From WXXI news.

This is connections.

I'm Rick Stephen.

The Covid 19 pandemic put a spotlight on the nation's nursing shortage.

Hospitals and long term care facilities were often forced to call in backup to help alleviate some of the caseload.

The support often came from travel nurses.

These contract nurses are usually hired through an agency and are on assignment for specific amount of time, usually months or shorter.

They can take over for staff nurses for any reason like maternity leave.

Disability nursing strikes.

Simply put, they make up for staff shortages when necessary.

According to the U.S. Bureau of Labor Statistics, 3 million registered nurses work in the U.S. and almost 2 million of them travel.

The bureau also reported that job growth for travel nurses grew by 35% between 2019 and 2021.

But hiring these essential workers can get pretty expensive for health care systems.

Travel nurses require a higher pay rate than regular nursing staff, and being the new kid on the floor can sometimes come with contentious work environments.

Today, we discuss the benefits and challenges of being a travel nurse in the current health care climate and how local institutions are trying to accommodate everyone.

We have several guests joining us for this conversation.

I have here with me in studio.

Everyone is in studio.

I love a full house.

I always say that I love a full house.

Everyone is in studio with me.

I have Shante Hale, she's a registered nurse, a traveling nurse based in Rochester, and she is all over, like she calls it.

Hi, Shante.

Thank you for joining us.

And I have here a Gerri Hayes.

She's a licensed practical nurse.

And she.

Are you.

You're from Houston.

You live in Houston?

I live in Houston.

I'm from Rochester.

You're from Rochester.

You live in Houston, and now you're on assignment back in Rochester.

Okay, just getting that right.

Okay.

Travel.

Travel nurse.

Indeed.

And we have Brandy Brumfield, your director of nursing at Wesley Gardens Nursing Home.

Thank you for joining us.

Brandy and, Daniel Ireland, the chief nursing executive with Rochester Regional Health.

Thank you for joining us.

Well, thanks for having me today.

Okay.

We're going to play nice today.

Right?

Yes.

We're talking about travelers.

I want to before we get into this, I want to talk to, Shante.

Can you tell us a little bit about your your nursing background and how long have you been a nurse, and when did you become a travel nurse?

So I have been a nurse since 2009.

I graduated from JC.

I got my bachelor's in 2000, 15 from the University of Rochester School of Nursing.

I worked at one of the hospitals for about five years.

And then I ventured off to start my travel nursing.

2014.

So first I started off working in schools, and then I actually stepped foot in.

My first assignment was in Hawaii start I started in Hawaii in 2016, and after that I got the travel bug.

And I've been all over the place.

So, I've been to Hawaii.

I, I've been to new Jersey, Pennsylvania, Oregon, California, you know, and I'm licensed in to our state, so I'm, I'm all over the place.

Oh, wow.

Okay.

And I brought you enjoyed this travel book.

What made you what made this travel bug stay with you?

So the travel bug stay with me because I'm an adventurous person.

I'm a people person.

I love to help others.

And when I do travel, I meet other nurses.

I love to, communicate with them.

We have share ideas.

Where do we go next?

We help each other out.

And I just love that.

And I still talk to a lot of the nurses that I met from 2016.

You know.

So and, you know, even outside of work, a lot of people know me outside of my nurse.

And, and I'm just a people person, everybody.

I get along with everybody.

So that's what you know, that's what I love about it.

So.

And I know you, you're hired through an agency.

Can can someone break down?

How do you become a travel nurse?

And do you have to find an agency and work with them?

How does that go?

So for me, when I started out, you can go on and be or, you know, hearsay, like I said, I found mines going on.

Indeed.

Or like another coworker said, hey, I applied to this job.

So what I would do is, first of all, you have to have at least two years experience, working on floor or in your specialty.

Specialty that you, you know, you know, for with nursing and you go from there and then they assign you somewhere, and then you go from there and just go to work.

Okay.

And Jerry, so you don't go through an agency.

No sir I do.

Yeah.

You do have to go through an agency all the time.

Yes.

Okay.

And Jerry tell us about your experience as a, as a travel nurse.

You're originally from Rochester.

You moved to Texas.

How long were you in Texas?

So I actually got my nursing license here in New York, in Rochester, New York.

I worked at the Jewish Home for six years.

And then during Covid, the opportunity for me to travel opened up.

I was on a Facebook group and, a recruiter called me and I was like, okay, so I really get to go somewhere.

And my choices were North Dakota or Alaska, and I have a chart, I have the travel book.

I'm an Army brat, so it's embedded in me to move around.

So my kids told me, no, don't go to Alaska because people come up missing there.

So I took my first assignment and North Dakota as a prison nurse.

So that was my first experience, working outside of long term care because I was a CNA before I was a nurse.

So I've always been in long term care.

So I was like, I want to do something else.

So I went to North Dakota, also been to California.

I've been everywhere too.

So what made you come back to Rochester?

Family I have family, my parents like, right now I'm staying with my parents.

So I have family here.

