After three years working in the same ER in her hometown of Cleveland, Abigael Kaszar craved adventure. She decided to become a travel nurse.
Travel nursing is a career path through which nurses work on temporary assignments that pay more than full-time roles and range from a few weeks to a few months, pitching in at different health care facilities to fill staffing needs.
The jump has taken Kaszar, 36, to rural Colorado, busy Brooklyn, Los Angeles and most recently Long Island. She has held a steady stream of contracts, working in 20 emergency departments in six states.
Such contracts have remained plentiful since a travel nursing boom during the peak of the Covid-19 pandemic. Hospitals, desperate for extra hands, relied on such professionals, also called contract nurses, to mitigate severe staffing challenges. It was also a bonanza for nurses, who could make extra cash when pay rates for temporary nurses soared to four times that of a staff nurse’s salary.
New York hospitals are still shelling out for travel nurses years after the pandemic gold rush, spending nearly four times as much on contract nurse labor in 2024 as in 2019. Persistent spending on travelers reflects a shift in hospital staffing norms driven by a wave of retirements among veteran nurses, pandemic-driven burnout and stricter state mandates that require more hands on deck, experts say. Hospitals have become dependent on the flexibility and experience that travel nurses can provide – and they’re still willing to pay a premium for it.
While compensation has dipped from its pandemic-era peak, it remains above pre-2020 levels. Nationwide, the average weekly pay has dropped from nearly $4,000 at the height of Covid-19 to less than $2,300 now.
In her latest contract, Kaszar has stayed at the same Long Island facility for more than a year because of persistent staffing needs in the ER there. Crain’s is withholding the facility’s name at her request. She declined to say how much she is paid.
“It’s never going away,” Kaszar said of hospitals’ reliance on travel nurses. “It existed before the pandemic, and it’s going to continue to exist.”
A billion-dollar Band-Aid
Hospitals across the state spent a estimated $1.7 billion on travel nurses in 2024 – $1.3 billion more than five years ago in the year before the pandemic began – according to a survey conducted by hospital lobbying groups including the Greater New York Hospital Association and the Health Care Association of New York State. In the city alone, hospitals spent an estimated $854 million in 2024 on travel nurses, $693 million more than before the pandemic, representing a 430% spike.
In one example, detailed in a report from the state Department of Health, a 752-bed hospital in central New York spent $50 million on all temporary staff – nurses, physicians and technicians – between April and June of last year alone, more than any other hospital in the state. The report omitted hospitals’ names, but the description fits Upstate University Hospital. New York City Health + Hospitals, too, exceeded its temporary staff budget by $168 million last year because of persistent challenges in recruiting and retaining nursing staff.
Despite the popularity of travel nurses, hospital officials say they only sign such contracts when necessity mandates it.
“It’s not a staffing strategy that any hospital wants to default to readily because of costs,” said Bea Grause, president and CEO of the Healthcare Association of New York State.
Despite the sustained spending, demand has fallen sharply from its pandemic peak. As of this past April, there were fewer than 400 travel nurse vacancies at New York hospitals, down from more than 3,600 openings in April 2020, according to data from Aya Healthcare, a San Diego-based travel nurse staffing company.
But hospitals can’t seem to wean themselves off contract nurses entirely. Part of the reason is that they need more experienced nurses after senior-level practitioners fled the industry in droves during the pandemic, with many retiring earlier than planned. Registered nurses in the city, for example, declined from more than 60,000 in 2020 to 57,000 in 2022, according to data from the state comptroller’s office.
The exodus of experienced nurses and high turnover rates among new nursing school graduates fueled staffing shortages across the state.
Low pay, inadequate staffing and stressful work cultures are the most-cited reasons new grads leave nursing jobs, said Dr. Allison Squires, professor and director of the global consortium of nursing and midwifery services at NYU Langone. Turnover and retention challenges have led hospitals to continue using travel nurses to keep up with demand, she added. But hospitals were never meant to rely on them.
“They are meant to be a temporary Band-Aid,” Squires said. “They are not meant to be permanent.”
New standards, new shortfalls
Also driving demand are state staffing mandates that went into effect in 2023. The rules, which say one nurse can provide care for two patients maximum in critical care units and establish individual hospital staffing plans for all floors, were designed to protect patients and alleviate some of the burnout that bubbled up among practitioners during the pandemic.
But they constitute a big adjustment from the previous standard that required no minimum staffing levels. Hospitals have struggled to meet the standards and just last year failed to keep staffing ratios at two critical patients per nurse at least 50% of the time, according to a survey conducted by the labor union New York State Nurses Association.
The staffing mandates coincided with momentum in the nurse labor movement that increased pay for clinicians. Nursing unions won contracts with public and private hospitals in the wake of the pandemic that increased pay in some cases by 25%, with the starting salary for a nurse at Health + Hospitals increasing from $84,744 to $106,301.
Pay increases were not uniform and staffing struggles remain. The challenge is more pronounced in rural areas where staff are harder to come by, Grause noted.
Despite the new rules, hospitals still struggle with filling staffing gaps, Kaszar said.
“It would be so unusual to work fully staffed,” Kaszar said. “We became nurses because we want to care for people, but when ratios get out of whack, we can’t physically provide the care that we want to.”
Rebuilding the workforce
Hospitals’ staffing woes may be a crisis of their own making. NYU Langone’s Allison Squires says she doesn’t buy the narrative of a nurse shortage.
“It’s not a shortage in New York at all,” she said. “There are plenty of new grads.”
State health care officials don’t necessarily agree. As hospitals continue to try to plug gaps, the state has launched a series of initiatives to address the broader workforce crisis. In response to a projected shortage of 40,000 nurses by 2030, the state has funded scholarship and training programs to encourage clinicians to enter and stay in the workforce. The state has tried to incentivize students to become nurses with scholarships, and has funneled millions into nursing simulation centers and residency programs that help students and new grads get hands-on training. However, it’s still too early to see the efforts bear fruit, the Healthcare Association’s Grause told Crain’s.
Some hospitals have taken matters into their own hands. In 2014 Northwell Health, for example, created an agency known as FlexStaff to fill its short-term staffing needs with its own employees as often as possible. The agency saved the health system $200 million in five years, Joseph Moscola, Northwell’s executive vice president of enterprises, previously told the industry newsletter Healthcare Brew.
But at the Long Island hospital where Kaszar is under contract, the need for her services as a travel nurse remains. In the emergency room, she said, patients are sicker, stay longer and require more attention. Without contract nurses helping with the caseload, she said, staff nurses would not be able to keep up, potentially leading to more resignations and fueling the shortage.
“People just get burned out,” Kaszar said. “It’s not an easy job.”
