The Million Nurse March

crunched by COVID. UM. And we're gonna particularly talk about a really critical aspect of our entire medical infrastructure that a lot of people don't know about traveling nurses. Uh. And with me today is our guest and and you are a traveling nurse from New York to California, all around the country. UM, thanks for being on the show. Glad to be here. Yeah. So I live in Colorado, and I was a regular staff nurse UM until COVID hit. And you know, at that time, we expected it to

crunch everywhere. UM, but my home hospital, like many places that worked on the coast, UM ended up being really empty when everybody locked down and stopped getting into car accidents and going to parties and all of the other things that bring people into the e R. And I see us UM, So at that time, I quit my full time job and went to New York as a travel nurse. UM. And then I've been dancing around hotspots since then. So New York, Texas, Ohio, rural New Mexico. UM,

I just finished my third contract in California. I've been up to Oregon. So UM, I've seen the health care system working and not working in a lot of different places, and also like how much disparity there is different communities related to covid as in the health care that we

can provide. Yeah, and I am kind of before we move on to some of the specific things going on the travel nurses, what is your sense of like how often are you in a place and feel like, well, this the hospital system here, this particular hospital, they're they're like right on the edge of a breaking point most

of the time. Okay, that's good to know where your seatbelts, folks. Yeah, I mean, particularly since everyone was able to get vaccinated right Like to me, I really feel like that that that point of like the tipping point of like the quote unquote crumbles kind of like after everybody was was able to get their second vaccination, UM, and we had so much hope last May and June and things were reopening and it was kind of like, wow, things could go back to normal. Um, and then like, I don't

believe that's going to happen. And since then, I've seen so much more despair in my coworkers, and I've heard about so many more healthcare suicides, um staff, nurses, travel nurses, arties, other ancillary people, and you know, the kind of running joke, and a lot of workplaces is like, well, I hope I test positive for COVID because that would be better

than coming into work another day. Yeah, all right, I hope I get hit by a car so I don't have to come in your job, I think, is what a lot of people would the people who you know are reasonable human beings and see what you're doing is incredibly necessary, find that would find the work to be something of a nightmare. I mean, it sounds like horrific um to have to to deal with this. I mean, it's it's it's not an easy job in the best of times, being a nurse, but like with COVID and stuff,

it's it's just there's so much else on y'all's plates. Um. And one of the things that has happened over the course of the last year or well almost two years now, UM, is that from January the advertised pay rates for travel nurses around the country have gone up by about sixty UM, which in staffing firms of you know, increase their building of hospitals by like so like this huge rays in what um travel nurses are demanding and what is getting

paid out. And I think a reasonable person would go, well, yeah, of course, UM, And yeah, I think anybody would go any reasonable person would go, well, yeah, of course, you guys deserve much more money than that for what you're

dealing with right now. UM. I have no problem with this, But people who do have problems with this are the American Hospital Association UM, among other folks generally the folks who are seeing this primarily as a well, now we're spending more money issue, as opposed to a, hey maybe we don't have enough nurses, which right, yeah, so I guess I have maybe a couple of comments on that.

So one of the things about trafical nurses, so if if you're not in the travel field and you say I want to change hospitals, even if you're an experienced nurse, they will take between a month and six months to go through their hiring process, and then they will give you a week, two weeks, maybe four weeks of orientation. So that's a long process to hire a nurse normally YEA.

