 pandemic . During the pandemic, travel nurses saw an increase in hourly wages. Sometimes wages were up to three times their pre-pandemic salary. They were also offered sign-on and assignment completion bonuses. Travel nurses were willing to work longer hours due to better benefits and hourly pay. This helped fill the gap with hospital staff nursing shortages.

👉 Read more: Trusted Guide to Nurse Pay

Adaptations To Work and Living Conditions

Travel nurses also had to learn to quickly adapt to the ever-changing work conditions. Early pandemic safety protocols were changing daily, which travel nurses had to keep up with.

Most travel nurses were afraid to visit or go home to family members and friends. This is because, in the early stages of the pandemic, much was still unknown about safety and transmission. Many travel nurses opted to not return home or waited 14 days in quarantine after completing their assignments for fear of transmission to loved ones. 

Many travel nurses have worsening stress levels and burnout rates . Nursing can be a stressful career, but COVID-19 added another layer of stress. Many nurses are seeking counseling from mental health professionals.

👉 Read more: The State of Mental Health in Nursing in 2022

How Will Travel Nursing Change as We Move To a Post-pandemic World?

Now that it appears the pandemic is winding down, it continues to impact the future of travel nursing . There are several ways travel nursing will change as we move post-pandemic.

For instance, healthcare systems are now transitioning back to hiring permanent, full-time nurses, instead of travel nurses. Some travel nursing contracts are being canceled . During the pandemic, many travel nurses were asked to extend their contracts. Now, it’s becoming rarer that healthcare facilities are asking for contract extensions.

Pay rates for travel nurses are starting to decline as well and are returning closer to pre-pandemic numbers. While the demand for travel nursing will decrease, travel nursing contracts will still exist. Many travel nurses will likely return to permanent, full-time positions for more stability. However, they may ask for higher wages, sign-on bonuses, and benefits.

Most likely, healthcare facility and mask safety protocols will not change. While masks are optional outside of healthcare facilities , it’s unlikely this will change inside hospitals for quite some time, if ever.

Call-out and sick protocols have also been impacted by the pandemic. If travel nurses are sick, it requires a negative COVID-19 test to return to work. If they are positive for COVID-19, an isolation period is required before returning to work. Due to the high transmission rate, this protocol will unlikely change in the years to come.

How Can Travel Nurses Adapt to This Transition

The COVID-19 pandemic has impacted travel nurses pre- and post-pandemic. During the pandemic, travel nurses have overcome unforeseen challenges. Now that we are slowly transitioning into a post-pandemic workplace, let’s review how travel nurses can adapt to this transition and the future of travel nursing .

Prepare For Financial Impacts

The need for travel nurses will never completely go away. However, travel nursing contacts are beginning to decline when compared to mid-pandemic numbers. This can have a large impact on travel nurses financially . While salaries are still higher than pre-pandemic numbers, travel nurses should expect to receive less pay.

To prepare, make sure you are saving at least six months of living expenses. 

Another way to prepare is to accept a lower-paying contract that is guaranteed for a longer time frame. This way, it may help you financially prepare and give you a long time to find another contract after your current one ends. Always have a backup contract in mind and voice this to your travel nursing recruiter. Voice your concerns for financial stability to your Nurse Advocate , and most likely, they will help you create a backup plan in case something goes sour.

Lastly, see if your travel nursing agency offers local assignments. As most local assignments have a 50-mile minimum radius, this will allow you to work closer to home. The pay and stipends may be slightly lower than a true travel nursing assignment. But your wages will still be higher than accepting a permanent staff nurse position. Also, if you work closer to home, then you may be able to work another part-time job or find another local assignment.

Update Your Resume

Since some travel nursing contracts are being canceled, it’s also a good idea to start updating your resume . There are several resume writing companies that specialize in travel nursing that can help you update it.

Consider adding new skills to your resume. For example, maybe you are a medical-surgical nurse but floated to the cardiac step-down unit several times. Make sure to add that you cared for COVID-19 patients. Including these shows versatility, commitment to nursing, and learning new skills. 

Also, consider obtaining certifications for your nursing specialty . Certifications will make you stand out amongst other travel nursing candidates. It shows commitment to and advancement in your field of nursing.

Take Care of Your Mental Health

During the pandemic, mental health declined and burnout rates increased amongst travel nurses. Since we are transitioning to life after a pandemic, remember that it’s important to take care of your mental and physical health. Set aside time for self-care activities that you enjoy, such as reading, getting a massage, or meditation. Promoting self-care can improve your mental health and stress levels. 

Since the pandemic, many have reflected on the importance of interactions with family and friends. Talk and plan events with your friends and family to help boost your mental health. If you have a busy schedule, plan phone dates with family and friends. Maintaining healthy relationships can help provide a strong support system. Strong support systems are often needed amongst travel nurses since you’re often far away from home.

If you feel like you are struggling with your mental health, seek support from a licensed therapist or counselor. They can listen to your concerns and improve your mental health. If you feel like you don’t have time to see a mental health professional, there is also Telemedicine. Telemedicine connects you with mental health professionals via smartphone apps.

Take Care of Your Physical Health

It’s also important to take care of your physical health. It can be difficult to take breaks while on shift, making it that much more imperative to take care of your physical well-being. Make sure you are eating healthy. Consume the required amount of vitamins and nutrients in your diet to boost your immunity. Exercise at least 30 minutes five times a week to boost your cardiovascular health. Try activities like walking, riding a bike, or doing yoga.

Remain Flexible

Travel nurses are prime examples of flexibility. It’s crucial to remain and communicate your flexibility when considering nursing assignments. Remaining flexible may help you land your next travel nursing assignment over other candidates. While floating to other areas of the hospital is not always ideal, still, be open to the idea. 

Stay Positive

It’s also imperative to keep a positive attitude. Staying positive can help boost your mood and the moods of those around you. If your travel nursing contract isn’t going as planned, remember that it’s only a few weeks. You will get through it!

Practicing gratitude is another great way to stay positive. Remember that a lot of coworkers and travel nurses are under the same pressures as you. Express your gratitude to them whenever possible by writing them a thank you note or offering to pay for their lunch. A little gratitude goes a long way!

Trusted Health is here to help you navigate the future of travel nursing

If you’re looking for your first or next travel nursing assignment, try Trusted Health . They offer many travel nursing resources, guides, and articles. Trusted Health’s many job listings and travel nursing recruiters will help you navigate the post-pandemic future of travel nursing .

‍ Sign up or log in to get started today!

Amanda Marten NP-C, MSN has been a certified nurse practitioner for over three years. With eight years of nursing experience, she has worked in a variety of specialties including urgent care, travel nursing, post-surgical, and intensive care.

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Why travel nursing will likely outlast the pandemic

Amid staffing shortages and rising hospitalization rates during the pandemic, many hospitals have relied on travel nurses to keep up with patient volumes—and while this practice is straining many hospitals' budgets, it's a trend experts believe will last beyond Covid-19.

The nursing shortage, discussed: A conversation with Advisory Board's top nursing experts

Hospitals are increasingly relying on travel nurses

Currently, there are more than 5 million nurses in the United States, including about 4.2 million RNs, according to the National Council of State Boards of Nursing . However, exhaustion, burnout, and other issues have led many to leave their full-time staff jobs to pursue less stressful careers during the pandemic. In addition, many have transitioned from full-time staff positions to travel nursing because of the increased pay and scheduling flexibility. 

Notably, the United States has enough nurses to fill the necessary full-time positions, according to Linda Aiken, a nursing and psychology professor at the University of Pennsylvania who researches workforce issues, but the issue stems from the harsh working conditions and inadequate pay that existed in full-time nursing since before the Covid-19 pandemic.

"This is not a failure of our supply of nursing," said Aiken. "It's really a failure of hospitals to invest enough of their resources, to have enough nurses working for them."

However, data from Indeed shows that interest in travel nursing continues to climb, with job searches now at more than five times the levels of pre-pandemic searches.

Zachary Shepherd, a 36-year-old ICU nurse, has worked as a travel nurse for the past four years. He has worked in ICUs in Covid-19 hot spots, including Newark, N.J. and Long Beach, Calif. Shepherd said he doesn't mind the uncertainty surrounding his work since he enjoys the flexibility associated with working as a travel nurse.

"I like the empowerment that I feel from being a traveler and having a lot more control over the direction of my career," said Shepherd.  

Meanwhile, hiring for staff nurses declined 3.2% in February 2022 compared with a year earlier, according to the U.S. Department of Labor .

"Everybody is searching for more staff, asking your staff to take on longer shifts," said Troy Clark, CEO of the  New Mexico Hospital Association . "That encourages them to go, 'If I'm going to do all this work, I might as well go become a traveler and get paid a heck of a lot more.'"  

The rise of travel nursing brings budget concerns and wage gaps

In 2021, travel nursing revenue tripled to an estimated $11.8 billion, up from $3.9 billion in 2015, according to  Staffing Industry Analysts . As a result, hospitals and health systems around the country have taken a financial hit from having to rely on highly paid travel nurses—with no clear fix in sight.  

According to ZipRecruiter , during the Covid-19 pandemic, wages for travel nurses surged as high as 3.4 times the wages of regular full-time nurses in January 2021.

In addition, ZipRecruiter in January reported a 15% increase in average monthly postings for open travel nursing jobs. According to Sinem Buber, ZipRecruiter's lead economist, the increase will likely continue as the backlog of patients who need elective procedures return to hospitals and the population continues to age.

"I don't see the trend going down or getting flat anytime soon, even if the pandemic wanes," Buber said. 

Before the Covid-19 pandemic, the  University of New Mexico Sandoval Regional Medical Center  (SRMC) never had to rely on travel nurses. Now, their monthly payroll ranges up to roughly $1.5 million for around 60 travel nurses—almost half as much as the payroll for its full-time staff of 580, who receive around $3.3 million.

During the pandemic, SRMC lost almost a third of its 200 nurses to traveling positions, forcing them to increase staffing levels further to meet the increased demand of Covid-19 patients, said CEO Jamie Silva-Steele. With potential travel nursing costs of $18 million in 2023, Silva-Steele plans to replace 40% of the center's travel nurses with full-time staff by the end of June.

"We are not budgeted for another $18 million in compensation, so we have to have those strategies to gradually reduce those types of staff in the organization," Silva-Steele said. 

To reduce the financial strain brought on by travel nursing, many hospital administrators are making efforts to reduce the number of travelers—and some are considering not renewing travel contracts, Bloomberg reports.

Ultimately, "[w]e want our nurses and all of our clinical staff to be paid fairly, but we have to be able to keep the doors open," Clark said. (Gooch, Becker's Hospital Review , 3/16; Adegbesan, Bloomberg , 3/15)

Workers are feeling overwhelmed by the demands of Covid-19 and are increasingly concerned about pay and staffing shortages. With resignations and even labor strikes on the rise, what can you do to recruit, support, and retain your workforce? We've uncovered the most important insights and turned them into actionable items for you. Whether you are trying to recruit a nursing workforce amid a shortage or simply trying to keep your existing staff, we have curated multiple pieces of expert guidance.

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Posted on March 18, 2022

Updated on March 18, 2023

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Travel Nursing Won’t Solve the Staffing Shortage, But Reimagining Staffing Models Might

Shift flexibility is critical to nurse satisfaction.

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It started as a response to quell the unexpected overflow of hospitalizations during Mardi Gras in 1970s New Orleans but today travel nursing is a contentious topic that has turned into a Band-Aid solution for the nationwide nurse shortage. 

During the pandemic, travel nurses played a key role in filling major gaps stemming from historic levels of staffing shortages. However, the infusion of a temporary, contracted workforce employed by external staffing groups has come under scrutiny, sending shockwaves through the profession and sparking questions about pay equity. One report from the Massachusetts Health Policy Commission even suggests that employing travel nurses contributes to the high turnover rate of permanent clinical staff. The report surveyed nurses from across the state and showed that the staffing shortage is not caused by fewer people wanting to become nurses, but instead is caused by nurses leaving the field after they have already begun working, signaling that health leaders must focus on retention to secure the longevity of a thriving workforce. 

To say that nurses are burned out is an understatement – nursing is in crisis. A recent study found the leading reasons nurses left healthcare employment from 2018 through 2021 included emotional exhaustion, insufficient staffing, family obligations, concerns related to Covid-19, and unsafe working conditions. Looking ahead, the American Hospital Association projects that 610,388 registered nurses (RNs) plan to leave the field by 2027. Over the next three years, hospitals must think creatively and act with an intentional focus on improving core staff retention to fill these staffing gaps. The reason behind the mass nursing exodus from healthcare signals an opportunity for employers to do more to support their current staff and provide the flexibility they are looking for.

With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?

Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.

Travel nursing

If you ask a staff nurse what they think of their visiting colleague, you’ll hear the familiar sentiment that the pay discrepancy between staff is unfair. As one analysis puts it, “[the] perception of pay inequity between the two groups provokes animosity, jeopardizing morale and teamwork.” In addition, an appealing element of travel nursing is the ability to focus on patient care and avoid being involved in the administrative duties of a staff nurse. However, this very benefit for travel nurses can exacerbate permanent staff’s dissatisfaction as they feel that travelers are not invested in the unit they are working in. On the health system side, the high cost of travel nurses is straining hospitals’ already limited resources. Employing a high number of travel nurses is not a sustainable solution to the clinician staffing shortage; health systems must innovate to reduce full-time staff turnover and improve nurse satisfaction, allowing them to only deploy travel nurses where they truly do make an impact during seasonality fluctuations and other extenuating circumstances. The perks of travel nursing – higher pay, a larger focus on patient care and a lesser emphasis on administrative work, and more schedule flexibility – highlight exactly what nurses want from their careers and give health systems a road map to support their permanent staff.

Investing in permanent staff

We all want to feel like we are in the driver’s seat of our careers – and clinicians are no different. That’s why it is imperative to reimagine hospital staffing models to ensure that they center on nurse satisfaction and career longevity. One way to do this is to deploy a ‘float shift’ staffing model. Float shifts operate similarly to float pools, but instead of being confined to the float pool and stepping into the hospital every day without knowing which unit you will be placed in, float shifts give staff the ability to pick up extra shifts for a dollar incentive, while having full visibility into which unit they will be assigned to for that day. An important element of the float shift model is that these shifts complement a clinician’s full-time schedule, giving them more opportunities to make more money or a part-time gig that gives them more control over their schedules and the flexibility they desire. Shift flexibility is critical to nurse satisfaction. As we imagine a future where our health systems have happier and healthier full-time staff, let’s empower nurses to pick what works for their unique needs and limit the likelihood of their burnout and departure from the bedside – or worse, the profession.

A Personalized Approach to Medication Nonadherence

At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.