My oldest daughter still lives here, so I go back and forth a lot and travel and nursing just makes me easy money wise.

So I could come here, I could spend time and I do short assignments now.

So six weeks or less.

Six weeks or less.

Okay.

Unless I'm going to Hawaii.

Right.

Okay.

So you are you are able to, to extend for as long as you like.

Oh yes.

Okay.

Yeah.

Oh wow.

Okay.

And what's the longest you've been on this.

I did an assignment in bath New York and I was there for a year and a half at the VA facility.

So they took me in for a year and a half and I just as long as is 50 miles away from your home is considered travel.

So I just did the hour drive every day and they paid me well.

I had great benefits.

Yeah.

What in shantay you?

Hawaii was your longest, I assume?

Yes, it was.

You know, what was it?

Basically?

That was, work.

Dream.

Yes.

Job.

Yes, I did my three twelves, and every four days I had, I was at the beach.

So when I came back home, I had so many bathing suits.

Yeah, I had to unpack because I did my three days and I had it was so awesome.

But, yeah, that assignment was really great.

So.

And have you ever done an assignment where you felt were you felt not welcome because you weren't there?

How was how has the culture been different places right now?

It's always different because you do make a little bit more than the other nurses make.

And they kind of, sometimes I feel like you, you think you're.

But I don't know how they think.

How we think, but they think you think you're better than them or they, you know.

But we on the contract is specifically says, like, what?

Hours we're supposed to be there, what shift we have to work and we have to stick by that.

So, we're a lot of other people.

They can switch their hours around.

We have like, I mean, and you could finagle that once you're in there, but we just go in and we say, well, this is what I have.

This is what I'm going to give.

You know, a lot of times we're here because we want to see, you know, outside too, but we're also giving our service to this place.

So you get your head.

Yes.

So what is an ideal assignment for for a travel nurse?

Hawaii, I think in a, in an ideal assignment is good pay, a good area, good coworkers, a good facility, good resources.

And that said that that, make or break where you're traveling to.

I've only had one experience.

I was in California because I've been there numerous times, and they gave me a horrible assignment, and I think I was probably a few years in and I almost, I almost cried in the room and was like, why am I doing this?

But then I had to snap out of it.

I was only there for a few weeks.

I was like, why did they give me this horrible assignment?

But like I said, that was my only out of my 16 years of nursing that I've had that experience where I question my why am I a nurse?

Yeah.

You know, so afterwards, after I got off that assigned, I was like, okay, I'm back to it again.

Let me find something else that's a little bit better, because I was like, I can't go back to this facility because they just did me any type of way.

So.

So I want to ask you, like, why nursing?

Why nursing as a as a career choice for you?

Just wanted to be a nurse.

That's a secret that most people don't even believe about me because I'm so good at it.

When I was like 19, I just needed a job, and my aunt got me a job doing, I was an aide, but I wasn't even certified yet, and I became certified as a CNA.

And when I was at the Jewish home, my supervisor signed me up for nursing school, and they were he was like, you are too good at what you do.

You know too much.

You should make more money.

You should move up.

And I got a letter from Rossi accepting me for the interview process.

but I love it.

I love being a nurse.

I am a nurturer by nature, and I'm very empathetic.

So I'm one of the good ones.

Yeah.

Okay.

I became a nurse because my mom is a nurse, so I just seen her like, oh my gosh, she's helping people.

So I just seen how well she work with people.

My mom is a great nurse.

So I said, this is what I want to be.

I want to be a neonatal pediatrician.

But I probably would have just graduated school if I did that.

But, you know, but that's why I wanted to be a nurse because of my mother.

So.

And Brandi, that's the study.

Why why this field.

So nursing is my passion.

I enjoy caring for people, taking care of them, educating leading and my nursing career has put me in positions to where I'm able to help others.

No.

And see, you can do this.

You can get here.

I was first the LPN, and as a LPN, sometimes you're being told that you have to be a R.N.

to do this, to do that, to do this, to do that.

And it's not true.

There's so many things you can do as a LPN that I was able to experience.

You know, I've been in management, I was an LPN for like a year, and I've been in management, I've been in nursing for over 15 years, and I was a LPN, carpenters one year, and I've been in management since.

Wow.

You know, a lot of people don't know that as a LPN those things can happen.

You can be a supervisor, you can be a charge nurse, you can be, you know, a resident care director.

You can, you know, you can do a whole lot of things.

And me being in some positions that I was, you know, had the opportunity to be in, I was able to help people grow in their careers and become directors, supervisors, managers.

And it just it just gives a lot of hope to people.

And at your, at your facility, Wesley Gardens, as director of nursing, what role do you play if travel nurses are needed?

Okay.

So we currently have travel nurses now, because, you know, it's very competitive and, you know, you can't pay what everybody pays.

And, you know, so the nurses know that they can go other places.

So as a travel nurse, you know, the things that we look at, we want someone, we have a schedule.

And typically travel nurses make their own schedule.

You know, they say, you know, when you're coming into like a facility, you say, okay, I can work these days, these days, or you just pick up, you know, send me what your openings are and I'll see what nurses are available to work.