For me as a travel nurse, I will talk to a recruiter, I will say yes, I will be on the road somewhere between four hours to twenty four hours later, I will get to the hospital. I will do a bunch of paperwork that is for compliance and makes no difference at all. I will get between two and six hours of orientation, which is basically, here's the bathroom, here's the store room, this is what we're going to audit in the charts, and then I'm expected to take care

of complex actively dying patients. So so you know, people complain about how much we're getting paid, but if you only have two hours of like where's the bathroom, and like this is how most of the time when you're spending with I t being like, hey I need computer access, buddy, and then there you are and you're in the thick of it with no backup. You know, so you already have to be an expert in your field, and you have to be able to walk into an unfamiliar chaotic

situation and hit the ground running immediately. So, yes, making a hundred twenty bucks an hour is a lot of money, But I don't know that that's so super unreasonable for two hours of like, yeah, it's now to take care of people who are actively dying, and don't screw it up. It's the way we're told the system is supposed to work, right, Like, this is how capitalism is supposed to function. The demand for something goes up, and the demand for nursing his

way the hell up, so the price goes up. Um, if you believe in capitalism, like one assumes these people who are responsible for you know, paying you and are currently lobbying. So what's happening. I should go back because we didn't note this. But the American Hospital Association and a number of other folks are lobbying Congress right now to put a cap on the amount of money that traveling nurses UM can uh can can receive, and a number of UM congress people have said that they're going

to be looking into the issue. Several states, Oregon, Illinois, Pennsylvania, Kansas, and Kentucky have introduced legislation that's attempting to cap nurse pay rates. So there's like this huge backlash attempting to lock down the amount of money y'all can continue to get pay aid UM because of all of the things. This country I guess has money for the people dealing

with the I don't know what. I don't know how many millions of additional sick and dying people UM are are are kind of beyond what these folks are willing to shell out for UM. Have I got the size of that? And I mean to clarify so in a FEMA contract, so what a lot of the contracts I take are. So the nurse is making between a hundred and hundred and maybe you also have a tax free stipend or you don't kind of depending on how you are in that. And then but the bill rate to

the hospital is usually like tot. So the legislation is against the agencies. The agencies are making between forty six. Of course, the agency is then going to say, hey, well we aren't going to pay you as much because we still want the same cut. Yeah, my understanding, so the trickle down effect is likely going to be travel

nurse wages. But my understanding is it's setting the FTC to take enforcement against the travel nurse agencies because the agencies, they're the ones that say they have the person on the phone that says, hey, you have these credentials, we want to send you to this hospital yes, or now we've got this hotel arranged or we don't or you know those types of and we're going to do this type of on boarding. So they have their own kind of infrastructure and they take you know, half of the cut.

And so some of those people are making a lot of money too. Yeah, And it seems like it's kind of the situation where the way this is being framed, they're trying to crack down on these people who are kind of profiteering or could be argued to be profiteering off the situation, um, rather than trying to cap the amount that that the nurses can make, so to speak, or at least not by as much. But the overall effect will be that because of the way these companies work,

y'all will still wind up making less money. Um. Yeah, how um within the traveling nurse community, what is kind of where are people right now with this? Like, what what is kind of the mood? Um? So I think there's a couple of things to note. So in the FEMA contracts, they're usually sixty to seventy two contracts, so you're working back to back to back to back. So I'll do a d our weeks sometimes. And most people are not white women like me. This is mostly first

and second generation immigrants and generally people of color. Um So, these are not people that are saving for Lamborghinis. These are people that are paying off their student loans because a lot of them went to private nursing schools because that was kind of what was accessible to them because all of the disparity and education and opportunities. These are people that are trying to pay off their mortgages. These

are people who are paying off their parents houses. Um So, this kind of idea that like nurses are greedy is I think really unfair because most of us are just trying to like, you know, make a life that works. And also, you can't do a d our contracts fifty two weeks out of the year, No, I mean doing it for any extended period of time. I've I've worked those kind of hours in a generally less stressful working environment.