Photo: baona, Getty Images

Becky Kahn , Chief Client Officer at Works & Trusted Health , is an experienced healthcare workforce solutions and staffing leader. She joined the company in 2019 as the Head of Client Solutions and took a brief hiatus from the company to serve as the Chief Executive Officer at Republic Health Resources, a mid-sized hospital staffing firm. She later rejoined Works & Trusted Health as the Chief Client Officer where she has been responsible for the development of the company’s account management and direct staffing efforts, significantly growing the Trusted presence across the US. Khan was a key player in launching the Works VMS platform to hospitals and health systems across the country.

Before joining Works & Trusted Health, Kahn served as the Managing Director, UK Operations, at Medacs Global Group, the largest provider of international healthcare staffing and workforce solutions in Europe. Prior to that, she spent nearly sixteen years of her career at AMN Healthcare where she held several executive leadership positions and was responsible for the oversight of AMN Healthcare's travel nurse client sales and services and local staffing divisions, as well as the account management of AMN's Managed Services and Workforce Solutions product offering, and technology divisions. Khan launched AMN’s Managed Services solution and grew it over her tenure to over $2 billion in spend under management. Khan is a passionate leader who is dedicated to bringing sustainable workforce solutions to healthcare.

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The Future of Work Issue

‘Nurses Have Finally Learned What They’re Worth’

As the coronavirus spread, demand for nurses came from every corner. Some jobs for travelers paid more than $10,000 a week. Will the boom last?

Chris Detten earned enough as a traveling nurse to make a down payment on a home in Lubbock, Texas. Credit... George Etheredge for The New York Times

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By Lauren Hilgers

• Published Feb. 15, 2022 Updated June 15, 2023

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In the early morning on Mother’s Day in 2020, Solomon Barraza walked into an intensive-care unit in Amarillo, Texas, and, with the fluorescent lights clicking on above him after the night shift, flipped through the stack of papers attached to a gray clipboard — his roster of patients and nurses for the day. Barraza, who was 30 at the time, had only recently become a charge nurse at Northwest Texas Healthcare System hospital. He was technically still a “baby nurse”: Just over a year earlier, he started working his first shifts in the I.C.U. Now he was responsible for overseeing the care of everyone there, making sure his nurses and patients had whatever they needed, answering questions and directing care in case of an emergency. As he looked through his roster, he saw that there were 11 patients on his floor; eight had Covid-19, and five of those were intubated. Then he looked at the other sheet of paper. There would be four nurses working for the next 12 hours. He needed at least six.

He could see the day play out: a cascade of emergencies, a cacophony of beeping alarms and running feet, disasters that ended with overwhelmed nurses and patients crashing alone. And so for the first time, Barraza made the decision to call for “safe harbor” under a Texas law that can be invoked to protect nurses’ licenses while working in conditions that are potentially unsafe for patients. Barraza grabbed a form from the nurses’ station, and one by one, they all signed it.

Almost immediately, the emergencies began. “You need to get over to 18!” someone shouted. Barraza grabbed his mask and ran. He started hand-pumping air into the patient’s lungs with a ventilation bag while two other nurses hooked the bag up to oxygen. They stabilized that patient, and Barraza jogged down the hallways to check on the other seven. One person’s blood pressure was dropping precipitously, and Barraza was preparing to go inside the room when he thought to check on another patient, one door down. That patient’s blood-oxygen level had dropped into the 40s, far below the normal range of 95 to 100. “So what do I do?” Barraza said. “Who do I help first? There are multiple people’s lives at stake at the same time. What if I pick wrong and someone dies?”

A year and a half later, Barraza was sitting on the desk in the middle of the cardiac-intensive-care unit, or C.I.C.U. — which handles both coronary and Covid patients — looking around the group of nurses, remembering those first months of an ongoing crisis. “There were some funky things going on with staffing back then,” he told the group. Nurses were leaving the hospital to take traveling jobs in New York. The rest of the hospital was shut down, so the I.C.U. floor was the chaotic heart of a ghost town. The hospital had yet to hire traveling nurses to pad its local staff, and Mother’s Day felt like a turning point. It was the day Barraza recognized that the pandemic would be defined by twin emergencies, two figures that he would watch anxiously as they rose and fell: the waves of patients on ventilators in his I.C.U., and the number of nurses available to take care of them.

In 2020 alone, Northwest lost 185 nurses — nearly 20 percent of its nursing staff. In the I.C.U., that number was closer to 80 percent. Many of those nurses left to take jobs with travel-nursing agencies, which placed them, on a temporary and highly lucrative basis, in hospitals throughout the country. When the nurses at Northwest quit, the hospital eventually hired its own travelers, who flowed onto Barraza’s floor to work for weeks or months at a time. There have been days when the unit was barely staffed and days when 20 travelers showed up unexpectedly. Barraza has watched friends burn out and retire. He has watched nurses leave for better pay or less stressful jobs. He has welcomed the strangers who have come to take their place — befriending them, folding them into his I.C.U. team and then watching them leave all over again.

Bedside nursing has always been, as one hospital chief executive put it, a “burnout profession.” The work is hard. It is physical and emotional. And hospitals have built shortages into their business model, keeping their staffs lean and their labor costs down. When the pandemic hit, shortages only increased, pushing hospitals to the breaking point. Nationwide, the tally of nurses with both the skills and the willingness to endure the punishing routines of Covid nursing — the isolation rooms, the angry families and the unceasing drumbeat of death — is dwindling. In a survey of critical-care nurses last year, 66 percent of respondents said they were considering retirement.

Sitting on the desk that day, Barraza didn’t know why he kept reflecting on May 2020. He had stabilized those two patients that morning, but that would not always be the case. For the most part, he said, the days bleed together in his mind. Sometimes it felt as if he had spent the last two years running the world’s longest marathon, his adrenaline pushing him from patient to patient, watching people die and trying his best to pause for a moment, just enough time to recognize each as an individual without being overwhelmed by emotion.

“That was the first time we called for safe harbor,” said Matt Melvyn, a veteran nurse who has stayed with Barraza throughout the pandemic. “But it was definitely not the last.”

In the flood of resignations, retirements and shortages that have redefined workplaces across industries these past two years, nothing has been as dramatic or as consequential as the shifts taking place in nursing. The scramble for bedside nurses is tied to everything from how we run our hospitals to the way we value the work of caring for others to our understanding of public health and medicine. And if our health care system has faltered under the weight of the pandemic, it will need hundreds of thousands more nurses to build itself back up.

For at least three decades, hospitals across the United States have followed a model that aims to match nurses precisely to the number of occupied beds. It’s a guessing game that has charge nurses performing daily tallies and hospital administrators anticipating the seasonal movements of illness and people — winter flus and migrating retirees. Many hospitals don’t offer nurses clear paths toward career advancement or pay increases. Depending on demand, they may trade nurses between units. When there are shortages throughout the hospital, they will send out emails and text messages asking nurses to come in and take an extra 12-hour shift. And when the shortages are too great, hospitals turn to travelers.

Even before the pandemic, there were many reasons to hire travelers. Nurses would be brought in for a season, a maternity leave or the opening of a new department. This kind of gig work grew increasingly common, and from 2009 to 2019, according to data from Staffing Industry Analysts, revenue in the travel industry tripled, reflecting a work force that was already in flux. There are hundreds of staffing agencies in the United States — national agencies, regional agencies, agencies that specialize in bringing in nurses from other countries, agencies that send American nurses abroad. In mid-March 2020, there were over 12,000 job opportunities for traveling nurses, more than twice the number in 2019.

Then, as the coronavirus spread, demand came from every corner. By December 2020, there were more than 30,000 open positions for travelers. And with the help of federal dollars — from the CARES Act Provider-Relief Funds and the American Rescue Plan — their salaries started climbing. Job listings in Fargo, N.D., advertised positions for $8,000 a week. In New York, travelers could make $10,000 or more. The average salary of a staff nurse in Texas is about $75,000; a traveler could make that in months.

Nurses often refer to their jobs as a calling — a vocation that is not, at its core, about money. At the same time, nurses have spent years protesting their long hours and nurse-to-patient ratios. In 2018 alone, there were protests in California, Michigan, New York, Pennsylvania and several other states. When the pandemic hit and travel positions opened up in hospitals all over the country, nurses suddenly had more options than ever. They could continue serving patients, continue working grueling hours in frantic conditions, but they would be paid well for it. Travelers were valued. Their work was in demand. The money would be enough that after a few weeks or months on the job, they could go home and recover.

Hospital associations were already beginning to see the steep costs of these workers, but they had little choice in the matter. The shortages were too severe, and they would only get worse. In July 2020, Texas established a statewide emergency staffing system, coordinated by select regional advisory councils. The state has put $7 billion in relief funds toward supplementing staffing, which has allowed hospitals like Northwest to attract travel nurses without shouldering the full cost. “The problem is that their salaries were so much higher than our employee salaries,” said Brian Weis, the chief medical officer at Northwest. “Our employed nurses were doing the same job, but they’re saying, ‘Why are we getting paid a fraction of what these nurses are?’”

The following year, the demand for travel nursing broke loose from Covid. In April and May 2021, as case counts dipped, hospital requests for travel nurses only grew exponentially. “They now know what pent-up demand does to a health care system, and it’s not healthy,” said April Hansen, the group president at Aya Healthcare, one of the largest providers of travel nurses in the country. “If you look at our demand today, it looks like our demand pre-Covid in terms of specialties: med surge, telemetry, I.C.U., emergency room, surgical. It’s just the volume that is being asked for in every specialty.”

It isn’t the traveling-nurse boom alone that has transformed the market. There are also more job opportunities beyond the bedside than ever. Nurse practitioners treat patients in doctors’ offices; insurance companies employ thousands of nurses; Microsoft and Amazon have hundreds of open nursing jobs. Today, only 54 percent of the country’s registered nurses work in hospitals. “There was competition for talent before the pandemic,” Hansen said. “But the pandemic took a small crack and made it as wide as the Grand Canyon.”

To make things worse, the nursing shortage is part of a worker shortfall that spans the entire health care industry. “This is labor across the hospital,” said Rose O. Sherman, an emeritus professor of nursing at Florida Atlantic University. “This is respiratory therapy. This is lab. This is dietary, environmental services. They have not been immune to having an Amazon warehouse open up and losing a significant chunk of their staff.” If labs are backed up, patients have to wait for a diagnosis. If rooms aren’t cleaned, nurses step in to do the work themselves. Barraza has been known to empty bedpans when the housekeeper is too busy.

Even as hospitals have scrambled to hire travel nurses, many have been chafing at the rising price tag. A number of states are exploring the option to cap travel-nursing pay, and the American Hospital Association is pushing for a congressional inquiry into the pricing practices of travel-nursing agencies. Sherman, however, believes that the problem will not be solved until hospitals start considering how to make bedside jobs more desirable.

After two years, nurses have borne witness to hundreds of thousands of deaths. They have found themselves in the middle of a politicized illness and faced countless angry, grieving family members. Many, now, are moving on. They are looking for jobs outside the hospital. Others are simply uprooting themselves — leaving their homes and their families and continuing to do their jobs for a higher salary. “Nurses have finally learned what they’re worth,” Nora Shadix, one I.C.U. nurse, told me. “I don’t think they’re going to go back to the way it was before. I don’t think they’re going to settle.”

One of the nurses who has cycled through Barraza’s staff is Kulule Kenea, who was furloughed from her job as a nurse practitioner in Minneapolis in March 2020 as part of the city’s initial lockdown. She spent her early years working in I.C.U.s and trauma wards. Her uncle was a registered nurse, as was her cousin. It was something she had always wanted to do. Kenea, who is 33, liked her job. She never had that itch to travel or move. Even before starting her furlough, she got text messages from travel agencies looking for nurses willing to fly to New York. She wasn’t sure how the agencies got her number, but the offers kept coming. “I saw and heard other nurses too,” she said, “just getting mass texts out of nowhere.”

Many nurses like Kenea started traveling in the early months of the pandemic. They were nurses who had also been furloughed, nurses whose personal circumstances allowed them to travel, nurses who felt the call to help people in an emergency and nurses who were drawn by the salaries. Ivette Palomeque, who lives in Texas, traveled to Florida during her divorce. Shadix, who was working at BSA Health System in Amarillo, the hospital across the street from Northwest, decided to travel for six months starting in the summer of 2020 after her boyfriend at the time gave her the number for a staffing agency. Susie Scott, a charge nurse in Abilene, Texas, left her job in the fall of 2020, after 19 years at the same hospital; it had become so short-staffed that Scott was doing the jobs of two or three people. Traveling was an escape. “Now, what I do,” Scott told me, “I go in, I take care of my patients and that is it.”

“People were so desperate for this particular skill,” Kenea told me. “My only responsibility at home is to water my plants. I don’t have kids. I don’t have any other responsibilities. It felt wrong. It felt unfair to be able to just sit at home in the comfort of my house when other people are suffering.” Kenea took a contract to travel to New York and was on an airplane within days — there were only a handful of other people on her flight. She spent a night in a hotel, woke up the next morning and boarded a bus heading to a hospital in Harlem. She was assigned to a medical surgical unit and, on her first shift, was given 11 patients, compared with the typical four or five. It was, Kenea said, unreal. “It did not feel like America.” She worked 14 days in a row, 12-hour shifts, compared with the three-day-a-week standard before the pandemic. She did chest compressions on one patient while another was in the room, watching her, terrified.

Kenea’s father sent her text messages daily, asking her to come home and to stop risking her health. “He would send me all these statistics,” she said. “And I would be like: ‘I’m in the hospital. I know.’” A few months later, in July 2020, Kenea contracted with a traveling agency called Krucial Staffing, which specializes in emergency disaster response. She knew her assignment would be in Texas but had to call in to learn which city — the agency was working primarily with nurses who were willing to go anywhere at a moment’s notice. Kenea would have about a day to get her bearings, taking quick tours of I.C.U.s, notebook in hand. The alarms in each I.C.U. have their own sounds. The charting systems change from place to place. “You need to know the pins for certain doors and a telephone number or email for a manager or somebody who can make stuff happen for you quickly,” Kenea said. “You need to get those things down pat first within the first couple of hours: eyes wide open, ears listening sharp, constantly aware of things.”

Kenea was sent to Corpus Christi and assigned to an older part of the hospital that had been reopened to help accommodate the influx of Covid patients. Not long afterward, she was transferred to another ward, where many of the nurses were younger than she was. Kenea worked a relatively manageable five days each week, although the job was still grueling. “I am not afraid of running toward the fire,” she told me. And the staff nurses were welcoming. Some stopped to ask Kenea for advice on how to start traveling themselves.

