The move for more money: Vt. struggles to address nursing crisis

BURLINGTON, Vt. (WCAX) - Caregiving is at the core of nursing, but money also matters and motivates. Facing ongoing workforce shortages and a global pandemic, Vermont hospitals spent upwards of $100 million to bring in higher-paid traveling nurses last year, nearly double the price tag from 2020. Christina Guessferd reports on the pay disparity that is driving many Vermont nurses to leave their jobs and what the state is doing about it.

“I work aside travelers who are great but they are making four times as much as me,” said Elise Legere, a UVM Medical Center staff nurse, who says she is leaving her job.

“If the hourly wage was better, I’m sure more nurses would be able to stay here longer,” said Rebecca Call, a travel nurse at UVMMC.

“It does really hurt when you don’t feel like your work is valued,” said Benton Taylor, a UVMMC staff nurse.

Three registered nurses working at Vermont’s largest hospital with three unique perspectives. After working at UVMMC for six years, Legere plans to quit and pursue a travel contract out of New York City, along with three children under five and a husband in tow.

Despite adoring her time living in Vermont since last July, Call says she isn’t interested in staying after her assignment ends next month.

And Taylor, who moved to a state he loves four years ago, has since lost a lot of his love for the job that brought him here.

“I can confidently say that if I made a wage that matched the cost of living here, we definitely wouldn’t have even considered leaving, because it’s a lot to uproot our family,” Legere said.

She says while the Green Mountains may be beautiful and she enjoys her position, neither is paying the bills. A combination of factors are contributing to her decision, including lack of affordable and accessible child care and housing, but she says finances is the main motivator. And receiving significantly less compensation than her travel nurse counterparts can be demoralizing. “They’re making really smart financial decisions for themselves, and why wouldn’t they if they’re able to. They’re really empathetic towards us. They’re not sitting there like, ‘Haha, making four times more than you!’ They’re like, ‘You guys need to make more money,’” Legere said.

While nurses like Legere are enticed by the promise of better pay, the staff nurses who do stick around assume additional responsibilities. Amid the revolving door of temporary personnel, Taylor says permanent staff must brief travelers on important policies and procedures so that the quality of patient care isn’t compromised. “In addition to just being a nurse and doing my job, we’re constantly training these people who come for a short period of time. So, then you’re also training people again and again and again, and it just wears you down. It’s harder to have good teamwork when you don’t know the team that you’re working with,”' Taylor said.

It’s a cycle of burnout and instability that’s pushing people out of the profession. In December, the Vermont Talent Pipeline Management published a survey forecasting that between today and next September, Vermont will need to hire more than 6,200 nurses in new or replacement roles, 42% of whom should be licensed RN’s -- where the need is greatest.

The survey concludes that filling those positions is the only way hospitals will drastically reduce their dependency on expensive travelers. Employers pay agencies $150 and $200 an hour per nurse. The travelers themselves take home about $80 to $100 an hour. By comparison, Vermont’s registered nurses make an average of about $38 an hour.

POSSIBLE SOLUTIONS TO THE CRISIS

The Vermont Agency of Human Services last fall submitted a 26-page document to the Green Mountain Care Board. The Workforce Development Plan acknowledges that officials knew this crisis was inevitable. For at least the last five years, hospitals have been spending exponentially higher sums on staff who only fill the critical nurse shortages for a few weeks. It says the “unsustainable trend” requires immediate and bold action that could increase patient costs.

“Sometimes it takes, really, a crisis for everybody to come together,” said Kevin Mullin with the Green Mountain Care Board, which regulates hospital budgets and insurance premium rates. He says the state has to start by raising nurse’s salaries. “We’re at a point in time where I think that people realize the seriousness of the situation and will make those hard choices.”

He says those choices could include approving higher budgets and accepting potential rate hikes, causing patient costs to go up. Mullin says his team will need to ensure hospitals’ submissions are allocating resources towards effective retention and recruitment efforts before giving them the green light. “It’s going to be painful but it’s going to be less painful taking the steps necessary to fix this nursing crisis than it would be if we started to lose loved ones because they didn’t have access to care,” he said.

“We know health care isn’t affordable for everyone and we need to always be working on that. We also need to make sure the system is available and safe and strong, and that’s a tough balancing act,” said Jeff Tieman, the president and CEO of the Vermont Association of Hospitals and Healthcare Systems. He says he trusts that providers and the state can strike the right balance. “If we can get some financial support from the state to help with those retention and recruitment costs, then we can relieve some of the pressure on the ratepayer side.”

And that’s exactly what Governor Phil Scott’s budget proposes -- invest $33 million in a program run by the Agency of Human Services to fund recruitment, retention, and training initiatives established by health care employers. “Provide things like, potentially, retention bonuses, sign-on bonuses, or other creative and innovative strategies,” said Ena Backus, Vermont’s director of health care reform.

Another strategy is to expedite visas for international nurse hires. Backus says living in a region with Boston and New York City -- where a worker in any sector could make more money -- creates an incredibly competitive market. “These employers have to be thinking about how their compensation keeps pace with their peers. Whether or not it’s reasonable to keep pace with traveling staff agencies and what they are offering is a different question,” she said.

Vermont’s permanent nurses say they don’t expect employers to completely close the pay gap, just decrease the huge disparity that’s driving them away when they would otherwise stay. “As much as I don’t feel well-compensated, I have great co-workers, I love my patients, and I really like the culture of the hospital I work at,” Legere said.

Mullin, Tieman, and Backus all want to know if staffing agencies are engaging in price gouging. Congressman Peter Welch is working to get that answer. On the state level, the Legislature will need to approve the more immediate plans.

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