Um and it like it breaks you down. Um. Over time, like you you can't do that and at any time in your life for one thing like um, and you can't do that forever. And it sounds like this is kind of a lot of people are taking it as like this is an opportunity. I can get my parents out of debt, I can I can get a house, Um, I can say for my kids to I can pay off my own college. Like it's a chance for a lot of these people by putting in an unbelievable amount

of effort to get ahead. Uh. And I can't can't even imagine the frustration at seeing so many people be like,

well no, not so fast. And I mean one of the things that people are bringing up is right like it in the same way that you know, we struggle to want to pass minimum wage laws for the minute immigrants that pick our food and you know, support this infrastructure that is totally unseen now that we have, you know what is mostly for stance second generation immigrants that are working these FEMA contracts, Like you're targeting a section of the population that are not the people that have

doubled tripled their wealth in the pandemic, right, Like, these are not all of the people that got the small business loans that didn't need them, and you know, and have are just putting all of that money into stock, right, is there not? These are people who just want a middle class American dream and we're working, will work really really hard for it. And I mean there these are people who are asking, can I have the thing we're

all promised? If I spend eighty hours a week watching people, in a lot of cases choke out their last fucking breaths, is that okay? And a lot of people are saying, oh, of course, not right. And you know, so we're taking care of dyeing people while we're getting yelled at at the phone and of like, is cursing a lot on the show or yes, of course? Yeah. I mean I had a family member saying, you're fucking imprisoning her on a ventilator. I'm going to come for you. Where do

you fucking live? You know we have to get security involved. Um, you know, we get death threats. I've had people like threatened to find where I live and raped me. And so I mean, yeah, taking care of your dying loved one who also probably would say those same things to me because I would say, hey, please be vaccinated and

they would say fuck you. But I'm still going to do everything I can to take care of them, and I'm going to do this abuse and like, yeah, if I'm going to leave my home and the safety of a hospital that works and go into these total cluster fox of hospitals where the educator has left, the manager has left, the director has left, so there's no leadership. It's travelers, some of which are great, some of which are also hot messes, and trying to take care of

these people. Then like, yes, I want to you paid accordingly for it. Now would I trade that for a social um, a social safety net of health insurance because I have to get private health insurance, which is shady. Um. I don't get any disability insurance. I have nostick leave right because you're you're you're a pinch hitter. You're not like salary anywhere. Yeah, But would I trade this high

salary for a social safety net? Personally I would yes, But I mean nobody's going to say, like, yes, you will be able to retire with dignity if you play by all of these rules. They don't believe that I want to make the money. Yeah, it's I mean we're all always in this kind of like yes, soccer way as much as you can while it's coming situation, and she's especially if you're especially if you're doing something you're gonna need to recover from later, right, Like this is

I I you know, I've I've done overseas work. I understand kind of the nature of like trauma. And while you're doing the job at the rate you're doing it, you're also like pushing off a day of reckoning mentally, and not having a cushion of savings helps with that. Yeah, Like in the middle of it, you're in it, and then you know, sometimes it's weeks, sometimes it's months. Um. I hiked the Colorado Trail for mental health, and half

of those nights I had I See you nightmares. So I was in these beautiful, the middle of over places where everything was quiet. I would wake up with all of the beeps and people dying in my head night after night after night. You know. Yeah, I mean, yeah, I'm angry that they don't want to compensate me for that, because I mean, they're definitely not paying for my therapist. They definitely like aren't giving me access to disability if I need it. Right, Like, yeah, because obviously again you're

you're a contractor. Effectively, Um, there's not like a union for traveling nurses, is there? Or Am I wrong about that? No? So, I mean the only thing you have each your negotiating power. Um. So I have eight years of experience between emergency and I see you, um and a lot of very um big and highly regarded hospitals. So I'm a hot commodity to them, so I can kind of pick and choose, um, who I want to work with compared to someone that

has less desirable specialties. Not that those specialties don't also work as hard, but they're just harder. They're easier to staff, so therefore they're not It's a it's a market things. I definitely don't believe that my specialties are more like inherently valuable just in terms of the market. Um. So you know, so I get I can I have the luxury of turning down contracts that aren't what I want. But I mean, I have no idea what I'm walking into.