Barraza’s unit sits on the fourth floor of a tower on the north side of Northwest. It is brightly lit and wide, and most doors have a yellow sign alerting everyone to the need for personal protective equipment. The medical intensive-care unit, or M.I.C.U., where Shadix has been working as a staff nurse after her stint as a traveler, is separated from the C.I.C.U. by a bank of elevators. There, the lights are dim, and most of the patients have been medically paralyzed so the ventilators can work without resistance. Alarms beep, and monitors are facing the glass, the oxygen levels of each patient blinking toward the hallways.

I.C.U. nursing demands a particular set of skills. Nurses here monitor life-support equipment, track patients’ reactions to medications and respond quickly in an emergency. It can be physical work — it takes multiple people, for example, to turn a patient without unhooking any equipment. I.C.U. nurses are trained to titrate several medications and drips. Good nurses can anticipate when a patient is about to crash. They’re expected to handle situations that are unpredictable and patients who are unstable. “If you don’t use those skills,” Kenea said, “you lose it.”

In December 2020, Kenea arrived in Amarillo for an assignment on Barraza’s team. By that time, the hospital had already seen waves of travelers come and go. Before the pandemic, potential travel nurses were carefully vetted by agencies for expertise and good standing. They were required to have clocked at least a year in their specialty, sometimes two or three. Kenea, for her part, had eight years of nursing experience under her belt. During the early days of the pandemic, however, with hospital staffs suffering from shortages and looking for immediate relief, many local nurses and administrators had doubts about the level of experience of some of the travelers who were landing in their I.C.U.s.

When groups of travel nurses started arriving in Amarillo, Barraza barely had time to connect with them before they disappeared. Their contracts didn’t stipulate how long they needed to stay in any particular hospital, and some would be gone within weeks. Barraza worked shifts in which he was the only member of the core staff, unsure of who had the experience to handle an emergency. “There were some travelers that came, and they were amazing,” he told me. “They were some of the best nurses I’ve worked with. But then there were the ones who shouldn’t have been there.”

If the challenge for travelers, before and during the pandemic, has been to do their job in an unfamiliar environment, the challenge for the nurses who stayed was to offer consistency amid the chaos. Barraza knew early in the pandemic that he would stay. He took on the job of keeping up morale and arrived at his shifts with the energy of a favorite aunt. He started taking in baskets of candy and snacks. He knew the moods of his nurses and which patients were feeling scared and in need of company. He knew who needed a break and who could keep going.

As time went on, the work of boosting morale became more difficult as nurses found themselves facing an unprecedented level of hostility from the outside world. A majority of Covid patients now in the I.C.U. at Northwest are unvaccinated — the region hovers below a 50 percent vaccination rate — and restaurants and malls are filled with unmasked people. Melvyn, the veteran on Barraza’s team, said that one of the most difficult parts of the job is walking outside the hospital into a world where it seems that the pandemic is already over. “You are here and it’s a war zone, and you walk outside and there’s no war,” he said. “My whole life we’ve been preparing for a pandemic, but in none of those meetings, in none of those drills, did anyone say, ‘What if there’s a pandemic, and nobody believes it’s a pandemic?’”

Families of patients now yell at staff daily, asking for unproven treatments or accusing nurses of doing harm. They oppose intubation or refuse to wear masks. Shadix still remembers the time a family blamed her for the death of their loved one. “I will always have compassion for my patients,” she said. “But I’m running out of compassion for the families.”

Nurses have compassion fatigue, fatigue fatigue and alarm fatigue, becoming desensitized to the beeps of monitors. Nurses at Northwest have nightmares about crashing patients, nightmares that they’re being intubated themselves, nightmares that wake them up doing chest compressions on their mattresses. Shadix turns on cartoons while she falls asleep to drown out the soundtrack of alarms that plays in her head. A lot of nurses are stoic, she said. They hold it in. They make jokes. “Surely the Lord is going to bless me for putting up with all of this crap,” one nurse told me.

On bad days, Barraza holds the nurses’ hands while they cry. “We have a pretty well versed nurse that has been a nurse for a long time,” he told me. “But there was a day when her patient was going to be intubated, and she was in the hallway crying, saying that this isn’t fair and she couldn’t do it. I hugged her, and I said: ‘It sucks that it is this hard, but you’re here for a reason. I am here for you, and you’re here for me, and we’re here for these people.’” He went on: “I’m still trying to keep holding on to that aspect of my personality and who I am. If I start losing that part of me, then I need to get out.”

When Shadix was traveling, she left her daughter in the care of her mother and ex-husband and struggled to leave her work at work, she said. For months she took it back to her hotel rooms and Airbnbs — the faces of the patients she lost, the feeling of doing chest compressions, the fear in people’s eyes when they came in. Now when she loses someone, she counts to 10 and allows herself to feel all her emotions. Then she takes a breath and does her best to put them aside.

But for many other travelers, the exhaustion and the hostility they regularly face is blunted by their ability to do something staff nurses can’t: leave. Kenea thinks that moving around has helped her navigate the emotional toll of the pandemic without losing hope — she has witnessed death firsthand, but in episodes, each hospital providing a change of scenery. And when she “decommissions” from an assignment, she allows herself a break before she takes a new job. She feels overwhelmed at times but never burned out. At the end of each shift, she assesses her day, and if she feels she has done everything she can, she lets go of it as soon as she leaves the parking lot.

Then, of course, there’s the pay. Kenea has made enough money to help cover the tuition to become a nurse anesthetist. Shadix’s six-month stint as a traveler allowed her to put a down payment on a house. Chris Detten, a traveler at Northwest, was also able to afford a down payment. Adrian Chavira, Detten’s friend and another traveler at Northwest, said the money has made it possible for his partner to stay at home with their new baby. “Money is a very good motivator,” Detten said. There’s a sense that all the hard work is being rewarded. “You don’t have to worry about the politics of the hospital you’re in.” The power plays, the interoffice dramas, the personalities you can’t escape — the travelers are insulated from it all.

“I appreciate that they’re here,” said Karen Hammett, a longtime charge nurse at Northwest. “Am I a little salty that they’re making more than me? Yes.” Hammett was a veteran of the hospital. She had made it through every wave of the pandemic. But last year was her hardest. “It’s having to deal with the secondary stuff that gets to me — the hate is what sucks. And it’s the worst it’s ever been.” She had her last shift at Northwest on Nov. 21. After nearly 20 years at the hospital, she quit.

As I.C.U. beds in city hospitals filled up and staff nurses started leaving in droves, another story of a precariously overextended health care system was unfolding in smaller hospitals across the country. Rural hospitals, which have long sent their most acute cases to larger hospitals, were left with patients they were ill equipped to handle. Many of these hospitals, with lower profits and wages, struggled to retain nurses and compete with the enormous salaries offered by travel agencies. With no padding, entire departments shut down. Only 40 percent of rural hospitals in Texas offer labor-and-delivery services, and with staffing shortages, many deliver babies only a few days a week. There are 71 counties in the state with no hospitals at all. Across the country, 22 rural hospitals have shuttered in the past two years. According to one 2020 study, 453 more are in danger of closing.

Hereford Regional Medical Center is roughly 50 miles southwest of Amarillo. Shortly before Christmas, hospital officials there declared an internal state of disaster — all the travelers had gone home for the holidays, leaving the remaining staff and administrators struggling to keep the doors open. Administrative staff took shifts over Christmas and New Year’s to avoid a complete shutdown. Nursing teachers from Amarillo drove in to help bridge the gap between the departing and arriving traveling nurses. The hospital had stopped performing surgeries and was sending its labor-and-delivery patients to other hospitals. It could no longer take referrals — serving only the people who showed up in the emergency room — and none of the larger hospitals nearby were able to take its acute cases.

Other rural hospitals are reeling from similar shortages. In Missouri, one rural hospital was unable to transfer a patient with acute pneumonia after contacting 19 different hospitals. A nurse saved the woman’s life by staying up all night, loosening the mucus in the patient’s lungs with a hand-held massager. Rural hospitals in New Mexico have reported calling 40 or 50 hospitals in order to find a bed for acute patients. Candice Smith, the chief nursing officer at Hereford Regional, said: “We need staff, we need supplies, we need medicines. We have spent multiple hours on the phone to try to get patients out of here. If they’ve had a stroke or a heart attack or a traumatic brain injury, we’ve been getting them to Dallas or Oklahoma.” Smith sent a request to its regional advisory council asking for more travelers, but she was unsure of when, or whether, they might show up. “As a rural hospital, we can’t pay for them forever,” she told me. “It will cripple the health care industry.”

“There has been an evolution in the travelers,” Smith continued. “Now they don’t come here or to any facility and say: ‘What can I do? I’m willing to work any day you tell me to.’ Now they say: ‘I’m only going to work Sunday, Monday, Tuesday. I’m going to take off for Christmas.’” When I asked Smith if there was anything else she wanted to share, she said simply, “Just tell people to pray for us.”

In light of the grim staffing numbers, both city and rural hospitals have tried to focus on retention efforts, in some cases mirroring the benefits of the travel-nursing industry. Northwest now offers higher overtime rates for nurses who take extra shifts, and BSA started offering better pay overall. In Florida, hospitals are hiring recent nursing graduates and placing them in nursing teams with more experienced personnel. UAMS Medical Center at the University of Arkansas for Medical Sciences is offering a signing bonus of $25,000 to qualified nurses willing to stay for three years. At Parkland Health and Hospital System in Dallas, doctors have been helping ease the burden on nurses by performing some of their duties.

Ronda Crow is the chief nursing officer at Moore County Hospital District, a nonprofit that serves Dumas, Texas, and the surrounding rural areas. She has spent nearly 10 years working on hiring and retaining nurses, including implementing scholarship programs to help local students through nursing school. Everyone was paid a full salary throughout the pandemic whether they were scheduled to work or not — an incentive, Crow hoped, to stay. “We’re lucky here in Dumas,” she told me. The hospital has the backing of a foundation that helps with funding. During the pandemic, Crow has managed to increase her staff and now has the ability to open every bed in the hospital. “By staffing up, it gives me the opportunity to grow nurse leaders,” Crow said. “Is it an expensive gamble? Yes. Will it pay off in the end? Yes.”

Other rural hospitals, however, will continue to struggle. Without state support, many can’t afford to pay the higher wages that nurses are commanding. Fewer patients are insured, and many are older, their illnesses more severe. And experienced nurses are continuing to leave for other, lower-stress jobs. There are around 153,000 new nurses being licensed every year, but based on projected demand, it will not be enough.

For Barraza, each new spike in Covid patients seems to happen overnight. He may know a surge is coming. He may worry about families gathering for the holidays, but the influx always feels sudden. In the fall, Covid cases in Amarillo dropped, and the hospital was assigned fewer state-subsidized nurses. But the moment the travelers started to leave, a wave of new Covid cases began to fill the hospital’s beds. Northwest scrambled to bring in travelers again. Then the Omicron variant arrived. The hospital’s exhausted nurses went into overdrive. In late December, Shadix texted me a GIF of an exploding house.

“It’s bad,” she said. “But it’s fine. We’re fine.” There were new nurses in the medical intensive-care unit, people who had just graduated, and Shadix was watching them flounder. “It’s a sink-or-swim situation,” she said. “And you learn to swim really quickly, because otherwise, people die.” She had taken on many of the hard conversations with families — telling them that their loved ones would probably not make it. “They started calling me the hospice queen,” she said grimly. Families were allowed to enter the I.C.U.s, and Shadix let them, hoping that once they saw how bad things were — how low the quality of life was for their family members — they would start to let them go. Early in the pandemic, Shadix told me, nurses in the M.I.C.U. tried to stay positive, to offer family members a ray of hope until the end. Now they are more realistic. They need to set expectations.

By January, Northwest had made appeals to the regional advisory council and FEMA for more nurses. Covid patients were filling up the emergency room and surgical floor. At one point, Brian Weis, the chief medical officer, knew of 43 patients in rural hospitals waiting for a transfer. Around 75 staff members at Northwest were in quarantine. While travel and military nurses began arriving, core staff continued leaving. Dellani Spradling, a charge nurse in the M.I.C.U. who never anticipated leaving, abruptly resigned in early February. Another Northwest nurse took a traveling job that moved him to the hospital across the street.

Shadix hopes to be a traveler again. She loves the physicians she works with at Northwest — she knows what labs they need and what questions they’re going to ask. But staying doesn’t make sense. “Here you are, killing yourself for five days making pennies,” she said, “versus working four days or three days making three times what you’re making right now.” Once Shadix goes, some of the longest-serving nurses in the M.I.C.U. will be travelers.

Many nurses are hoping to move on from the I.C.U. entirely. Kenea is starting the nurse-anesthetist program in May. Shadix is taking classes toward her nurse practitioner’s license. “Maybe once this is all over and done with, I’ll come back to the I.C.U. and take my normal patients,” she told me. “But if I never have to see another N95 mask in my life, I will not be sad.”

Barraza is hanging on for now, providing as much continuity as he can. In December, he was working six days a week. The C.I.C.U. was so full of Covid patients that it couldn’t take transfers from the emergency room. “We have beds; we just don’t have the ability to staff them,” he told me. “If we do bring them in, we just overwhelm people even more and possibly push them out the door.”

Barraza has begun taking patients himself in addition to overseeing all the nurses in his unit. He tries to take his candy cart down to the nurses in the emergency room now — he knows they are tired, too. Emergency-department doctors are in such huge demand in smaller hospitals that Weis recalled at least one at Northwest who was contacted and told to name his price.

As the new year started, however, even Barraza was beginning to fray at the edges. He has been having trouble falling asleep. He passes out on his couch most nights. “I lay there, and I see the people that I saw all day and the people that I saw before. I try to keep myself centered and not dwell on it too long, because it puts me in a low place.” He thinks, instead, of his staff. He thinks of the nurses who have made it out. He thinks of a patient who recently recovered. He tries to relax, but sometimes his body won’t let him forget.

Lately, as he tries to fall asleep, he has been feeling the phantom pressure of a hand in his — the feeling of a patient about to be intubated, another frightened person on the edge of life and death. “You get all these sensations and feelings,” he told me. “Feeling them grasp you, and feeling their grasp letting go when the medication hits them.”

Lauren Hilgers is a writer based in New York. She is the author of “Patriot Number One: A Chinese Rebel Comes to America.” George Etheredge is a New York City based photographer raised in North Carolina. He was recognized as one of “The 30: New and Emerging Photographers to Watch in 2020.”

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The History of Travel Nursing: Then vs. Now

• November 17, 2022

Modern-day travel nurses are essential to any healthcare ecosystem. The career itself is gratifying, with plenty of personal and professional growth opportunities. However, travel nursing only came into existence as an employment option for nurses a few decades ago. 

Travel nursing was not as popular as it is now, and it took a while for travel nurses to be recognized and compensated for their hard work. However, travelers are currently on the rise, working in various healthcare facilities while exploring the world. This now massive industry has undergone multiple transformations over the years, and it’s essential to know how it came to be.