In our facility, we kind of change that up a little bit to meet our needs, because you have a lot of nurses that don't work weekends, don't want to work evenings, you know, want only work this, you know, two days or, you know, so the benefit of having a agency nurse or travel nurse come into the facility, it has to be able to benefit the facility.

So we have we look into what the, the, the nurse is able to do what she's able to offer, the facility and we kind of work around that.

And with the agency, it's very competitive too, because, you know, it depends on what they're paying and it depends on what's required and things like that.

So all of that plays a big role.

And so even signing the contract.

Yeah.

With the agency.

So then it seems like a long term care facility and maybe a hospital has have different requirements for for travel nurses would you say or.

Well I think I think it's circles around that needs that the institution has because, you know, institutions can set up their requirements of what they're looking for.

And, you know, as was mentioned, there are now a lot of agencies out there, I think Covid, right.

A huge, bloom of agencies and and so now you you can set your requirements for what your needs are in your facility.

You know, 100%.

Right.

There's actually an interview process that happens when you're, bringing on, a travel nurse to say, okay, you know, I've got these shifts open.

Is this work for, you know, okay, let's look somewhere else and figure that out.

I think most importantly is, you know, and I think, Brandi, you might shares we're all on the same team.

Like, when it comes to this, it's like, how do we get in and work and care for patients?

And we figure out where the right matches for people.

And and like Shantay said, you know, sometimes there's not sometimes it's the wrong match.

They get assignment that and people and we've had travel nurses say that like this.

This is what I thought it was.

Yeah.

And and we work hard to say okay.

How can we flex around, you know, your contract as you work in this unit.

Can we, can we work something and 90% of the time, people are willing to say, okay, you know, I want to stay here.

You're going to work with me.

I'll make some adjustments, and we'll we'll work it out.

But, you know, the core requirements, and I agree, whether it's a LPN or R.N., like, we're a team of health care, folks, I mean, we we were.

And that's actually something that helped a lot of our hospitals come out of the Covid era, with, you know, balancing the dependency on our NS versus lpns, a number of hospitals that I, that I work with and, our, our partner with, they're doing a team based care model now that they weren't doing before.

And that team based care model is relying on the lpns to work to license the.

Ahrens worked up a license.

Your technician supporting you and, patient satisfaction is higher, outcomes are better.

And the you know, the overall experience works well.

So I think as we bring it all together, you know, whether you're working for a travel agency or you're a core employee, you're part of that team.

Once we enter the doors and we try to make that that work out as well.

And, I think the one other question you asked about why be a nurse?

And I would tell you, I think you'd all agree it's probably one of the most rewarding fields there is, and it's the most diversified field, like, you can a nurse for over 30 years there.

Yeah.

Right.

Yeah, yeah, yeah, I've GCC alumni.

Yeah.

Oh, yeah.

Yeah.

And you know what?

It's been, every part of nursing that I've touched has been rewarding.

And, whether it's I did some clinic last year at one point in time.

And to see the impact you can make on the nurses who are doing the work and IT systems, it's just as rewarding as holding the hand of a patient who just needs a moment to to, you know, feel comfortable and sharing that compassion and that empathy, that, that, that we share.

So it's, it's, you know, the nursing field is, is just and I think we have to get that message out there because I think people heard a lot of bad stuff over the last five years or so.

And I think any of the nurses that are working in the field today would say, you know, it's still the most rewarding field and it's still there's so many opportunities to do things and have people that open doors like the one that did for you.

I mean, that's that's half the battle of somebody who's willing to say, I'm behind you, I'll support you.

I'll, you know, I remember my my beginnings started when I was, actually, a roller skating skate guard.

And, the guy I worked with was an EMT, and he brought me all his medical books, and that inspired me then to read more about, you know, what that was and got me into being EMT and then eventually right into nursing school.

So it's somebody setting that spark.

Yeah.

And and that's what that's what we want to be able to do.

Yes.

And I know some sometimes the spark probably dimmed a little bit during the Covid pandemic.

Right.

In 2019, about 2% of all our ins were travel nurses.

The need for travel nurses skyrocketed during the Covid 19 pandemic, with one researcher said, up to 10% of all nursing staff worked as travel nurses in 2022.

And I want to speak with all of you about your I want to take me back to your experience during the pandemic, and what that was like for you as a nurse during that time.

So you can go ahead.

Sorry.

So, I became a travel nurse here.

I was a local traveler.

That's how bad nurses were needed.

And I was at rg h Loved it.

Loved my experience.

In the beginning.

Yeah.

The new nurse, the new traveler, you know, but, the experience was, was was great.

And being at RG, h, as a travel nurse during that time was a, it was a lot it was, you know, in the hospital you have a whole lot of changes.

You know, things were changing every single day.

Like, you know, CDC everything was changing every day.

So one day you did something, tomorrow you can't do it anymore.

So it was it was a lot of changes.

Things were moving fast.

And those moments, I, I realized that this is why I do what I do.