So on Monday, I'll walk into somewhere. Um, they said, you'll do some paperwork, you'll get your orientation, you'll have it'll all be it'll be a busy day and then you'll be on your own and I have no idea. Sometimes you're oriented in one unit and you never see that unit again. So um, and I you know, you have no idea what you're walking into. And how how long are these contracts? Generally? For so, before COVID, the standard nursing contract was thirteen weeks UM. Since COVID, a

lot of them are shorter. And I've only done in short contracts because if it's a decent place, then I can renew and stay longer usually, and if it's a bad place, then I'm pretty happy to get out early. UM. So I do between four and eight week contracts, and I usually do sixty plus hours a week. Is there any kind of like organization that you've seen come together a little more between people who are doing this this

gig since you don't have kind of representation. Is that something that started to take form in the last two years since COVID. I mean, there's definitely a lot of talk about it. Um. I think like those of us that started traveling since the pandemic, you know, I would say that I've only done crisis contracts, like I've never done a normal thirteen week, thirty six hour a week, not crisis assignment. Like I've only gone into the ship

show hot spots, um. And so therefore, like my needs and desires are different than somebody who likes that previous lifestyle. So in some ways it's a little bit hard for us to kind of agree on common goals because we have a lot of different you know, we're very diverse group of nurses. Um. Definitely, the Million Nurse March is kind of a step towards that. Tell me about that what what is this? Because I just learned about this

pretty recently. Yeah, so I dropped off the grid for the last five days, which was fantastic for me, but it means I'm also just starting to figure it out. Um. So the kind of general idea is that you know, we have I think, uh, I'm gonna hopefully I don't get it wrong, four millions some nurses in the country, A huge number of nurses in the country, and a huge number of dropping out. Um, you know, hundreds of thousands quit last year. They think one estimate is five

thousand make quit this year. And we were just so people know, tens of thousands of nurses understaffed, before COVID nation. Yes, right, right, um. And you know, I think one of the things to understand two is that like if you work, I don't know what's what's a normal type of job that people work. I don't know. If you work at the d m V, A bookman, Oh right. If you work at the d m V and the d m V is slow, you will still stay there eight hours and you just get

paid for your eight hours. If you are a normal nurse and you work thirty six hours and the e R is running slow, they could say we're just canceling you for the rest of the day, go home. We won't pay you for those last six hours. And so like we've always had pretty like flexible like we've never had like most of the places I've worked, I've never had guaranteed hours. And so one of the reasons to go to travel contracts to is also so you can

at least have guaranteed hours. So there's a lot of kind of protections that nurses have never really had, like guaranteed hours. UM like UH staff ratios, so some states California and organ or um two of them. If you go into the i c U, which is the highest level of care, so people are actively dying actively unstable. Things can go bad within seconds. Usually it's a one nurse will have two patients UM, which is pretty much all you can handle because they're on multiple drips, multiple

types of life's the part keeping them alive. So ventilators UM being the one that we see the most UM, and it's really your responsibility to know every inch of that person's body UM and everything going on with them, and you really direct a lot of their care UM. So two to one kind of makes a lot of sense. Since the pandemic and not having enough nurses, sometimes that slid to three to one or even in bad situations four to one. So one of the statistics that UM.

One of the kind of nurse influencers and comedians Nurse Blake talks about UM is that for every additional patient that a nurse takes on, and I believe he's talking about med starch not I se you that that patients UM mortality increases by seven percent. So yeah, so asking a nurse to do more with less is not just like hey, just suck it up, be busier. This is actively contributing to people's disability and early deaths. So one of the things that the million Nurse march UM wants

to talk about is man man dated staffing ratios. So, I see you would be two to one MED starch is usually four to one. I think you are. They're asking for three to one UM. So these have been studied by the American Nurses Association UM and other sort of UM nursing organizations UM. And not only do they make your job as a nurse so much better because we go into nursing because we want to fix things