Travel Nurse Pioneers

Florence Nightingale and 37 other volunteer nurses were the first to travel to another country. They went to Turkey to assist wounded English soldiers from the Crimean War. Six and a half years later, a nurse during the Civil War, Clara Barton, traveled from Europe to Washington D.C. to attend to the wounded from both sides.

Although they weren’t our modern version of “travel nurses” staffed by travel nursing agencies and healthcare organizations, these women sparked the idea that nurses could travel to different locations to assist those in need. 

The Beginning of Travel Nursing

The emergence of hiring travel nurses in America can be accredited to New Orleans, Louisiana, in the late 1970s. Due to the high volume of injuries sustained during the 1978 Mardi Gras week, hospitals filled up and overwhelmed the little staff available. Hospitals in New Orleans contracted nurses around the country to provide extra support for a few weeks. After this incident, the idea of travel nursing took off in the 1980s as a temporary solution to a growing national nursing shortage.

Travel nursing positions continued to be widely accepted and available since the end of the 1980s. Short travel nurse assignments became a cost-effective method for healthcare facilities to deal with staff shortages. For some nurses, it offered a lucrative way to hone their skills and acquire experience in the industry—this is still true for travelers today. As technology and the Internet become more accessible, the allure of travel nursing shot through the roof.

Where We Are Now

The digital age has been an essential factor in helping travel nurses expand their horizons. With limitless information online and mobile technology, hospital organizations can quickly find travel nurses and vice versa. Travel nursing agencies rely on this to better promote the nurses to the organizations.

The COVID-19 pandemic has undeniably impacted the healthcare industry, with shortages across all medical fields. The need for travel nurses skyrocketed due to a lack of permanent staff in various facilities, the high volume of patients, and burnout and exhaustion. Also, as the population ages and life expectancy increases, there is a need for more chronic and long-term care for older generations. The changing demographics and the widening gap among active healthcare professionals have made the travel nursing industry more essential than ever. 

The Future of Travel Nursing

Although the nation has been through a nursing shortage before, the lingering effects of the pandemic have made it difficult for some industries to make a full comeback. Healthcare facilities face as many shortages as they did in the 1980s when travel nursing positions first opened up on a wide scale. Opportunities for travel nurses are not likely to recede any time soon as interest in the profession continues to rise.

In addition to nurses, healthcare professionals like doctors, dentists, pharmacists, physical therapists, social workers, psychologists, nutritionists, and others could all benefit from traveling abroad for work. The demand for these services will continue to grow as we move forward into recovery mode.

Final Thoughts

The number of registered nurses (RN) who work in home health care has increased steadily since 2000. In 2001, RNs working in this field were outnumbered by those employed in hospitals and long term care centers. By 2014, however, home healthcare jobs had outstripped hospital employment. This trend is expected to continue into the future. As baby boomers age, demand for home health services will increase.

If you’re curious to know if you have what it takes to become a traveler, make sure to think about the six travel nursing qualifications and travel nurse requirements that are a must. This industry has come a long way; only time will tell where it’s headed next! If becoming a travel nurse is on your radar, visit Nurse First Travel to learn more about our agency. We update our job board with available travel nursing jobs across the country. Let’s travel!

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How the era of travel nursing has changed health care

Travel nursing is a short-term and unsustainable solution for medical understaffing.

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In 2016, I was working as an ICU nurse in Reno, Nevada. But I didn’t live in Reno. In fact, I hadn’t trained as a nurse in the US at all; I’m from Canada and went to nursing school there. My initial contract was for just 13 weeks. I was what was called a travel nurse — someone who was brought in from a different city, and sometimes even from a different country — to meet a hospital’s temporary staffing needs.

At the start of my contract, we had a couple of days of onboarding and were then expected to hit the ground running. Every morning, I would report to the trauma ICU, one of four ICU units in the hospital, and only then find out where I was assigned, which was sometimes outside the ICU entirely.

Six years ago, travel nursing jobs like my Reno gig were a fringe part of the nursing landscape. But that’s changed. During the pandemic, the need for travel nurses has soared, and so have the wages paid them. Because I was a former ICU and travel nurse, I received frequent emails from travel nursing agencies when the pandemic first erupted, offering upward of $6,000 per week and occasionally as high as $10,000, if I were willing to relocate on as little as 48 hours notice to one of the cities experiencing a Covid-19 surge.

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This was a steep increase from the average US ICU travel nurse’s salary of $1,800 per week, per this 2019 report . (I didn’t accept any of them, but I have to admit it was tempting.)

The rise of the travel nurse in the time of Covid-19 isn’t that surprising. From the earliest days of the pandemic, registered nurses bore the brunt of the increased strain on the health care system. With ICUs across the country overflowing, hospitals were forced to open specialized Covid-19 wards and staffing was strained. Nurses were often required to work grueling hours with heavy patient loads, a shortage of personal protective equipment (PPE), and limited access to Covid-19 testing.

As we enter the third year of Covid-19, the staffing shortage is only getting worse . Many nurses are facing burnout, choosing less arduous roles in non-hospital settings, or retiring from the profession altogether. Others are staying in the profession, but leaving the hospitals that employ them for travel nursing agencies, which offer them better-paying, short-term contracts.

In travel nursing, rather than working directly for a hospital as permanent employees, nurses are hired by a staffing agency, which then arranges time-limited contracts with hospitals to meet temporary or seasonal staffing needs. Over the course of the pandemic, crisis demand for additional staff sent travel nursing wages skyrocketing, and thousands of nurses across the country accepted these offers. While travel nurses previously represented 3-4 percent of all nursing staff across the nation, the figure has risen to 8-10 percent.

Travel nurses are extremely valuable to hospitals, rapidly and flexibly providing critical staff during case surges. But relying so heavily on temporary staff brings disruption. With many of their permanent nurses leaving for lucrative travel gigs, hospitals are increasingly being forced to bring in travel nurses from elsewhere to make up the deficit, leaving teams fragmented. This is especially hard on small rural hospitals, which lack the resources to compete with larger hospital networks.

The massive pay discrepancy is likely a temporary side effect of the crisis and various economic and funding constraints, but the underlying situation is not about to disappear. Covid-19 has taken a nurse shortage that predated the pandemic and dramatically worsened it.

Relying on temporary staff weakens hospital teams, drawing away the best and most experienced nurses and making it that much harder to onboard new staff, train students, and provide high-quality care. With more and more nurses burning out and quitting by the day, hospitals and the federal and state governments have yet to address the factors that would help frontline health care workers stay in the profession. Travel nurses are at best a temporary fix, and the long-term cost is unsustainable.

How travel nursing works

Travel nursing didn’t begin with the Covid-19 pandemic. The idea originated in New Orleans in 1978, as a response to the annual influx of patients during Mardi Gras. The practice became more prevalent over the next decade; by the late 1980s, travel positions had become widely available.

Travel nurses are hired by a staffing agency, rather than a hospital; the agency then arranges contracts with hospitals to provide nurses during periods of temporarily high demand and usually arranges housing for the nurses in their destination city. The standard contract is 13 weeks long, though nurses can sometimes choose to extend it to six months or longer.

In the past, travel nursing wages varied widely by state and region and were often higher than permanent staff salaries (though some of that difference came from the free housing or housing stipend and other incidentals that were often included). Since the start of the Covid-19 pandemic, though, the pay for travel nurses has increased dramatically, and much faster than permanent salaries.

“When I worked as a travel nurse, there wasn’t that much of a discrepancy between my wage and permanent staff,” said Mary Jorgensen, an operating room nurse at UW Health in Madison, Wisconsin, and a former travel nurse. “We were more attracted to travel nursing for the lifestyle of going to different locations. But now that hospitals have this over-reliance on travel nurses to try to make up for the nursing shortage crisis, the amount they’re spending on travelers is astronomical.”

Over the past 18 months, it has become common for many nurses to double their paycheck by choosing the travel route. It’s not for everyone. It requires high levels of adaptability, independence, and tolerance for uncertainty, not to mention the personal freedom to pick up stakes and move temporarily, but for nurses who can take advantage of the opportunity, travel nursing can provide a financial windfall.

Lydia Mobley, a travel nurse with the major travel nursing agency Fastaff, believes that health care workers deserve more pay, and that travel nursing offers a route toward that end. “I know two amazing nurses who are some of my best friends, who are travel nurses and they are single mothers, but they still make travel work because they just want to give their kids the best life possible,” Mobley told me. Thirteen-week contracts also mean that nurses can choose to take breaks to recover in between periods of intense workload.

Mobley also sees the novelty with each contract as a perk, offering nurses (and by extension the hospitals they normally work for, and in the past at least, usually returned to) the chance to learn how other hospitals operate. “Even if a hospital happens to have maybe some older, outdated policies, at least you learned, ‘Hey, that’s a way that that probably should be done,’” she said.

In my case, the experience was very positive. It felt good to be where I was most needed, and to bring my own background and experience to an understaffed unit. By the end of my initial 13-week contract, which I chose to extend for a total of six months, I was familiar with the hospital’s processes, and actually able to provide support and mentoring to the many recently-graduated nurses on the permanent staff.

For hospitals, travel nurses provide a huge advantage in flexibility and response time in a crisis. It’s extremely difficult to hire and fully train a cohort of permanent nursing staff fast enough to respond to a surge in case numbers, which can happen in weeks or even days. Hiring travelers also means that when local case numbers begin to drop, a travel agency can send its nurses on to other states with the highest needs.

Bart Valdez, CEO of Ingenovis Health (which owns Fastaff as well as several other travel nursing agencies), told me how his company was among the first agencies to send nurses to early Covid-19 hotspots like Washington and New York. These staff became early “veterans of Covid,” he said, bringing their experience of the challenges of Covid-19 patients to other facilities.

“A less stable ecosystem”

But there are real downsides to taking this model too far, which are apparent to travel nurses as well as the permanent staff.

For one thing, hospitals end up paying far more in hourly wages for staff who are less familiar with local conditions, which can erode nurses’ teamwork and the quality of care for patients.

Kelly O’Connor, another registered nurse from UW Health, mentioned a colleague of hers left Madison, Wisconsin, for a travel position in Milwaukee the very same week that O’Connor’s unit resorted to hiring a travel nurse from Milwaukee to fill the vacancy at a much higher cost to her hospital. Travel nurses are not only paid a higher hourly wage, but the agencies generally mark up the bill by 32 to 65 percent to turn a profit. (Texas has recently resorted to banning nurses currently in permanent positions from accepting contracts in-state in an attempt to circumvent this dynamic.)

Increasingly relying on travel nurses more often can also warp the inner workings of a hospital. “There was a time when travel nurses were used appropriately, as a ‘Band-Aid,’ but this is beyond that,” O’Connor says. “There’s so much that goes into a hospital running smoothly, and historically if a travel nurse was needed, they were able to pop in, understand the ecosystem quickly, and everything would function as normal.”

But now, she notes, “we’re relying on them too much, and they’re thrown into a less stable ecosystem without the support to figure it out.”

The delicate “ecosystem” of a well-run hospital unit is made up of all the staff needed to keep a medical center running: doctors, pharmacists, lab techs, respiratory therapists, and of course, nurses. To mentor new staff and train travel nurses, the unit needs a certain base of experienced nurses, with years of commitment and investment in the local hospital and community. But with high levels of staff turnover — and many experienced nurses shifting away from bedside care or choosing early retirement due to burnout — this essential resource is in jeopardy.

When the nursing ranks are chronically understaffed and overstrained, even the best nurses can’t spare the time to properly mentor a new staff member, and instead have to tag-team just to cover all the basic tasks.

O’Connor described a revealing situation she found herself in: She realized only in the final few days of a new nurse’s multi-week orientation that she had never found time to show her trainee where the wheelchairs were kept. That’s a basic if important piece of information that would usually have been covered in week one.

“I used to feel that I helped the new nurse grow, and now more often than not we’re having to rely on each other just to get through the workload,” she says. “Nursing is already so hard. This is only making it harder than it needs to be.”

The cost of good care

If experienced, committed permanent nurses are so essential to a hospital’s functioning, providing value that no temporary travel nurse can replace, why aren’t they compensated accordingly?

One contributing factor may be that during the pandemic, crisis funding from government institutions such as the Federal Emergency Management Agency (FEMA) couldn’t easily be allocated to hiring more permanent staff, or toward efforts to retain existing experienced staff via retention bonuses, hazard pay, or other support.

But there are systemic issues at work as well. The National Nurses United is the largest professional association of registered nurses, with more than 175,000 members working at the bedside in nearly every state. Its latest report — titled “Protecting Our Front Line: Ending the Shortage of Good Nursing Jobs and the Industry-Created Unsafe Staffing Crisis” — explores the background of the nursing shortage and the worsening conditions during Covid-19. It lists a number of specific policy recommendations, such as mandated staffing ratios and better workplace safety regulations, that they believe will help create sustainable, rewarding jobs and keep nurses in the field. (On a more local level, Mary Jorgensen and Kelly O’Connor are working with other nurses to form a union with SEIU Healthcare Wisconsin, in hopes of addressing the short-staffing and other challenges that have plagued UW Health during the pandemic.)

Such reforms were needed before the pandemic, and are even more necessary now. The spike in travel nursing demand and pay shows that the system as it exists now is not equipped to respond to a major crisis without significant disruptions that will have serious consequences down the line. The worsening personnel shortage, with many nurses retiring and leaving the profession entirely, is a symptom of a system that prioritizes the short term at the expense of sustainability.

Travel nurses have been a part of the nursing workforce for decades, and as a supplement for temporary needs, they are very valuable. But it’s not fair to either travel nurses, or the patients they care for, to ask them to take on so much of the ongoing essential duties of running a hospital unit.

A hospital relying too heavily on travel nurses will lose institutional knowledge, be less able to fit in new hires or provide nursing students with a strong education, and will end up being a frustrating and draining work environment, leading to more burned-out nurses and a worsening staff shortage at a time when the US can least afford it.

Clarification, March 3, 3:40 pm: This story has been updated to clarify the role of Mary Jorgensen and Kelly O’Connor in the effort to form a nurses union with SEIU Healthcare Wisconsin.

Correction, March 4, 3 pm: Due to a copy-paste error, an update to this article previously transposed the last names of Mary Jorgensen and Kelly O’Connor.

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For travel nurses, jobs at home can't come close to pay they get on the road

Blake Farmer

Nurse Sara Dean of Mount Juliet, Tenn., attends her daughter Harper's gymnastics practice. Dean spent nearly two years travelling the country as a nurse, gaining a much higher salary than she could at home. Blake Farmer/WPLN News hide caption

Nurse Sara Dean of Mount Juliet, Tenn., attends her daughter Harper's gymnastics practice. Dean spent nearly two years travelling the country as a nurse, gaining a much higher salary than she could at home.