This is why I chose nursing.

This is.

This was the rewarding part, being able to, you know, be with those who families couldn't be with them.

And the worst time ever being able to, you know, help my colleagues, you know, deal with whatever situations were going on on the units, being flexible, showing that team and ship and being able to, you know, float over here and go over here, you know, even when, you know, sometimes you want to stay on your unit.

But if other units were in need and you know, you're able to do it to just go be able to help other nurses because it got hard, because even with travelers, you still were short.

Yeah.

Even with travelers, you still had seven, eight patients that, you know, were acute.

So they were like critical.

You you can't there's too many patients to watch for one person.

Yeah.

So even in those moments pulling together as a team, you know, you have your charge nurse, you have the other nurses even with the, you know, lpns on the unit because before LPN, they were taken out of the hospital, they came back, you know, they came back because the need was in that.

And so appreciative of that because, you know, you have some really great lpns that from one they know their staff to they, they want to learn more.

And, you know, they're they're a great resource and they're very helpful in the things that they can do.

You know, some people in nursing, they want to do the bare minimum.

They don't they don't want to do they they don't want to operate with under their scope.

Yeah.

You know, but those nurses that do, you know, you appreciate that because there's things that you can do, the things that you can help, you know, and working together as a team made those moments so much better because, you know, getting patients fresh out of surgery that you got to watch and you got three of them and you got, you know, somebody that's getting ready to fight, then you got somebody that is, you know, on their last, you know, and then you got two families and, you know, it's it's a lot it's a, it's a lot.

So being able to have those that team put in place where you can, you know, lean and call on your coworker was was great.

Great.

I think I also had brandy.

You you stated very well the amount, the immense amount of change that happened in hospitals across the country on a day by day basis.

What my reflection was of that, though, was the amazing resiliency of our nursing team.

And, and I saw a team come together, at the hospital.

I was at, out in Batavia, whether they were travel or not.

Travel, they became that team and they were resilient.

Today you got to wear this mask.

Nope.

Tomorrow you got to wear this mask.

Oh, wait, we've got these homemade masks.

And, you know, every bit of change was happening, but it was that I have to say, it was that nursing resiliency that that kept up with those changes and saved lives.

And they really saved lives.

Our nurses stood by conditions that no one in our, any of our generations thought we'd ever have to work.

And and when they did the very, very best for patients, I mean, we had nurses working out in tents in parking lots.

Yeah.

Nobody thought in the United States we would have people in tents in parking lots, but they were and they were keeping people safe and they were.

And so it's that resiliency.

And I think that's something that nursing has held true to in all, of all of nursing, all of time is that we are resilient.

We can make changes quickly.

Then we can look for what the evidence says and make it make it work.

And that's something I was so proud of our nurses and it was touching.

One day, just a story.

I came to work that morning, and somewhere during the middle of the night, somebody from the community came out and wrote in chalk on a sidewalk.

Thank you.

Nurses.

And so every nurse that walked in the work that they saw that someone from the community, unbeknownst to us, you know, did that and they, they brought food trucks to the facility.

They did everything they could to say thank you to the team of people that were helping their neighbors and loved ones.

And and that's what makes it so special.

Just just thinking back and imagining that.

I can't believe that we went through those times not too long ago.

And you said Brandy, that Lpns were coming back in.

Jerry, your LPN, were you told to come back?

Come back in the I did work in a hospital during Covid, but, it wasn't when Covid was crazy.

It was kind of like when Covid was coming down and you could wear the mask or you didn't have to wear the mask.

I was in the hospital during that time, but my experience, but I don't hear a lot of people talk about during Covid was in the prison.

And a lot of people, when they think of nursing, they think of hospitals or nursing homes.

But, I was excited to go to the prison because I just wanted to experience something different.

I was like, oh, I'm this sounds cool.

But when I actually got there, these guys are stuck in a building where they say, like, going outside is like the most healing thing that you can do around Covid.

They were stuck in a building, so you would have a floor of 400 men, all sick, and some of them are passing away, and they didn't get to see their loved ones before they left.

They didn't they didn't get those visits that they you normally would get because visitation got shut down.

So there was just the good people in their eyes were the nurses because, you know, you got the CEOs are they're not really they're friends for, for them, you know.

So they just had the nurses.

So it was a very humbling experience to be able to be there with some of those guys passing away without their families.

So for me, it was wore like it was like it was wore time.

I felt like I'm not in the military like my parents were.

But this is a different type of fight.

Like we have to get up every day and show up and and everybody worked as a team.

I never experienced so much love and support and community than I did during Covid.

And like everyone, loved the nurses.

We were like the super heroes of those.

We had two years when we were heroes and everyone.

We had free Crocs, we had food, you know, most days, discounts everywhere.

It was, with North Face.

We had, you know, so we had so many great benefits, but it's like, it's to me, it was like it was.

We needed that to keep going.

Yeah.

You know, because a lot of times we will come home to our families and we're scared to get our family sick, like there was one way in my house and one way out of my house, and everybody knew that.