and take care of people. We want good outcomes, right Like, you don't go into nursing to just run around with your head cut off and watch everyone die, right Like, that's terrible. You go into nursing because you want the people to get better under your care and you want to be able to give them that. And so when you're asked to take care of more patients than you're able to, you're not able to do that and it's

just crushes you. UM. So not only is it better for nurse satisfaction, it also saves patients lives and also prevents things that will give cause lasting disability like ventilator associated pneumonia or bed sores or delirium things like that. So you know, mandating UM patient ratios is one of the really big things that the million Nurse marks is for UM. There's a lot of talk about pay and

living wages. You know, like every section. Housing prices and inflation have gone through the roof because you've got to like be renting a spot whenever you're like the hospital only putting you up right well, and for staff nurses to write like if you're you know, maybe you're maybe they gave you a two percent raise, but hey, rent

increase UM. I used to be on the interview board at my old hospital all and we would just tell people like, if you're moving to Denver as a single person, we lose most of our nurses because they haven't looked at housing. So like they'll accept a job and then they'll look replace to live and be like, oh, I can't afford to live here, so hey, like, I mean, we can't ask if you're single moving here, but like you probably can't afford to live here with what we're

going to pay you. I mean, cool, I I It's just it's so eternally frustrating that like the one thing that everybody when you sit them down agrees is in controvertibly necessary medical care. Um. We can agree on a lot of things, but not how to make sure that people doing it have a good quality of life and

good income. Like we can we have all these fun, fun rules that make it possible to charge X number of thousand dollars for a dose of insulin um, but we don't just have a law that's like, hey, if if you're working full time as a nurse, uh, maybe you shouldn't have to be housing insecure. I don't know how do you make that into a law, but it seems like there should be some option for a country that can make some of the things we make. Yeah,

I mean tying wages to housing prices. It seems like I don't know, not being an economist and not being an administrator, like that sounds super easy to me, Like everybody gives a race. Sure, I'm sure it's more complicated than that, but it seems super simple to send a guy around with a stick to threaten landlords when they raise rent. Like there's we could debate the answers to this.

What do you think I mean? Not not that like you have any sort of comprehensive knowledge of all of the people doing this, But like, do you think there's a possibility of like a wildcat strike, which is again for people who maybe aren't is when there's a strike of workers who are not unionized. UM. I mean to some extent, with everybody quitting to do travel nursing, it's

not so different. I mean, some things have lost eight of their staff, right some like when a unit says, oh, well, we lost of my staff, I'm kind of like, well you did better than most, you know. UM. So in

some ways it's already happening. And in that same way, I am seeing hospitals give better extent incentives to their nurses that have stayed um, either retention bonuses or UM, increasing bonuses for pick for core staff, picking up extra shifts, UM, or kind of other perks like increasing education benefits or things like that. So I think hospitals are responding to like, hey, we don't want to lose these people to traveling, Like

can we tip the balance a little bit? And I think, you know, overall, hospital leadership is moving slower than they need to UM. But I mean at least they're moving a little bit. So I mean, in that way, I can see a wildcat strike. UM, just coming from the kind of labor forces at play. UM, and I could and I mean there were one of the hospitals in the South, I think it was Alabama, all of their staff, their staff coordinated, UM, so that the ship that was

on agreed to stay late because you can't because abandoning patients. UM, you can put your license at risk. Right. So if we all walked off in the middle of a shift and said fuck you to the hospitals and patients died, then like our licenses at risk. So we also have to kind of balance that a little bit. But there was a hospital they organized for the day shift basically to stay as late as they needed, and night shift all stood outside of the hospital and I wouldn't refuse

to clock it in. So sometimes these things are happening in small levels. Um. Also UM really interesting. Yeah, it is like UM, I mean, and that is like such a tough thing to balance. Just the idea that like, well, you are health care workers, like withholding your labor is a thing that's going to be necessary from time to time. There's also consequences for it that are not present. If you're making I don't know, tires, you know, yeah, and