Nursing is a second career and a calling for Sara Dean of Mt. Juliet, Tenn. Dean loved her work at Ascension Saint Thomas Hospital. But then the pandemic hit and she saw how much nurses were getting paid to travel — as much as $10,000 a week.

"That's a life-changing number. That's a number that helps you pay off debt, move out of your grandma's basement or whatever," Dean, 38, says. "I'm not saying we were struggling. We were a two-income household. But we made ends meet."

So she took a leave from her hospital job and signed her first three-month contract to go to New Mexico. Her immediate family came with her; her boyfriend could work remotely and her daughter was in virtual school. And when not working, they enjoyed exploring the desert on dirt bikes.

Nurse Sara Dean of Mount Juliet, Tenn., cheers on her daughter, Harper, as she perfects her back handspring. Dean says she stopped taking traveling jobs when 12-year-old Harper was ready for her to return home. Blake Farmer/WPLN News hide caption

Nurse Sara Dean of Mount Juliet, Tenn., cheers on her daughter, Harper, as she perfects her back handspring. Dean says she stopped taking traveling jobs when 12-year-old Harper was ready for her to return home.

Dean eventually quit her job at home as the money got better and better following COVID hotspots from New Mexico to Maryland to rural Alabama. At one point, Dean's overtime rate was more than $200 an hour, and she was working 60 hours a week saving the lives of COVID patients.

But after nearly two years, it was really cheerleading that brought them home.

On a recent weekday afternoon, Dean yelled up the stairs to her 12-year-old, Harper, while blending a protein shake. They were on their way out the door to offseason tumbling practice. Harper was working to perfect her back handspring before next season.

"I didn't really have that many friends," Harper explained about her desire to come home. "I miss it so much being able to be surrounded by different people all the time."

The money was previously unimaginable. But there came a point where being uprooted wasn't worth the sacrifice. Dean says Harper is the ultimate boss.

"She's the one that says, 'No more traveling...I want to go home,'" Dean says. "But that also puts me in a bind."

The pandemic has proven just how valuable highly-trained nurses are.

Hospitals are still paying several times their normal wages to traveling nurses filling in staffing gaps. And turnover is still increasing, with the highest rates in the southeast with roughly one-in-four RNs leaving annually.

But many hospitals won't hire local travelers, even though they're hurting for nurses. They want those RNs to accept full-time positions. And full-time pay, while marginally higher, doesn't come close to the more than $120 an hour that travelers make.

"This makes me sound like I'm in it for the money, but essentially I'm in it for what's best for my family," Dean says.

Sara Dean makes an energy smoothie for her daughter to take to tumbling practice. Supporting her daughter's love of cheerleading and need for social connection brought them off the road after nearly two years of travel nursing during the pandemic. Blake Farmer/WPLN News hide caption

Sara Dean makes an energy smoothie for her daughter to take to tumbling practice. Supporting her daughter's love of cheerleading and need for social connection brought them off the road after nearly two years of travel nursing during the pandemic.

She's been applying at Nashville area hospitals that are still employing hundreds of travelers and holding out for a more acceptable offer.

Hospitals have been exploring ways to get out of relying so much on staffing agencies, who the American Hospital Association has formally accused of price gouging during the pandemic. The AHA has requested that the Federal Trade Commission investigate , though an FTC spokesperson said there has been no inquiry.

Vivian Health is an online marketplace for travel nursing jobs and tracks pay rates across the country. The San Francisco-based tech firm also is assisting hospitals that are trying to move away from their reliance on temporary staffing. And that will require paying full-timers more, said CEO Parth Bhakta.

"You're caught kind of between a rock and a hard place," he says. "I think ultimately health systems need to figure out how to retain their workers more and ultimately, probably, have to pay and incentivize their existing staff more."

The full-time incentives are building. Some hospitals are trying out temporary positions that essentially allow a nurse to work like a traveler without having to leave town. Bonuses have also become the norm for new hires in some parts of the country.

"We are actually seeing a very, very good labor market for nurses with upwards of $15,000 to $20,000 sign-on bonuses for nurses almost anywhere you look around this Nashville area," says Julie Hamm, president of the Tennessee Nurses Association.

Still, the average pay bump last year for full-time nurses was only marginally more than usual nationwide at roughly 4% . And when a nurse has gotten used to making $8,000 to $10,000 a week, a one-time bonus of $20,000 doesn't sound quite so generous, says Sara Dean.

Which is why she and other pandemic travelers face such a difficult transition.

With money in the bank from months on the road, Dean can be a little more choosy about her next job. And she's making the most of her downtime — from spending Christmas with her daughter in New York City to cheering on her preteen at cheer practice.

Meanwhile, she's been trying out something entirely different — working part time at a wellness spa near her house that offers rejuvenating IVs. Beyond how to pull back their nurses from traveling, hospitals are facing burnout like they've never seen. An estimated half million nurses are expected to leave the bedside entirely this year.

"It is refreshing to do preventative health," Dean said. "I have done nothing but death and dying for two years."

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Why You Should Treat the End of Travel Nursing Jobs like Opportunities

The vast majority of travel nursing jobs  are wonderful experiences. You’ll enjoy the hospital, they’ll enjoy you, and it will end amicably. I recommend treating every contract-end as an opportunity to advance your career for three primary reasons. First, you may wish to return to the hospital in the future either as a travel nurse or a permanent employee. Second, you’ll want to ensure that you have references for future assignments and permanent jobs. Third, travel nursing presents a unique opportunity to expand your professional network.

Travel nursing is an opportunity to network

The first two reasons are pretty obvious, but the third reason warrants discussion. As a permanent nurse, your professional network tends to be limited to the people you work with at your one and only job. As a travel nurse, you may become a part of a new team every 3 months . This significantly enhances your networking opportunities. Taking advantage of these opportunities will have a positive impact on your career.

Discover your next travel healthcare job on BluePipes!

Many people are quick to scoff at the idea of professional networking. In my opinion, this is unwise. The vast majority of job openings are never advertised. In fact, I’ve seen numbers from recruitment industry surveys indicating that only 20%-35% of job openings are advertised. A majority of jobs are either filled from within or filled based on referrals from colleagues, current staff, and former staff.

Have you heard of the concept known as “6 degrees of separation”? Most people associate this with the movie star Kevin Bacon. However, there’s a whole interdisciplinary academic field of science devoted to the study of networks, Network Science. Social networks are one of the main topics of study within this field. Researchers have shown that every human on earth has just 6 degrees of separation between every other human on earth through their social networks. Imagine how closely connected the relatively small world of American healthcare professionals is. Meanwhile, the advent of social and professional networking web sites has made it easier than ever for you to manage your own professional network, and for employers to find talent by leveraging their employees’ networks.

Why is networking so important for travel nurses?

There’s a reason that LinkedIn is on pace to generate $915 million in revenue in 2012, just 9 years after being founded. It’s a highly effective tool for both employers and employees. A professional networking service like LinkedIn allows job seekers to view jobs and then see if they have a connection with someone who currently works with the employer, or worked with the employer in the past. Even if the job seeker doesn’t know someone directly, they may have a 2 nd or 3 rd degree connection. They can then leverage their 1 st degree connection to get introduced.

Meanwhile, human resource costs are typically among the largest expenses, if not the single largest expense, for employers. Talent acquisition is a big part of that cost and employers are always looking for ways to reduce their costs. Employers resoundingly believe that interviewing and hiring candidates based on the recommendations of their great employees is a low-cost solution in talent acquisition. They figure birds of a feather flock together. Employers are also more welcoming of those who may be 2 nd and 3 rd degree connections of their great employees. Professional networking services allow employers to take full advantage of this networking solution to talent acquisition.

BluePipes  is an even better option for healthcare professionals interested in utilizing a professional networking service. Studies indicate that employers report better recruitment results when using industry specific services. Therefore, employers like using industry specific sites more than general services like LinkedIn or Monster. As a professional networking service dedicated to healthcare professionals, BluePipes fits the industry specific mold. BluePipes also provides healthcare professionals with features and services designed to help them address their unique career challenges.

Free: Universal Job Application and Credential Management for travelers.

I have worked with many travel nurses and healthcare professionals who capitalized on professional networking. In one case, a travel nurse who had traveled for 2 years ended up marrying her high school sweet heart who lived in Kansas City, MO. She moved there and had difficulty landing a job until she sent messages to her professional network connections asking if anyone had any connections to hospitals in Kansas City. She received a response from a nurse she had worked with in San Francisco, CA who was originally from Kansas City, MO. The travel nurse was put in contact with a Unit Manager at one of the hospitals in Kansas City and ended up landing a job.

In another instance, a travel nurse who had previously completed a travel assignment in Houston, Texas decided she wanted to move there when she was done travel nursing. When the time was right, she contacted her old Unit Manager in Houston via Facebook. The Unit Manager had switched to another hospital and offered to bring the travel nurse on staff at the new hospital. The travel nurse accepted and has been working there for 4 years now.

How to network on your travel nursing  job?

There are many things travel nurses can do to take advantage of networking opportunities, garner positive references, and be welcomed back to the facility. Obviously, being a pleasant, productive, team-player always helps. Participating in extra-curricular activities with your coworkers helps too. Beyond that, there are steps you can take at the end of the assignment that will go a long way.

Negotiate travel nursing pay like a PRO with our free eBook.

Be sure to let your coworkers know that you’re leaving. Let them know you’ve had a good time and thank them for any assistance they’ve provided. Bring treats for your co-workers before you leave if you’d like. Pay particular attention to your supervisors and Unit Manager. I recommend requesting some one-on-one time with them to let them know you’re leaving and ask them how they think you can improve. This shows both that you care and value their input. Ask everyone if they are on a professional network. If they are, then ask them if you can connect with them to stay in touch. If they’re not, then ask them if it would be alright to invite them to yours or stay in touch via email. Finally, try to leave every assignment with at least 1-2 solid references.

You never know where life is going to take you, especially when you’re out there traveling around. Remember, there are only so many hospitals and potential healthcare employers in any given area. Chances are very strong that you’re going to want to settle down as a permanent staff member at some point. Having a strong professional network and references can go a long way toward helping you achieve your career goals.

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Travel Nursing Trends: A Look Into the Future of Travel Nursing

by Trusted Nurse Staffing | Jan 4, 2023 | News | 0 comments

Staffing shortages have kept the need for travel nurses a hot topic since the pandemic in 2020.

With a high demand for nurses, we might expect the coming years to continue offering higher salaries and new opportunities for travel nurses to work short-term contracts around the country. 

Unfortunately, since 2020, burnout and lack of personnel have led many hospitals to seek more help. By staying on top of the many travel nursing trends — from salary to how to handle mental health to an increase in job opportunities and more — you can stay ahead of the game and better prepare for the future of an often challenging career. 

Learn what travel nurse statistics tell us about the future of travel nursing this year and beyond.

Table of Contents

Travel nursing statistics: where does the data come from, pay attention to these 3 big travel nursing trends, 7 additional trends we’re predicting for the travel nurse industry in the coming years, take advantage of future travel nursing trends with trusted nurse staffing.

Many resources work hard to gather data used to help healthcare professionals understand the trends of their jobs. For travel nursing, statistics are gathered from a variety of places.

Every two years, the National Council of States Boards of Nursing (NCSBN) partners with The National Forum of State Nursing Workforce Centers and conducts a survey focused on the nursing profession. The most recent National Nursing Workforce Survey was done in 2022 and generated information on the supply of nurses in the country. 

The findings included things like:

• The median age of RNs was 46
• Male RNs have steadily increased
• Most RNs (57.5%) work in a hospital setting
• The median pre-tax earnings for RNs is $80,000
• Over 60% of RNs reported an increase in their workload since the COVID-19 pandemic

COVID-19 impacted many jobs throughout the United States, but nurses and other medical professionals saw a huge change that altered the way the profession would be in the years following the pandemic.

The Impact of COVID-19 on Travel Nursing

Demand for travel nurses soared in 2020 and 2021 due to the crisis caused by the pandemic. According to data from the American Hospital Association, the percentage of total hours worked by contract or travel nurses in hospitals grew from 3.9% in January 2019 to 23.4% in January 2022. 

Additionally, hospitals spent about 4.7% of their nurse labor expenses on travel nurses in January 2019, while in January 2022, that average reached 38.6%. This increase illustrates the boost the travel nurse profession has seen over the past couple of years. 

Since the onset of the COVID-19 pandemic, the 2022 National Nursing Workforce Study represents the largest, most comprehensive, and most rigorous evaluation of the nursing workforce. This survey concluded that approximately 100,000 RNs and 34,000 licensed practical and vocational nurses have left the workforce since 2020. 

Although travel nurse statistics show that many things require change in the coming years, three big travel nursing trends jump out — demand for travel nurses, pay for travel nurses, and how the mental health of travel nurses is approached.

Demand Trends in Travel Nursing

Many travel nursing specialties are topping the charts for most demand by healthcare facilities between January and March 2023. 

According to report results , these travel nurse specialties are in demand:

• Med-Surg – 17% demand
• Emergency department – 8% demand
• Step-down – 7% demand
• Med-Surg/telemetry – 6% demand
• Medical ICU – 5% demand
• Telemetry – 5% demand
• Operating room – 5% demand
• Labor and delivery – 2% demand
• Rehabilitation – 2% demand
• Psychiatry – 2% demand

The analysis also notes that of all U.S. states, Texas has the most (7%) travel nursing jobs available, likely because it’s a compact state, which means it allows travel nurses to obtain a multi-state license and speeds up the credentialing and employment process for them.

These states followed with the most travel nursing jobs available in the United States:

• California – 6%
• New York – 6%
• Florida – 5%
• Massachusetts – 4%
• Pennsylvania – 4%
• Illinois – 4%
• North Carolina – 4%
• Maryland – 3%

With some percentage of travel nursing jobs still available in these states, it’s clear that healthcare facilities continue to struggle to fill their permanent positions . With this, a reliance on travel nurses will continue to grow.

Pay Trends in Travel Nursing

Before the pandemic, travel nurses made an average of between $1,800 to $2,600 a week. During the pandemic, this number grew to between $8,000 to $10,000 a week. 

In 2022, the average salary for new travel nurses was just under $84,000 a year . ZipRecruiter reports that in 2023, the national travel nurse salary is just over $105,000 a year. 

Yet, it’s also reported that travel nurse salaries can float around $200,000 a year as the need for nurses continues to grow. 

A 2022 report shows that as turnover rates for nurses continue to rise, and the fact that it takes roughly three months to fill a new nurse position, the need for travel nurses is even greater. With high demand comes higher pay.