Don't come in the wrong door.

Yeah.

So it was it was a different experience in prison.

I, you know, I appreciate you for sharing that perspective.

But we don't talk about.

Yeah.

In prisons when you talk about, like you said, hospitals and nursing home.

And we don't we don't realize that the nursing the nursing field expands past those walls, those nurses hospital walls.

So I appreciate that perspective.

Shanti, were you on assignment elsewhere?

Were you called to, like, New York City or, be where there really needed?

I ended up going to I started doing Covid swabs here in Rochester.

Then I went to Miami to do, Covid swabs.

And then I ended up in Texas.

And just like how Jerry said, I worked in a hospital, I was like, ed med surge.

And that was a very humbling, very emotional.

Very.

And people thought, oh, Covid is a hoax.

Covid is a for real.

But when I left that facility, and I'm a quick story, I had a patient.

He came in for high blood pressure.

Okay.

We're going to treat the high blood pressure.

The hospital was probably like 15 minutes away.

We couldn't keep them there because it was like in and out.

Ended up sending him to his, ultra level.

Was, going down place on my nasal cannula.

You know, that's nurses.

We know the lingo.

So, I feel like the first time I ever feel out of place.

So we have had the BiPAP.

BiPAP wasn't working, and, ended up sending him to the hospital, and and so he ended up passing away, and I was just like, he only came here for his blood pressure, you know?

So it's like for people to say, oh, it's not real.

This is fake.

And I was like, I was here doing this, you know what I'm saying?

So just like a very it was an experience working, you know what Covid.

So then I ended up, going to Buffalo and I work with Covid patients for like three months, so BiPAP and oh, to try and deliver, you know, all of that.

And it's just like you just are very thankful when you're on these assignments and like how you can help the patients.

You get to hold the patient, you know, hands when the family is in there because they have visitations.

You know, we were gowned up like our whole 12 hour shift, you know, was basically like how you said, like being in the military, you have to put your mask on when we step out, take everything off, come back and put your mask on, put the goggles.

That was half of our shift changing.

And it was yeah, change.

And it was just like changing your clothes like, you know, so Covid was very like an emotional all like time and thank God it's over, you know.

But it was a it was an experience to, you know, to go through different time.

So and I would say another thing that, we didn't talk about as much during Covid was the lack of, human touch.

Because we were so gowned up there was never like with our patients how we would hold their hand like, like touch.

I didn't know how important that was until Covid when people were like depression was up here, like suicide rates went, went crazy from people not being able to see people, but the physical touch.

I felt like it was such a simple remedy that we were missing.

And the nurses feel that, you know, as nurses, we were like, we can't do this.

And as the patients, it's like, you shouldn't do that.

But it's like it's it was such an unnecessary thing that outside of medicine and outside of like what we learned in school, like we need like that physical touch to survive.

It's a it's a very simple thing that went over a lot of people's hair.

So I was the hugger.

They were like, Jerry.

I was like, you know, I would definitely agree with Jerry at that one, because even with our demented residents, they, they that's they thrive off of you know, that touch, that communication that, you know, and not being able to do that with them, they got depressed.

And you know, when the elderly and especially with dementia, once they go down, it's hard to get them back.

And they were and you are losing people for that just because, you know, they were saying broken heart because they didn't see their family and the family that they thought was their family, which was you.

They couldn't touch you, you couldn't touch them.

And, you know, you couldn't just sit next to them and, you know, talk to them and do their hair and, you know, rub their hand and things like that.

It was it was very, very hard for, those residents.

It was so was so interesting to have to switch and actually do video FaceTime with families just because that's the only way they could see each other.

I mean, that isolation is huge and it's it's I think it still has its long lasting effects on people that have come out of Covid, and on all of us.

The weight.

I think that nurses that carried through what they saw, you know, again, this is something none of us ever thought we'd experience in our lifetime.

And now we're carrying that, and now we're describing it to our children.

We're describing it to, you know, people who are, you know, just this will be new for them.

But we have lots of lessons out of it.

And absolutely.

So I know, I know, this could have got pretty expensive on on the health care systems.

We'll talk about cost and payment right after this break.

Stay with us.

We're talking about travel nurses right here on WXXI.

I'm Evan Dawson coming up in our second hour.

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Mary Carey, ola.org, Carrie, Yola and we're back with WXXI news.

I'm Raquel Stephen and today we're talking about traveling nurses and the systems that hire them.

In studio with me, I have Shanti Hale.

She's a registered nurse and a traveling nurse based in Rochester.

I have Jerry Hayes.

She's an LPN based in Texas and on assignment in Rochester.

Brandi Brumfield, the director of nursing at Wesley Gardens, Nursing Home, and Daniel Ireland, a chief nursing executive with Rochester Regional Health.

And, Dan, you have the honor of speaking for the entire RH system when it comes to, this topic.

Now, I know, I know the system dependent heavily on travel nurses due to the pandemic, but now it says there's the need has decreased by 40%.

Right.