as much as teachers and nurses are the same. Like I don't think our country cares about educating children as much as it cares about their parents dying, you know, like for better or worse. Yeah, I mean, yeah, that's another subject. Um. Is there anything else you wanted to get into today? Um? Before we we close out for the for the episode? UM, I mean if it's okay with you, and you can cut it if it's not. Um, you know, I try and tweet about kind of what's

happening on the ground. Yeah, absolutely, and the things that I'm seeing. Um. And I'm mostly finished with a book about the first year on the front line and seven different hospitals and kind of the disparities between you know, critical access in New Mexico versus trauma hospitals in you know, the Bay Area, and kind of what that first year looked like. UM. So if you want, you can follow

me on Twitter. UM it's an A N N E like and of Green Gables and r N, which is when I started traveling ur saying, um, you know, and so that I kind of talked a little bit about like what I'm seeing and what's going on. UM. I was recently in an e er where you know, people often had to stay outside under the heat lamps for thirty hours waiting for a hospital bed just because everything was packed so they couldn't even come inside the hospital and they were you know, waiting, um to get their

appendix out and things like that. Again, where your seatbelts and a helmet, be real, be real careful right now, guys, right um? And I mean I think the other thing is the blood shortage. Um, So most hospitals are revising their guidelines of who will get a blood transfusion, so you now have to be much more critical before they will give you a blood transfusion. So um, there's a lot of politics around blood donation. But if you feel like you can donate blood, um, it's really desperately needed.

And people are gonna where your seats because people are really going to legitimately die because we run out of blood. Yeah, um boy, how do you please wear your seatbelts folks, Um, just just hunker down for a little while. No, no new risky experiments in life for just a minute. Not the time to take up skydiving. Yeah yeah, maybe avoid that.

Maybe don't go skiing. Uh if you haven't gone skiing before. Um, I just did that and broke my wrist because I'm I'm exactly as dumb as the people I'm trying to warn.

And then I guess just check in with your mental with your mental health of your health care workers, because I mean, so many people have you know, I think a lot of us are dealing with at least passive sort of like puck, maybe I should just drive off the road instead of going into work today sort of thoughts, you know, And oh, for a lot of us, that's just that fleeting thought and then we get our shipped together. But for some people it's going to be more than that.

And you know, nursing is one of those things where people have to find themselves by their career and they need people in their lives saying like, if you are never a nurse again, you are still valued, you are still loved. Just being alive it is enough, and this is how you know we can help take care of you if you need to quit for three months, you know, um, and supporting people with their intrinsic value rather than like you are only productive and valuable because you were there

saving lives. Because I think a lot of us really get stuck in that, and a lot of us are drawn into nursing because we feel some lack of worthiness without it. You know, Well, that's the hard thing to get other people to do, because in part this is a society where we just have such generally crummy attitudes towards mental health. But like we're great at at saying things like, oh, you know, there's a pandemic. Our healthcare workers are heroes. You're all heroes because of the work

that you're doing. The work makes you a hero, as a was to saying, hey, thank you for doing that. I know things are still fucked up right now, but if you decide you gotta like take a break or whatever, you know, you're you're you're. That doesn't mean you like what you did was still wonderful and you're still great and valuable, and maybe the best thing is for you to take that break and not drive yourself off of

a cliff. Yeah, yeah, that's that's harder to get people to like wave banners that say outside of their apartment complexes, banging on pots to like let healthcare workers know that no matter what they do, their valued members of the community that people love. Um. But yeah, all right, Well, and thank you so much for talking with us today. Um, I hope uh you you hold together and help the people in your life hold together, which is all any

of us can really do other than we're a seatbelt. Yeah, and thank you for being a part of the conversation. And thank you for you know, listening to hard things. And you know that's one thing that I think we really appreciate it is is to people who will actually listen with open hearts and will witness this with us so that we're not alone in it. It Could Happen Here

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