Pay for travel nurses depends on many things, one being where in the United States you accept a travel nurse contract. ZipRecruiter reports that in 2023, the highest hourly paid states for travel nursing are:

• New York – $61.67
• New Jersey – $53.28
• Wisconsin – $52.95
• Nevada – $52.50
• Wyoming – $52.49
• Massachusetts – $52.40
• Indiana  – $51.79
• Arizona – $ 51.77
• New Hampshire – $51.73
• Pennsylvania – $51.58

And the lowest-paying states were reported as follows:

• Kansas – $43.09
• Michigan – $42.76
• Louisiana – $42.56
• Missouri – $42.47
• Texas – $42.23
• Nebraska – $41.24
• Idaho – $40.99
• Kentucky – $39.73
• North Carolina – $39.7
• Arkansas – $39.04

When compared to RNs with permanent positions , travel nurses are making more, and there are many travel nursing job opportunities available. 

If you’re hoping to take advantage of competitive salaries, Trusted Nurse Staffing can help you find a travel nurse contract that works for you. You can also utilize Pronto to search for current available positions.

Mental Health Trends in Travel Nursing

Amid the pandemic, the mental health of medical staff across the board suffered. Because the pandemic was intensified by a lack of personnel, the fact that many healthcare facilities were not crisis-ready, and inadequate emotional backing, healthcare professionals have been leaving their careers in droves. 

Many issues causing the drop in medical staff, including nurses, have been associated with:

• Lack of support

With the mass exodus in nursing, it became evident that something needed to change. For nurses to provide top-notch care to their patients around the clock, they need to be prioritized — especially their mental health. 

If you find yourself struggling with mental health as a travel nurse, consider some of these options that will become widely available in 2023 and beyond:

• Join a support group
• Attend therapy, in-person or virtual
• Utilize sleep relaxation apps
• Exercise regularly
• Practice gratitude daily
• Confide in family or friends
• Seek professional help
• Take breaks when necessary
• Share or talk about work traumas
• Join an employee assistance program (EAP)

There are many resources available to the nursing community — including the ANA and American Nurse Foundation’s Well-Being Initiative — to help avoid both mental and physical burnout. Once you recognize the triggers, you can help prevent it from happening time and time again.

As a travel nurse pondering the future of your career, there are many trending factors to consider. 

Remember, travel nursing statistics show that a career as a travel nurse is in demand. In 2020, travel nursing grew by 35% and it hit a 40% growth in 2021. Will this trend continue as permanent RN positions are still left open throughout many healthcare facilities? 

If you choose to take on a career as a travel nurse, what could you expect for the future?

#1: An Increase in Travel Nursing Within Hospitals

More hospitals and healthcare facilities are offering internal travel nurse programs as a way to help combat the staff nursing exodus they’ve been experiencing over recent years. 

As travel nursing has become increasingly more popular (thanks to its many benefits ), paired with the effects of the pandemic on healthcare professionals, many hospitals have begun to lose their staff nurses. 

Now, many large healthcare facilities are launching travel nurse programs, offering short-term and high-paying contracts to travel nurses. Some even offer limited benefits. 

For a nurse looking to try out a short-term contract or who wants more flexibility in your work schedule while still remaining local, an internal travel nurse program is a great option that benefits both you as a nurse and the healthcare facility.

#2: An Increase in Flexibility

With the pandemic also came telemedicine and travel nursing to the forefront of society —  and it looks like they’re both here to stay . These two nursing professions offer great flexibility to a nursing career.

Telenursing provides care through technology, allowing nurses to practice their careers remotely with much flexibility. 

Travel nurses get to choose (to an extent) where they want their next assignment to be, allowing them to spend time in different places, experience new locales, and get a feel for different areas of the country. They also can easily take time off between contracts or sometimes have the option to extend a contract if that works best for their lifestyle.

#3: A Steady Number of Opportunities in Nursing

As mentioned earlier, the demand for travel nurses is high . And many different nursing specialties need nurses. 

Between 2020 and 2030, the U.S. Bureau of Labor Statistics estimates that there will be around 194,500 annual openings for RNs — an 8% growth rate over the decade. 

But the demand for nurses doesn’t just come from RNs leaving their positions. 

With the median age of RNs in 2020 being 52 years old, many were/are on the brink of retirement. It’s estimated that one-fifth of the RN population will retire by the end of the decade.

Whether you’re a med-surg nurse, an ER nurse, or a labor and delivery nurse, there are and will continue to be many travel nurse contracts available for you to pursue.

#4: A Growing Demand for Home Health Care Travel Nurses

Today, there are around 46 million baby boomers — adults aged 59 to 77. An Aging in the United States report says that by 2060, this number is expected to be more than 98 million . That’s a dramatic increase!

Because of this increase, it’s expected that about 75% of Americans will need care in a nursing home, offering many opportunities for travel nurses to work outside of a traditional hospital.

#5: A Growing Demand for Behavioral Health Travel Nurses

As a behavioral health nurse, you typically care for patients with behavioral and mental health conditions or substance abuse disorders.

Unfortunately, opioid addictions and suicide rates are rising, and people need help. 

In 2023 , the percentage of adults in the United States with any mental illness is 21%. The percentage of adults with substance abuse disorder is 15%. Overall, 5% of adults have thoughts of suicide.

The U.S. The Department of Health and Human Services states that by 2025, the U.S. will be 250,000 professionals short of what the demand will require. 

#6: Technological Advancements in the Healthcare Profession

Technology is revolutionizing healthcare and the way that medical professionals practice medicine, treat patients, and conduct work regularly. 

Travel nurses will begin to see things like:

• Electronic medical record systems
• Telemedicine platforms
• Mobile health apps and devices
• Wearable technologies for patient monitoring

As travel nurses learn to adapt to these many technological advancements in healthcare, many things can change. 

#7: Consistency Across the Demographics of Travel Nurses

According to a July 2023 report by Zippia , there are over 1,733,502 travel nurses currently employed in the United States. 

• About 85% are women while 15% are men.
• The average travel nurse’s age is 43.
• Regarding ethnicity, nearly 70% are White, 12% are Black or African American, 9% are Asian, and 9% are Hispanic or Latino.

As for the future of travel nursing, these numbers are expected to remain consistent, just as they have over the last decade.

Does the future of travel nursing sound promising? With the many job opportunities available, the pay rates, and the chance to travel to new places, why pass up the chance to work as a travel nurse?

Trusted Nurse Staffing works to connect you with rewarding job opportunities that offer great benefits and competitive pay. We are dedicated to helping you achieve your goals which is why we encourage (and help with) continued education, reward success and accomplishments, and help you pursue your growth. 

With Pronto, you can search for available travel nursing contracts and work alongside your recruiter at Trusted Nurse Staffing to secure your desired contract with the pay and benefits that you deserve.

Contact us today.

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50 Useful Travel Nursing Tips for First-Timers in 2024

Are you an experienced nurse looking for some excitement and a change but not sure what options are available? Do you enjoy traveling? Does meeting new people and learning about new cultures excite you? If so, have you considered what it would be like to become a travel nurse? Perhaps you are wondering how to get started or asking, "What are some useful tips for first-time travel nurses?” If this sounds like you, the 50 useful travel nursing tips for first-timers in 2024 featured in this article are just for you!

WHAT ARE SOME USEFUL TIPS FOR FIRST-TIME TRAVEL NURSES?

1. learn about travel nursing and what it involves., 2. determine your availability to work as a travel nurse., 3. consider working as a float nurse at your current nursing job., 4. consider getting a compact nursing license., 5. update your resume., 6. make sure all licenses and certifications, and immunizations are current., 7. create a medical records portfolio and keep it up to date., 8. gather necessary documents., 9. get excellent letters of professional reference., 10. don't burn bridges., 11. choose the type of transportation you want to use., 12. take care of the tiny details, so you don't feel overwhelmed later., 13. do your research., 14. consider getting a recruiter or agency representative., 15. prepare for the interview., 16. be honest with recruiters and potential employers., 17. ask questions., 18. read the fine print in your contract., 19. create a budget., 20. find out what the early cancellation penalty is., 21. ask if you will be reimbursed if the hospital cancels your contract., 22. consider getting a personal liability insurance policy., 23. think about health insurance., 24. be flexible., 25. plan for housing., 26. don’t pack your whole house, 27. get to know other travel nurses., 28. don’t forget about your fur-babies, 29. be confident about your knowledge and skills., 30. try not to take things personally., 31. if you have a recruiter, stay connected with them., 32. accept assignments with an open mind., 33. don’t forget self-care, 34. arrive in your new town a few days early, if possible., 35. be early for work., 36. find a mentor., 37. learn coping mechanisms to help reduce stress and promote a positive outlook., 38. develop friendships with your new coworkers., 39. enjoy your new town, 40. embrace opportunities to learn and master new skills., 41. create a healthy work-life balance., 42. leave work at work., 43. don’t limit yourself to one agency., 44. remember, travel nurse agencies and recruiters work for you as much as you work for them., 45. consider earning a certification., 46. get experience in different specialty areas., 47. never stop learning, 48. be committed., 49. prepare for your next assignment., 50. have fun, useful resources to help prepare for your first ever travel nursing assignment, youtube videos, • travel nursing 101: what to know before you travel (don’t get played on your 1st contract) -, • travel nurses who left staff jobs reflect on newfound freedom -, • behind the scrubs: the travel nurse experience -, • atlas all access- travel nursing where you belong -, • hitting the road: a guide to travel nursing, • the truth about travel nursing, websites/blogs, my final thoughts, frequently asked questions answered by our expert, 1. is it a good idea to start as a travel nurse right out of college, 2. will travel nursing look good on my nursing resume, 3. when can i start applying for my first travel nursing assignment, 4. what do i need to make sure of in my first travel nurse contract, 5. as a first-time travel nurse, can i choose where to go, 6. i'd prefer to drive to my first travel nursing job. can i do that, 7. what if i get my first travel nursing assignment and i hate it, 8. as a first-time travel nurse, can i make my own schedule, 9. do first-time travel nurses get health insurance and 401k, 10. as a first timer, can i negotiate my pay with my travel nurse recruiter, 11. as a first-time travel nurse, how much will i make, 12. will my first travel nurse stipend be taxable, 13. can first-time travel nurses travel on international assignments.

Travel Nurses and Patient Care: Their Impact on Patient Outcomes and How Hospitals Can Help Them Succeed

• Hospitals are using more travel nurses to fill staffing gaps.
• Travel nurses typically cost more financially than staff nurses.
• The use of travel nurses is sometimes associated with worse patient outcomes based on limited research.

Travel nurses help fill gaps in hospital staffing, but there are questions about their impact on patient outcomes. Hospitals have consistently relied on travel nurses for decades to fill temporary nursing shortages — and that number is only growing – so healthcare providers must understand the potential impact on patient care.

A recently published systematic review concluded that the relationship between travel nurses and patient outcomes is unclear. The use of travel nurses may be associated with some adverse events in patient care, but these events may be due to hospital staffing and work environment issues.

The review found limited or no impact on patient falls, the number of medication errors, or patient satisfaction but a consistent correlation with hospital-acquired pressure ulcers, the severity of medication errors, and the incidence of nosocomial infections (healthcare-associated infections).

Discover how hospitals can better accommodate travel nurses to reduce the effect on patient outcomes.

What Is a Travel Nurse?

Travel nurses take on shorter-term assignments at hospitals, often traveling out of town or state to fill staffing gaps. While many of them work to fill the role of a specific staff member absent for vacation, parental leave, illness, or other reasons, employers also use travel nurses to alleviate nursing shortages.

Travel nurses generally earn higher salaries than staff nurses because of the additional stress of travel, being away from home, and lack of benefits. Travel nurses must adapt readily to new situations, procedures, and colleagues. Registered nurses can become travel nurses as independent agents or through a travel nurse agency.

The total hours worked by travel nurses as a percentage of the total hours worked by hospital nurses grew from 4% in January 2019 to 23% in January 2022, according to the American Hospital Association .

How Does Patient Care Differ Between Traditional and Travel Nurses?

According to the review, staffing levels did show a consistent correlation with travel nurses and worse patient outcomes. This finding is unsurprising since hospitals employ travel nurses to address low staffing levels. There is also a strong and consistent evidence-based association between nursing staff levels and patient outcomes, according to a qualitative study.

Staffing levels were the key variable affecting patient outcomes, according to the systematic review. Some patient outcomes did not show a consistent correlation with the use of permanent/traditional nurses rather than travel nurses. The outcomes that did not show an association include:

• Patient falls
• Number of medication errors
• Patient satisfaction

However, some negative outcomes did show a consistent correlation with the use of travel nurses. These include:

• Hospital-acquired pressure ulcers
• Severity of medication errors
• Nosocomial infections (healthcare-associated infections)

Because the research on patient outcomes and travel nursing is still limited, the systematic review included only 21 articles. Many reviewed articles tracked only one or two patient outcomes, and sometimes, studies of the same outcome found different results. For example, some studies found better outcomes for some variables with greater use of travel nurses. More research is needed to further understand the relationship between the use of travel nurses and patient outcomes.

How Can Hospitals Better Accommodate Travel Nurses?

The review also examined how hospital structures, patient risk factors, and travel nurse experience levels impacted patient outcomes. Ultimately, the work environment strongly correlated to patient care.

The study did not find that the type of unit (such as critical care) had a consistent correlation with outcomes and the use of travel nurses. Similarly, patient risk factors and travel nurse experience levels did not show a relationship between travel nursing use and patient outcomes.

The work environment had the strongest impact on overall patient outcomes. Some, though not all, of the studies in the systematic review, indicated that work environment may be the underlying factor that determines whether travel nurse use is associated with adverse patient outcomes.

Some of the factors associated with a positive work environment include but are not limited to:

• Appropriate level of challenges
• Career advancement
• Collaborative work environment
• Control over work environment
• Manager support
• A non-punitive environment
• Nurse input into error prevention
• Job satisfaction
• Patient-centric culture
• Perception of being valued by leadership
• Support for education and development
• Workplace civility

Hospital work environments and staffing levels may have an association with greater use of travel nurses. If permanent staff find staffing levels inadequate or the work environment unsupportive, they may be more likely to leave. Negative work environments can fuel the nursing shortage, which may lead to greater use of travel nurses. Where adverse outcomes seem to be associated with travel nurses, it is entirely possible that the work environment and staffing levels are the underlying causes.

AHA Senate Statement on Examining Health Care Workforce Shortages: Where Do We Go From Here?” (2023). AHA

Blume K, et al. (2021). Staffing levels and nursing‐sensitive patient outcomes: Umbrella review and qualitative study . NIH

Kieft R, et al. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study . NIH

Krupp A, et al. Intensive Care Unit Utilization Following Major Surgery and the Nurse Work Environment . AACN

Vander Weerdt C, et al. (2023). Travel nurses and patient outcomes: A systematic review . NursingCenter

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How to Get Out of a Travel Nursing Contract the Right Way

By Sarah Wengert

When you sign your contract for a travel nursing assignment, you should do so knowing it’s an important, binding agreement. Travel nursing contracts are there to protect clinicians, facilities, and agencies, and to ensure a staffing need is adequately filled and patient care standards are properly met. That said, there are infrequent circumstances that may merit a contract cancellation.