What what was the what was the financial impact of of having travel nurses?

It was tremendous.

We saw, such an exodus of nurses, either that were late careerists and as soon as the pandemic was happening, said, I don't want to go down this road.

We saw people leave to travel because at one point, I think people thought they could go somewhere else in the country and be less impacted than Covid than here, which we all learned wasn't, so I'll give a perspective, in 2019, as a health system, Rochester Regional Health spent about $9 million on travel nursing.

So travel nursing has been around, as we've illustrated for a long time.

We use them to cover disabilities.

We use them when departments.

We're short staffed for a longer period of time.

And you would do those contracts.

So we did use them.

At the height of Covid, we spent $260 million on nursing, travel, nursing costs, to be able to, to cover the need.

And it's something that I think if you talk to any of the leadership team or whatnot, if we had to rewind and do it all over again, we do it all over again like it was about getting care for the patients.

It's about keeping capacity in our community.

And and that's something that our health system does is when the need arises.

And I and I'll just say our health systems, when they need arise, you step up to that need and you figure out how to navigate through the immediacy of it.

But then as Covid has gone down and we have seen more people coming into the market, as more nurses coming into the market, you know, we've been able to bring back more nursing.

We've actually been able to increase the capacity in nurses going through nursing school.

Now, Rochester Regional started, had an LPN program, before Covid and bridged in and has added an R.N.

program, so that we have both Lpns and our NS graduating 61 graduates this year between the Iowans and Lpns.

Plus, all our partner schools have increased capacity.

We have to fill this void.

It's not a Rochester void.

Nationwide, the data shows that there's a nursing shortage around, around our country much through 2030.

So there's going to be continued effort about that.

But we have, we have brought down, the percentage of, of agency nurses that were using, at the end of last year, we were running about 34 or 35% of our nurses were agency.

We're down to about 24 now.

And, and we've also branched into some other areas.

There's a huge opportunity for global nursing.

And so we've, you know, we have nurses, that are coming from, the Philippines, Puerto Rico, the, European nations, coming in as well.

They, they want to come work for us.

And so pulling all those levers, doing all those things, we're doing everything we can to get back to that core nursing.

Somebody asked me once, do I ever think travel nursing would go away?

And my answer is no.

I think there's a need there.

There's a true need for it to happen.

Does it need to be as high as it has been?

That's unsustainable given where the cost differences.

But there will be a need.

And and we've, as we've said all the way through the pandemic, our travel nurses have been our lifeline.

They've been our partners.

And in many of our organizations, I walk up on the units and I couldn't tell you the difference of they're treated like family.

You know, I know there's always exceptions, but the general rule I felt was that, you know, most people really valued the the folks that came to help us out.

And, and we continue to value them, as we navigate our way into changing times and health care.

Yeah, I know, I have a caller who wants to talk about, money and finances.

I have, Louis, I believe is Louis from Brighton, and his question is about pay.

Louis.

Louis from Brighton.

Are you on the line?

Yeah.

I'm.

Hi.

How are you?

Yes, you're live on WXXI.

You have a question or comment for our for our panel?

Yeah.

Well, I, I think you were somewhat color.

You know, I wonder like how the business side for the agencies like how much are are they making out of this, and thinking more about the contract coming up in our Medicaid and Medicare, you know, where is that going to be affecting staffing for nursing and.

The American that is going to be part of like a way to address that the cuts are going to be happening.

Yeah.

Yeah okay.

Thank you.

Thank you Lisa I don't know who wants it.

Dan if you want to I'll jump that question.

I'll jump in first.

We recognize the fact that the agencies perform a function, and so they get a cut of, cut of the pay.

So, you know, if the hospital's paying a certain rate, you know, we know that the nurses making somewhat less than that, the agency's keeping their cut of it.

Like any business, like any consumable business you would have, you always try to hope that the agency gets the lower cut, the nurses get the money.

And, you know, we always try to keep our costs, costs low.

So one inventive thing that we have done, and I know other health systems are doing too, is we've tried to create our own internal travel pool.

So, we know that there's the travel bug, as our, as our colleagues here have said, but some people are willing to travel within the region.

And now when you have a system that has, 8 or 9 hospitals, they're willing to travel amongst those different hospitals, but, but work for our internal, agency pool so they're able to move around, and, and it has a differential compensation.

So it's less than what we'd be paying the external agencies.

Taking the middleman out of it, basically, is what, what happens.

But it helps tap that need and that desire for the workforce of today that wants to be able to not just be in one unit all the time, but move around.

With respect to the Medicaid cuts and the cuts that are happening, you know, I think that's going to put a new focus on how we manage.

And I believe everyone, including the agencies, the insurance companies, everyone is going to have to come to the table during this time and say most important thing is we keep health care viable and we're able to keep nurses at the bedside.

How do we work through that?

And I think the more we have those conversations, the more we're able to navigate through changes in health care, which we'll always have, and really get us to the other side and make sure that care's kept where care is needed.

Yeah.

Great.

And, Brandi, how does this play in with with nursing homes, and agencies.

