Travelers, or contingent labor, have historically been a key lever in a healthcare workforce strategy. Seasonality, census fluctuations, global pandemics, natural disasters, leaves of absence, and notorious retention challenges have required health systems to leverage contract labor to keep beds staffed and patients cared for.

While this is a contentious topic, nearly every health system has become increasingly reliant on travel nurses over the last few years. According to Staffing Industry Analysts, travel nursing revenue tripled to an estimated $11.8 billion in 2021 from $3.9 billion in 2015. This has resulted in significant agency spend for hospitals and the ensuing strategic priorities for CNOs and health systems to decrease utilization and spend. While this is achievable through a workforce strategy focused on creating more flexibility for an internal workforce enabled by more modern technology, it’s likely that health systems will continue to engage travel and contingent healthcare professionals in some fashion for the foreseeable future.

Why Your Travel Nurses’ Experience Matters

It’s critical to consider the travelers’ experience while working within your health system. Here’s a few reasons why.

1. It’s highly likely you’ll need them at some point.
   Whether you’re strategically planning to or not. Whether it’s a global pandemic, staffing gaps related to turnover and long hiring cycles, or staff leaves of absence, it’s nearly impossible to optimize a workforce structure without utilizing some level of contingent labor. Simply relying on existing staff to work more to cover gaps results in higher levels of burnout, greater retention challenges, and increased premium spend, feeding the vicious understaffing cycle.
2. There’s a limited number of them.
   At any given time, it’s estimated that there are about 50,000 travel nurses (though this surged to ~100,000 during COVID). This pool is highly fluid: while the barrier to entry is minimal (~1-2 years of clinical experience), the barrier to exit is even more minimal. When you need contingent labor, or travel nurses, you’re competing with health systems across the entire country, not just on cost but on location and experience as well.
3. Nurses talk, and listen to each other.
   Consistently being voted the most trusted profession isn’t just due to perception from others. Nurses especially trust each other and often seek feedback and recommendations about experiences before making decisions. Whether it’s forums, groups, or just word of mouth, nurses will do their research prior to pursuing an opportunity at your health system and weigh it heavily against other options, even when there is high financial incentivization.
4. It decreases cost - or can be good for your bottom line.
   When used correctly (truly contingent and not as a continuous crutch for understaffing), travelers can be cost effective when compared to premium spend, burnout and subsequent turnover, or having to close beds or postpone procedures. While money matters, so does experience and the desire to work in a safe, supportive clinical environment. Having a reputation for being a welcoming, supportive, and opportunistic place for clinicians to work could help attract contingent labor without having to necessarily offer the most money. Additionally, it’s often much more cost-effective to extend a resource than recruit a brand new one.
5. It can enhance the quality and safety that your hospital delivers.
   First and foremost, inadequate staffing has been shown to affect the ability to deliver safe, quality care. Secondly, travelers often have robust and diversified experience across multiple health systems, regions, and patient populations. They’ve seen things done in a variety of ways and have had to be flexible and adaptable to be successful. In this way, I like to think of travelers as bees: cross-pollinating a variety of healthcare settings with best practices and new ways of doing things.
6. The future of work is flexible; nurses will work in dynamic ways, and come and go.
   The modern workforce highly values flexibility, variety, and control. So while retention is top of mind for most health systems, the ability to re-engage will be key and once they’ve had a poor experience, it’s unlikely they’d consider future opportunities.
7. Contingent employment is at-will employment.
   Like health systems, travelers can cancel their assignment agreement at any time if they are having a poor experience or perceive a work environment to be unsafe. In this case, the money and time spent to get them there may be wasted and you’ll end up searching for a new resource again.

How to Provide a Great Experience for Travelers & Contingent Labor

Now that you know why their experience matters, how can you ensure that contingent labor or travelers who work within your health system have a great experience?

1. Be efficient.
   ‍First impressions matter - whether it’s reviewing profiles or getting back to candidates quickly, providing rejection reasons, ensuring offers have robust information, or onboarding requirements are clear.
2. Recognize that an interview is for them, too.
   Give them an opportunity to interview with a hiring leader. If this isn’t always possible or scalable, ensure that the staffing partners you’re working with (internal or external) are supplying as much information as possible about the opportunity from bed count, patient population, scheduling, etc for candidates to make informed decisions.
3. Engage them.
   ‍Ensure they meet their manager, assign them a buddy (someone different than a preceptor), check in with them periodically, and involve them in unit meetings and events (voluntarily).
4. Try not to make it a one-size-fits-all.
   While it’s ideal to provide a specific onboarding framework with a set number of precepted shifts, consider that some travelers may need slightly more support from the get-go to be successful and the minor additional investment is often worth it - especially if they have a great experience and want to extend their assignment.
5. Ask for their feedback.
   ‍You can only improve what you measure and know needs improvement. Prior to contract completion, solicit traveler feedback in a way that allows them to be honest and transparent without fear of repercussions. And don’t do it simply to do it - be open minded about the feedback with the intention of further understanding and addressing it.
6. Utilize them efficiently, but also fairly.
   Travelers are often fairly seasoned nurses with significant clinical experience. They are prepared to be flexible, adaptable, and they understand that they’re there to be as helpful as possible, especially during staffing shortages. However, there are misconceptions that travelers should always have the heavy (and the often undesired) assignments, ‘difficult’ patients, always be the first to float, or should simply accept whatever assignment they’re given. Invest in finding a fair way to balance caring for your own staff while leveraging travelers to ensure they feel like they are part of the team and not just a disposable resource.

Healthcare’s Contingent Labor Strategy

While we all know that contingent labor is crucial, where does it fit in your nursing workforce strategy? There needs to be a good balance between external and internal labor and staff. Especially with the recent years’ pandemic situations, it has accelerated the need for health systems to tweak or fundamentally rethink their approach of healthcare staffing to be more flexible. Read about the common themes and statistics surrounding external labor in this blog, Where Does External Labor Fit in a Nursing Workforce Strategy?