Who Can Cancel a Travel Nurse Contract?

Both facilities and travelers can cancel contracts, and there are many unique scenarios that could lead to either party doing so.

Hospitals cancel contracts for several reasons. Often it’s due to an error or unforeseen change in seasonal demand forecasts — either of which could lead to an overstaffing problem. EMR/EHR conversion contracts are sometimes canceled for various reasons, too. The healthcare staffing industry also saw many hospitals cancel contracts throughout the COVID-19 pandemic. For example, as elective surgeries were canceled in droves, travel OR nurse contracts followed suit. However, probably the most common reason a hospital might cancel a travel nurse contract is that a traveler’s performance is unacceptable.

Travelers can also cancel a contract in dire circumstances. A supportive recruiter/agency should help you try to troubleshoot to avoid cancelation, when possible, before guiding you through a last-resort cancelation.

Reasons for Breaking a Travel Nurse Contract

In two words: Life happens. But, of course, it’s always more complex than that!

If a traveler legitimately needs to seek a contract cancelation, it’s usually due to a situation like major personal health problems, a family emergency/serious family illness, an unacceptable work environment that may even endanger a traveler’s license, or other such valid reasons.

In the case of an unacceptable work environment, a traveler should make a good faith effort to resolve the issue in other ways before going straight to the level of contract cancelation. First, express your concern to your recruiter. Discuss the issue with them and ask to speak to a member of the agency’s internal clinical team — a quality healthcare staffing agency will have one to better support their travelers on clinical issues! Let your agency’s support system work with the facility as necessary to correct any work environment issues you feel may be endangering you personally or putting your nursing license in jeopardy.

When it comes to a serious personal health problem, well, you can’t pour from an empty cup. If you need time to manage and heal from an illness or other personal health emergency, most agencies and facilities will understand. And it’s similar with an unavoidable family emergency.

Depending on your specific circumstance, you might also consider that a total contract cancelation could be avoided and perhaps the contract could just be amended. For example, you have to go home to help with a family emergency, but you would be able to resume the contract in three weeks. In that case, you might consider discussing all possibilities with your recruiter and potentially avoiding an outright cancelation.

Bad reasons for breaking a travel nurse contract? You found a better assignment with higher pay and decided to bail on this one. You’re just not feeling it. You don’t love (fill-in-the-blank location) like you thought you would. If you find yourself wanting to cancel for these or other such frivolous reasons, just don’t!

Remember, it’s not just about a contract. Your patients, colleagues, facility, and agency are all depending on you, so you should just bide your time and meet your commitment in these types of situations. The contract will be over before you know it and you can move on then — with your professional reputation and integrity intact.

Canceling a Travel Nurse Contract the Right Way

The first thing to ask yourself is,  “ What does the contract say? ”  Every travel nursing contract should specifically address what happens in the event of a cancellation by either you or the facility. If your contract does not cover this situation, then you might also check any service agreements you signed with your travel nursing agency. Some agencies will have you sign a service agreement that covers the professional conduct travelers are required to maintain while on assignment. These types of agreements can also cover what happens in the event of a cancellation by the facility and/or the traveler. If an agency uses service agreements, they’re usually signed on a yearly basis and cover all assignments a traveler might work during the year.

After you review what your contract stipulates — or, in some cases, what it does not state — you should call your recruiter immediately. Be 100% up front with them and explain the reason you want to dissolve your contract. As a healthcare professional, you agreed to a contract and should have a good reason for wanting to sever it.

After you fully explain your situation and reasoning to your recruiter, then it’s your turn to listen. A great recruiter is willing to listen and provide helpful feedback and solutions. In fact, in this trying situation, you’ll see just how good your recruiter and agency are. When you come to a recruiter with a legitimate need to cancel, you should never feel threatened or bullied by them or the agency. You might also find that they’re willing to work with you to minimize the damage and provide you with other travel opportunities in the future.

Open communication is key if you ever need to modify or cancel a travel nursing contract. If you intend on traveling again once the situation is resolved, make sure to tell your recruiter that. As previously mentioned, with the blessing of your agency and facility it might even be possible for you to take off a few weeks and then return to your assignment when you’re able. The point is, don’t just call your recruiter and say, “I need to break my contract.” Explain your situation and work with your recruiter to find a solution that will make you, the facility, and your company as happy as possible.

Also, you should give as much notice as possible. If you foresee a potential contract-canceling issue on the horizon, it’s never too early to bring it up as a possibility to your recruiter. That way they can help you monitor the situation and plan ahead. If it never ends up happening, they’ll be elated for you and the contract. Depending on your situation you should also attempt to cover as many of your scheduled shifts as you can. This is a show of good faith and will mean a lot to the other parties involved.

Canceling a contract is never something we’d encourage. However, things do happen that are beyond our control and might require such a drastic decision. If you handle yourself properly, you can minimize any costs and negative outcomes from breaking your contract.

Consequences of Canceling a Travel Nursing Contract

Depending on the terms of your contract, there may be repercussions that fall on you, your recruiter, and/or the agency you’re working with. For example, if your agency provided housing, it’s probably still on the line for that, and you may be required to pay the remainder of the lease. If you secured your own housing, you will have to navigate that situation on your own. Another example: Your health benefits may lapse when your employment ends — something to especially consider if you or a covered family member is facing a health emergency — so you can make a plan to maintain benefits through another channel. Again, much of this should be outlined in your contract.

Canceling contracts can also affect your future contracts and employment opportunities , even for permanent staff positions. It may make it more difficult for you to get good references. You may have to face tough questions during future interviews. Depending on the circumstances, your agency might have your back, or you might not be invited back to work with them again. Travel nursing agencies thrive on having good relationships with facilities and travelers. If the facility is in the wrong, your agency should side with you. However, if you’re in the wrong, you may find that your agency will decline working with you on future contracts. Some facilities will also move you to a DNU or DNR status and be unwilling to hire you in the future.

Also, finding yourself in a situation where you need to cancel an assignment is often very stressful. First, your reason for wanting to cancel is likely a major stressor. Then on top of that, you have a lot of work to do and hard conversations to have if you’re going to cancel the right way. Throughout this process, don’t forget to take care of yourself to manage these types of consequences to your mental and physical health.

Bottom Line

Contract cancelations should be avoided at all costs. However, certain circumstances can make them necessary. Travelers don’t appreciate having their contracts canceled by a facility, so it’s important to practice a “golden rule” approach here and only move to cancel as a last resort and due to an emergency situation. Remember that your patients and colleagues may be the ones who suffer the most, but that you’re also putting the facility, your recruiter, and the agency in a real pinch.

If you do wish to cancel, communicate openly and honestly with your recruiter, work with them on the best solution, give as much notice as possible, and try to work your scheduled shifts. Also understand that you may face professional, financial, and other consequences. Above all, we hope you never have to face the kind of situation that necessitates a travel nursing contract cancelation, but if you do, please take care of yourself and lean on your recruiter!

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Travel Nurse Tax Guide 2023

Navigating travel nurse taxes can be a challenge, especially because travel nurse tax amounts can be a bit different depending on what state or states you worked in. In general, however, taxes are very different for travel nurses compared to traditional staff nurses. From choosing a tax home to keeping your receipts to knowing exactly how your income will affect your long-term financial goals, here is the information you need to know about travel nurse taxes.

RN’s can earn up to $2,300 per week as a travel nurse. Speak to a recruiter today!

Travel Nurse Taxes + Income Breakdown

Travel nurses are paid differently than staff nurses because they receive both a base hourly pay that is taxed and additional “payments” that are non-taxed to make up their “total” pay. When you sign up to commit to a travel nurse position you’ll receive a pay package that will detail all of the different aspects of what will make up your actual compensation.

Essentially it’s in the travel nursing agency’s best interest to keep the base rate of a travel nurse’s pay package low, so many travel nurses have a modest base pay but will receive additional stipends. In a technical and legal sense, those additional stipends — which typically cover things like meals, housing , and work-related expenses — are expense reimbursements for doing your job as a travel nurse, which is why they aren’t considered income and are non-taxable.

Travel agencies offer “standardized” bill rates. This means that there is one rate for all workers with any given license covered by the contract. For example, all Registered Nurses have the same bill rate, all Physical Therapists have the same bill rate, and so on. It’s also possible for the licenses to be broken down by specialty and every so often by level of experience. For example, Medical Surgical and Telemetry Registered Nurses have one rate while all other Registered Nurses have another. Registered Nurses with 1-3 years of experience get one rate, while those with more than 3 years of experience get a slightly higher rate. The important thing to understand is that standardized bill rates are set in stone by the contract for all intents and purposes. There is no possibility of negotiating a higher bill rate based on a particular travel nurse’s salary history or work experience.

Joseph Smith, EA/MS Tax, an international “taxation master” and founder of Travel Tax , explains that in addition to their base pay, most travel nurses can reasonably expect to see $20,000-$30,000 of non-tax reimbursement payments in a typical year working as a travel nurse.

Find travel nurse credit cards to earn points or miles while traveling.

Qualifying For Non-Taxable Income

In order to avoid being taxed on those reimbursement payments, however, you need to clearly prove that you have what’s called a “tax home” to the IRS. The IRS defines a tax home as “the entire city or general area where your main place of business or work is located, regardless of where you maintain your family home.”

Smith explains that you can qualify for a tax home in two main ways:

• If your primary area of residence is also your main area of income, which typically does not apply to travel nurses.
• You visit your primary residence at least once every 12 months and can prove that you are paying for expenses to maintain your primary home.

If you can’t prove that you have a tax home, or don’t meet the qualifications for having a tax home, you will be taxed on the stipend payments you receive as part of your travel nurse pay package. Additionally, Smith cautions that most travel nursing agencies will not verify that you qualify for a tax home, so it’s up to you, the travel nurse, to ensure that you are meeting all requirements for establishing a tax home in order to collect your non-taxable stipends.

Joseph Smith, EA/MS Tax, an international “taxation master” and founder of Travel Tax, explains that in addition to their base pay, most travel nurses can reasonably expect to see $20,000-$30,000 of non-tax reimbursement payments in a typical year working as a travel nurse.

While many people commonly believe that you must have your tax home at least 50 miles away from where you work as a travel nurse, there’s actually no specific distance requirement . The only real requirement is that you must prove that it’s farther away than a reasonable commute and requires rest and sleep before going back and forth.

You should always check with a tax professional, but in general, travel nurses can take the following steps to help ensure that they qualify for a tax home in the eyes of the IRS:

• Keep proof of any payments you are making to show that someone else is maintaining your primary residence, such as receipts for a house sitter, mortgage, rent, utilities, or home maintenance expenses.
• Maintain your driver’s license and voter registration in your home state.
• Keep your car registered in your home state.
• Keep a per-diem position, if possible, in your home state.
• Return to your permanent home at least once every 13 months.
• File a Residence Tax Return with your home state.

To file taxes correctly, it’s very important to maintain your tax home and prove that you have to actually pay for “double” of everything—for both your tax home and your new living situation as a travel nurse. That means that if you rent out your home temporarily while you’re gone, you no longer can classify it as a tax home.

What About State Taxes?

Travel nurses should plan on filing their taxes by the April 15th deadline, just like everyone else in the United States, although there may be a little wiggle room for extensions due to the nature of being a multi-state professional as a travel nurse, according to Smith. Every state has different laws for filing taxes, but travel nurses may need to file a non-resident tax return in every state they have worked in, as well as the state that they consider their permanent tax home.

Travel Nurse Tax Tips

Smith advises travel nurses to keep a receipt book to help them make tax preparation a little easier by having all of their paperwork in one place. Although digital receipts may be more convenient or “modern” for younger nurses, keeping paper copies as a backup is always recommended. Your receipts can include things like:

• Housing and lodging expenses while traveling
• Mileage travel
• Uniform and scrub expenses
• Work-related expenses, such as continuing education courses or certifications you must maintain to keep your position
• Costs for Internet and phone providers

The 2022 tax reform laws did away with many job expenses at the federal level , which means that travel nurses can’t deduct certain travel-related expenses such as food, mileage, and gas on their federal return. You can still get a stipend or reimbursement from your travel agency for those expenses, but they may not count as deductions.

That being said, a handful of states still allow job expense deductions on your state tax return, such as New York , California , Alabama, Hawaii , and Arkansas, so there may be additional tax deductions you can make if you’ve worked in a qualifying state.

Smith also adds to be careful when filling out residency on your tax return, as he sees many travel nurses make the mistake that working a travel assignment means they have moved. However, working a temporary (under 12 months) travel nursing position does not qualify as a move of your permanent residence — instead, they are just away from home temporarily and that’s an important distinction to make come tax time.

Keep your tax home as a permanent residence address, and don’t change it unless you actually move permanently!

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Can You Get Audited As A Travel Nurse?

The travel nursing industry as a whole does tend to be scrutinized closely, says Smith. As a travel nurse, you may be more at risk for an audit if you’re displaying high expenses and low income. For instance, if your mortgage is $10,000 a month, but your overall income with your base pay as a travel nurse is only $20,000 annually, the IRS may be puzzled as to how you’re actually affording your lifestyle.

You can reduce your risk of an audit, or increase your risk of getting through an audit favorably by always making sure to work with a certified tax professional who is familiar with traveling healthcare professionals and not solely relying on your nurse recruiter or travel staffing agency for tax advice.

Lower Taxable Income Considerations

One of the appeals of travel nursing is that you have the potential to make a high income, especially through non-taxed stipends. And although at first glance, having non-tax stipends for things like housing may sound like a great deal for you as a travel nurse, it does come with a catch: because the additional stipends you receive as a travel nurse are not taxed, they are not considered income, and as such, will not be reflected in your annual income.

That may not sound like that big of a deal unless you find yourself in need of a loan, mortgage, or disability payment, or are nearing the age to collect Social Security. All of the aforementioned items are calculated based on your income. The lower your income, the lower the loan amount you will qualify for, and the less you are contributing to Social Security and therefore will be eligible to collect when you’re ready for retirement.

If you know that you will be needing a loan or a mortgage in the near future, Smith suggests talking to your lender as far in advance as possible to explain your situation and plan ahead. Working with a lender who is familiar with the pay structure for travel nurses can also be helpful.

In some circumstances, such as for nurses who are nearing Social Security’s retirement age, it may also be helpful to legally declare that you don’t have a tax home on your tax return, and instead, pay taxes on all of your stipends, so you can count it as taxable income.

And remember – you should use this guide as information to help you learn more about filing taxes as a travel nurse but remember that it is not tax advice. You should always consult your own CPA or tax professional before filing your tax return.