Well with so in the nursing home and agencies with the regards to the pay and you know, we do have where of course in-house staff is how much you make in what they pay, you know, because they, you know, and then they also, like we said earlier, you know, we want to give the hardest assignment or you go to work the floor was just one nurse, you know, for the residents and, you know, and things like that.

But as Dan stated earlier, we're all here for the same reason.

Our focus is ensuring that our patients, our residents are receiving the care that they deserve.

Yeah.

And and doing that as a director of nursing, that's part of what I strive and I teach on a daily basis.

Is that where you have to be passionate to be a nurse?

This has to be something that you want to do.

It can't just be the money.

We need the money.

But it can't just be about the money.

Yeah, it has to be about ensuring the safety and well-being of the people that we're caring for.

Yeah.

And in doing that, is it fair to put someone that's new in our facility on a floor that they don't know by themselves with, with no support on the floor with them at that time?

Just because their agency or just because they're making a couple more dollars than you are.

And I have to put that perspective to my staff and let them know, you know, because yesterday you didn't want to do it, but you you work at the building.

Yeah.

You don't want to do it yesterday, you know, and in doing that, they kind of look at it from a different point of view.

Because if we don't have the agency there by themselves.

Yeah.

When we leave the agency, you know, we need them.

So putting it out there to them in that sense and kind of taking it away from the monetary part of it and taking it back to the beginning as to why we all are here.

Yeah.

And how how do you keep things fair?

And then you have that kind of back and forth between coworkers?

Well, I think I think it's putting a perspective to like people will stay in a core position and not travel because they want certain things from that core position.

There may be a benefit that's offered by the institution.

There's stability that I'm not, you know, because because a lot of our contracts will go, usually and, you know, 13 week increments, sometimes eight weeks or six weeks, but 13 week increments.

And so you lift even though there's a need today, you live with the risk as a travel nurse that at the end of that 13 weeks there, the organization's going to say, we filled our spots and you have going to find another assignment today.

And please, my travelers tell me.

But today, I think the worry has been a lot less because there's lots of assignments still out there and you can still get a lot of that.

But, you know, some people have not gone to traveling because they want that stability, that family stability.

They don't want that risk.

So so you try to balance it and say, well, what?

You know, we we always try to pay the market rate.

We try to pay what's fair with the market, you know, and do do the best we can and offer the best benefits that we can for our folks.

But recognizing the premium that the travel nurses are getting or they're getting it because they're taking risk in early on, some of the travel agencies weren't even offering any health benefits or anything.

So they were, you know, you had to respect the fact that they had to make sure they had money to or if they had somebody who had their health plan, they were on.

But so that you try to balance out that equity, and work through it.

Some people understand that in the conversation.

Sometimes people still feel it's unfair.

I have to agree with Brandi, though.

We we work really hard trying to say you have to keep the assignments balanced and fair because you lose those travel nurses because you're abusing them and you've really lost your ability to care for the patients.

And so we we want to be fair all the way around.

That's why I say we care like family, even to our travel nurses.

They're our family.

Yeah.

And for the most part, I feel like all the most of the facilities I work at has has been fair with trying to make the work load, even across the board.

I do feel like that.

Yeah.

Because we not we don't really hear about the disadvantage of being a travel nurse.

We hear about the good money.

But are there disadvantages other I would say the disadvantages are sometimes when you get to the facility, you know the nurse to patient ratio.

Again like your coworkers, you know management does some things you may or may not get around.

A recruiter may say, oh yeah, this is a great facility.

And then we step on the floor.

What what number from around here, you know.

So, and I'm seasoned.

So it's like I have like a whole thing of questions that I ask.

So the recruiter be like, oh, have you done this before?

Oh, yeah.

So we're not about to play those games.

We all get down to business and that's going to be there.

So a lot of the agencies be like, okay, we we can't beat your pay or your hours in because.

So so yeah because I've been doing this for a while.

So you're not about to play my face you know.

Yeah.

So you know some disadvantages.

You know, like I said, your coworkers, the nurse, the patient ratios, management, you know, sometimes pay.

But then again, I tell people you have to do your research, you know, do your research.

Because if not, again, when you step on the floor, it's like what happened.

Yeah.

You know.

So yeah.

Yeah.

I have a comment here from someone on YouTube or.

Yeah, on YouTube.

And Rob in Rochester, he says, can they discuss being a travel nurse going from house to house, not at a hospital, but on the road, going from patient to patient.

Is that is that a thing?

Would that be considered a travel nurse or aid?

That's more like home health care.

I, I don't do that though.

Okay.

Yeah, I don't either.

Okay.

Okay.

I want to talk about burnout.

Right.

Because travel nurses experience a significantly higher rate of burnout.

Emotionally drained, used up, fatigued, at least a few times per week compared to non travel nurses.

Do you do you experience a higher degree of burnout as a travel nurse then or not?

That's why I travel though.

That's why you travel.

That is the main reason I travel because I am.

I don't believe in carrying extra stress, stress in your life.