Travel Nurse Tax FAQs

Yes, all travel nurses must pay taxes on all income that they earned. They will need to file a tax return for every state that they worked in, as well as their home state where they have permanent residence.

If possible, it’s always beneficial to work with a tax professional, such as a Certified Public Accountant who can help you file and pay taxes that you owe as a travel nurse. An accountant can provide you with the physical paperwork that you can use to mail your tax payment in or help you set up an online account if digital payments are acceptable. If you file your own taxes using TurboTax or another software, you will be provided with the exact mailing address and instructions to submit payment. If you don’t have one already, you may need a book of checks in order to pay your taxes. The most important thing you need to know about paying taxes as a travel nurse is that you will need to both pay taxes and file a tax return in every single state you have worked in. If you’ve worked in many different states, that’s where hiring a CPA can be very helpful to help you navigate all that paperwork and payment.

It depends. American Traveler explains that you may end up paying taxes in every state you worked in as a travel nurse, depending on which states those are. Some states have what’s called a “reciprocity” agreement, which means that they have agreed that travel nurses working in those states will only be responsible for paying taxes to one state in total. You will have to check with your accountant or look into the tax rules for each state that you’ve worked in to determine exactly how much you owe in taxes. You should also check with your travel nursing agency if this is your situation because you will most likely need to file tax exemption paperwork through them as well. You will also need to pay taxes in both your home state and any state you worked in. That means that all income you make will be ultimately taxed through your home state taxes as well as the state where you earned the money. That might look like getting taxed twice, but the good news is, your home state will deduct the difference if the percentage rate of your home state is higher. And if it’s the other way around, you will generally only pay the higher state rate. This can get a little confusing, which is why we recommend hiring a tax professional.

Some states do not have an income tax , including Alaska , Washington , Wyoming, Nevada, South Dakota, Tennessee, Texas , Florida , New Hampshire, USVI, and the District of Columbia (if you don’t live there.) If you live in one of these states, you will still need to pay any set income tax rate in the state where you work. If you don’t live in those states but you do work in those states, you will still pay your home state tax rate, so be sure you keep that in mind with your total earnings so you can have enough to pay your taxes come tax time.

This depends on if you’re considered a W2 employee or a 1099 contractor, but in general, travel nurses may be able to deduct the following expenses: – Mileage or the cost of gas – A rental car – Uniform and equipment costs – Continuing education – Licensing fees – Travel expenses – Some meals – Retirement and insurance contributions – Expenses that go into paying for your tax home

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Travel Nurse Tips for Saying Goodbye to Friends at the End of a Contract

Tips to Saying Goodbye at the End of Your Travel Nurse Contract

As soon as travel nurses step into their hospitals on a new assignment, they are focused on learning the ropes, getting to know their new city, and making new friends. However, they may have forgotten to think about their goodbyes at the end of the assignment. Travel nurses are used to having to get acclimated to a new environment quickly, but they may not be so accustomed to saying goodbye over and over again.

It can be difficult, especially if they had a great experience and developed close friendships with fellow nurses, hospital staff and neighbors. To help cope with the end of an assignment, travel nurses on a new assignment should keep a few things in mind.

Extend Your Contract

If you truly loved your new hospital and city and have made great friends, there is no harm in asking for an extension. If the hospital still needs travel nurses, it may be in their benefit — as well as yours — to simply extend your contract. After all, they’ve taken the time to train you, and getting a new set of travel nurses may only set them back further as they have to retrain on hospital protocols all over again. Talk to your personal recruiter and recruitment agency to see if you can extend your contract by a few weeks or months — but remember, at the end of the extension, you may still have to say goodbye.

Throw a Goodbye Party

If you’ve bonded with your colleagues at the hospital, there’s no reason to only say a quick goodbye on your last day on the job. Instead, invite your coworkers to a casual get-together at your apartment or house, or host a happy hour (or after-work) gathering at a nearby restaurant, café or bar. After weeks of working together closely, it may be the perfect way to bid farewell to those you have to come to consider friends.

Bring in Farewell Snacks

If you and your coworkers don’t have the time to attend a small party — or you’re limiting your party to only your closest friends outside the hospital — bring some cookies, cupcakes or other baked goods or snacks into the hospital to share with the staff. Since hospitals are generally busy places with little time to sit around, attach a brief note to the box that everyone can read. In this note, you can describe your experience to fellow staff, expressing your appreciation to them for making your experience on this assignment one to remember. If you are particularly close with any staff members, you can also write individual notes to those colleagues, or even offer individual treats.

Look for a Similar Nursing Position

Sometimes, it’s not just the people at the hospital that made your assignment successful. If you particularly enjoyed the type of position in which you were working, it’s worthwhile to seek a similar one to ensure that you continue to enjoy your work as a travel nurse. If you do decide to go for a similar position, make sure to ask for recommendations and references — the feedback from senior members of staff can help boost your chances of landing an even better assignment in a similar position elsewhere.

Stay in Touch

Keeping in touch is easier said than done, but thanks to smartphones and social media, it’s easier than ever before. If you use Facebook, Instagram or any other social media platform, follow or friend them to keep in touch after you’ve left. Form chat groups to stay in touch with your former colleagues, keeping them updated on your life and theirs. If you don’t have the time to do so, make sure to add them to your annual holiday card list or note their birthdays to send cards each year. You can also plan visits back or try to get another travel assignment at the same facility.  Make sure any time you’re back in your old city, stop by the hospital or make an arrangement to meet up for a cup of coffee.

Travel nurses are often excited to start their new position, but less excited to say goodbye at the end of the contract. After weeks or months of working with new nurses and hospital staff members, you may have formed close friendships — but even though you’re leaving the hospital, there’s no reason for it to be a permanent goodbye. Throw a party and promise to keep in touch, and stick to that promise. You may realize that you’ve formed lifelong friendships around the country.

Take it From a Nurse

Check out this guest article over on The Gypsy Nurse where a travel nurse breaks down the life of leaving new friends.

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NBA Admits Tyrese Maxey Traveled on Pivotal Four-Point Play in 76ers–Knicks

This call would've changed everything.

• Author: Tom Dierberger

Philadelphia 76ers guard Tyrese Maxey stole the show Tuesday night, scoring seven points in the final 25 seconds to force overtime and eventually defeat the New York Knicks in Game 5 of their first-round playoff series at Madison Square Garden.

But on Wednesday, the NBA revealed in its Last Two Minute Report that one of Maxey's game-changing plays in the final minute shouldn't have counted. He traveled before launching a three-pointer from 25 feet with 25 seconds remaining.

"Maxey gathers the ball on his left foot, takes two legal steps, and then moves his right foot again just before he is fouled on his shot," the report indicates.

TYRESE MAXEY DRILLS THE 3 + THE FOUL !!! SIXERS CUT THE DEFICIT TO 2 ON TNT 25 SECONDS REMAINING pic.twitter.com/rEEHKWthL0 — NBA (@NBA) May 1, 2024

Instead, no traveling violation was called, and Maxey drilled the three-pointer and the free throw to cut the Knicks' lead to two points.

If the travel had been called, the Knicks would've been awarded the ball with a six-point lead and 25 seconds left. The 76ers would be forced to foul, and the game likely ends in a Knicks win if they avoided turnovers and knocked down free throws.

The Last Two Minute Report also indicated that Knicks guard Josh Hart was not out of bounds with 41 seconds left in overtime when he tried to tap a loose ball to teammate Isaiah Hartenstein underneath the basket.

Instead of Hartenstein getting a chance to tie the game at 108, it was ruled a turnover. The 76ers went on to outscore the Knicks 4–0 the rest of the game to secure the victory.

The Knicks, up 3–2 in the series, will get another chance to end Philadelphia's season on Thursday in Game 6 at Wells Fargo Center.

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Politics latest: MoD contractor hacked by China 'has contracts across Whitehall'

The defence secretary has given a statement about a hacking attack on the UK's Ministry of Defence, which Sky News understands China was behind. The government has been criticised for not naming the perpetrator, and concern is mounting over the contractor that was targeted.

Tuesday 7 May 2024 23:09, UK

• China hacked Ministry of Defence, Sky News learns
• Contractor behind system named in House of Commons
• Sam Coates:  This could get quite sticky
• Scotland's new first minister voted in
• Labour rejects PM's election prediction
• Jon Craig: MPs hold most heated Gaza debate since war began
• Live reporting by Ben Bloch and (earlier)   Faith Ridler

Thank you for joining us on the Politics Hub for a busy day in Westminster.

Here's what happened:

• The defence secretary, Grant Shapps, gave a statement to the Commons confirming that a hack had hit the Ministry of Defence's payroll system, run by an external contractor, with personal details of British service people targeted;
• But he did not confirm Sky's revelation that China is behind the hack because it is a months-long process for such a formal designation to be made by ministers (China firmly denies it is behind the cyber attack);
• The refusal to blame China provoked fury from many MPs who want stronger action from the government against China - but Rishi Sunak defended his policy as "robust";
• The defence secretary did state in the Commons that contractor SSCL was responsible, with the government launching an investigation into all SSCL work with government;
• The deputy foreign secretary told the Commons that the government is firmly opposed to an Israeli offensive in the Rafah area of Gaza, with the PM saying he is "deeply concerned" by the prospect;
• Shadow chancellor Rachel Reeves gave a speech in which she blasted Tory "economic fiction", saying ministers arguing the economy is turning a corner is not reflecting "reality";
• New SNP leader John Swinney was formally elected the new first minister of Scotland, with him expected to formally take the role as soon as tomorrow.

Join us again from 6am for the very latest political news - and the first PMQs since the local elections at noon.

The Garrick Club, a central London gentlemen's club, has voted to accept women into the ranks of its membership for the first time in its near two-century history.

Founded in 1831, it is one of the oldest members' clubs in the world, and its membership is drawn from across the British establishment.

Among its ranks are said to be 1,500 members including at least 160 senior legal professionals, at least 10 serving MPs, dozens of Lords, heads of public institutions, actors, artists and businessmen.

King Charles is even said to be a member, along with around 150 men with knighthoods who cough up the around £1,000 a year to get access to its dining rooms, luxury lounges and exclusive bedrooms.

Women have been effectively banned from becoming members, and until 2010 were barred from even visiting the club as the guest or spouse of a member.

But in a vote this evening, the membership changed the rules to allow women to become full members.

One member told Sky News that 944 members attended a meeting tonight, either in person or remotely, and said: "It was fairly clear the majority was in favour of admitting women."

The club had been at the centre of a controversy after the UK's chief civil servant, Simon Case, came under heavy criticism for his membership, which he eventually resigned in March ( more here ).

A list of members of the club was recently published by The Guardian newspaper, which included the King, Deputy Prime Minister Oliver Dowden and Sir Richard Moore, the head of MI6.

Read more about the club from our political reporter Tim Baker  here:

An early release prison measure, used to relieve capacity problems in jails across England and Wales, has been extended for a second time since its introduction in October.

As of 23 May, some male prisoners will now be freed up to 70 days before the end of their sentence in order to free up space, under the End of Custody Supervised License scheme.

Originally - it was 18 days, later extended to between 35 and 60 days.

In an email sent to prison and probation officers informing them of the extension, seen by Sky News, staff were told that "despite the push" and efforts of the scheme in previous months, that "pressures continue" in male prisons, and so further extensions to this emergency scheme are necessary.

Sex offenders, terrorists and category A prisoners, plus those serving four years or more, are excluded and aren't eligible for release.

However, sources close to the service have expressed concern about the extent to which the scheme is being amended, at pace, and often with little warning.

Read the full story from our news correspondent Mollie Malone here:

By Jenness Mitchell, Scotland reporter

John Swinney will become Scotland's new first minister after being backed by a majority of MSPs.

Following his victory in the SNP leadership race on Monday, the 60-year-old faced a vote at Holyrood to confirm him as Humza Yousaf's successor.

The Scottish Greens abstained from the vote, with Mr Swinney able to fend off challenges from Scottish Tory leader Douglas Ross, Scottish Labour leader Anas Sarwar, and Scottish Liberal Democrats leader Alex Cole-Hamilton.

His name will now be submitted to the King, with an official swearing-in ceremony expected to take place at the Court of Session in Edinburgh as early as Wednesday.

Mr Swinney will then be able to appoint his cabinet.

Read the full story here:

We've just had a statement from the Home Office amid chaos at UK airports due to a nationwide issue with the border system.

A spokesperson said: "We are aware of a technical issue affecting eGates across the country.

"We are working closely with Border Force and affected airports to resolve the issue as soon as possible and apologise to all passengers for the inconvenience caused."

Queues are building at airports across the country as flights land, but passengers are unable to be processed.

Follow live updates on the outage affecting the UK border on our dedicated live page here:

Are you affected? Send us a message on WhatsApp . Check our contact us page for more information.

By Tim Baker , political reporter

The government is "gaslighting" the public about the state of the economy, the shadow chancellor has said.

Rachel Reeves attacked the Conservatives in a speech in the City of London, as the opposition takes the fight to the government on their own turf ahead of the general election.

Running a strong economy has long been the focus of Conservative election campaigns.

And with a raft of economic data coming out this week, Ms Reeves is looking to get ahead of the government's messaging - saying Chancellor Jeremy Hunt and Prime Minister Rishi Sunak claiming the economy is improving is "deluded".

Over a year ago, Rishi Sunak made five pledges for voters to judge him on.

The prime minister met his promise to halve inflation by the end of 2023.

But with the general election approaching, how is Mr Sunak doing on delivering his other promises?

You can see the progress for yourself below:

Chaos has been reported at airports across the UK - as two airports have confirmed a nationwide border issue.

A Heathrow spokesperson said: "Border Force is currently experiencing a nationwide issue which is impacting passengers being processed through the border.

"Our teams are supporting Border Force with their contingency plans to help resolve the problem as quickly as possible and are on hand to provide passenger welfare. We apologise for any impact this is having to passenger journeys."

Manchester Airport also confirmed that the UK Border System is down as part of a nationwide outage.

It said its teams are working to assist passengers in the airport.

Sky News has contacted the Home Office for comment and further details:

The Sky News live poll tracker - collated and updated by our Data and Forensics team - aggregates various surveys to indicate how voters feel about the different political parties.

With the local elections complete, Labour is still sitting comfortably ahead, with the Tories trailing behind.

See the latest update below - and you can read more about the methodology behind the tracker  here .

Two of Westminster's best-connected journalists, Sky News's Sam Coates and Politico's Jack Blanchard, guide you through their top predictions for the next seven days in British politics. 

Following the local and mayoral elections, Jack and Sam discuss how Rishi Sunak will try to get back onto the front foot and whether the Conservative rebels will continue to plot against him.     

They also predict that the country will come out of recession and look forward to a new SNP leader in Scotland following the resignation of Humza Yousaf. 

 Email with your thoughts and rate how their predictions play out:  [email protected]  or  [email protected]          

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