And if I say I'm going to take this assignment for six weeks or eight weeks or 13 weeks, I know I'm here for that amount of time, but I could take a break.

I'm not attached to a facility where I have to wait for my vacation time to roll over.

I could be on vacation, right?

And, you know, just give me two, three weeks to get myself together and go back into it.

So I always give myself at least two weeks before I go back to work assignment.

Oh that's a good that's a good.

That's a good strategy right there.

Oh.

Oh always some travel.

There's there's some like.

And another thing I what we were saying before real quick it's important for our travel nurses not to talk about their pain to other people.

And I think that there's kind of create the friction, the friction that I did experience, that nurse, if they find out that I'm making.

But that will be me telling them it could be rumors going around.

But I am a negotiator.

I don't negotiate, usually because I've been doing this for a while.

I know that I can negotiate.

I know that there's a middleman that's taking part of what I could have, you know, the middleman.

Back in.

So I'm going to negotiate.

Now, Dan, I want to talk about technology, right?

And advancements in technology and how that is helping, reduce the workload as well.

Right.

When we dealing with, whether it's AI or what are you guys doing at Rogers Region?

I know you had a moxie robot at one point.

How did that go?

That's going fantastic.

Yeah, we have moxie Robots at Rochester General in Unity, and the one thing the Maxis have done as it is reduce the amount of time the nurses have to leave the floor to run and get stuff like we don't I mean, we don't know.

Hospitals that I know of has perfect environments where everything is where you need it to be.

So someone's running somewhere.

And oftentimes, especially in lean departments, the nurse is the one doing it.

And now Maxie's been able to help that.

And, you know, tens of thousands of of steps have been reduced.

And that's more time at the bedside or be able to do that.

Virtual nursing, it's it's it's a real thing now.

And we're, you know, we have a couple pilots going on right now to add into it unity.

And we're, we're mapping out an expansion to that.

But that's a that's a nurse in a central location watching over 12, 24 patients, using AI that's got built in technology that and I was amazed when I saw this, but it has built in technology that actually can sense the movement of the patient in the bed and can predict if the patient's going to try and get out of bed before the patient even looks like they're trying to get out of bed.

So it allows that nurse to intervene and say, you know, wait just a minute, you know, I'm going to call your nurse and get somebody in there.

All of that is really taking the workload of the nurses and changing it.

And, you know, and I don't want to sell a story that it's going to be magically lighter and a and but, but we all know as nurses we have to continue to change the workload because it's the the whole health care environment's changing.

So let's make those changes.

Let's, you know, free that up so I can teach on a higher end drug and spend more time with a patient in one room.

Well, I know that the virtual nurses watching my other patient over here and working through that, and then telehealth is the other one and, and more, you know, getting, care to the, to the home, you know, even virtual urgent care, all that technology changing the flow of patients.

So that we're only putting the, the people who really need to use ERS in ERS, we own there, you know, and you're giving people care where they need along the way.

So, tremendous investments.

You know, in Rochester Regional Health, my my little plug because this is what I'm passionate about is we've doubled down on innovation.

We have, many of our hospitals have innovation hubs now, we we are teaching our people how to do human centered design.

We're encouraging people to to pilot projects and change things.

We we are going to be the forefront of how health care changes.

And I personally, as a leader in nursing, want to make sure nursing is right there at the front of the line saying, you know what we've got?

We're all complex world problems that we're dealing with in our patient care areas.

Let's fix them here and let's be the example for others.

So it's really, it's I see your little recruitment there, You know, they're listening like, always working right now.

I think these I want to know if how do you feel about AI and advancement in technology in your field?

Are you scared at all?

Do you feel as if you will always be needed?

What do you feel about AI?

Well, I, I feel that, we we we need help.

We do need help.

I do feel like, one of the things that I do love is telehealth.

Because in the, in an emergency situation, especially in a nursing home, you know, the doctor or the provider is not there 24 seven but if I can always do telehealth and they can see the resident and we can kind of figure out what's going on, it can prevent some rehospitalization, you know, at night or when everybody is gone.

My nurses and my managers, they can, you know, just get the iPad, go on telehealth and have a visit and get something prescribed or things like that that will help the resident be able to stay in the facility.

You know, and we can do things inside.

So I do think that, telehealth is a great thing, like, and for psych too, like we use like telehealth WI and which is great.

So that benefit helps us out a lot with our residents.

You can comment with any of you not do travel nursing anymore and, and just stay by the bedside or non travel.

What we not.

Yeah.

I think I will always go between the two.

And being that is you know as in the nursing home, your your skills are a little different and than in the hospital.

Yeah.

In the hospital, you would do your skills in, in nursing homes, you know, you have less skill.

So going between the both, it keeps you on your skill level.

But we can all conclude that nursing is a team based, team based sport, and everyone is valued non travel and travel nurses, thank you to my guests for coming with me.

Shante Hill, Brandy Brumfield, Jerry Hayes and Dan Ireland.

Thank you to everyone in the booth and thanks to all our listeners.

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