Stephanie Brown, a nurse specializing in cardiac surgery, became part of a growing workforce in Alaska last year when she took a job far from her Florida home.
Brown was hooked by the appeal of work as a "travel nurse" — part of a corps of medical professionals who take temporary assignments around the country to fill staff shortages, a job that comes with an alluring combination of adventure, flexibility and lucrative contracts.
She was especially enticed by Alaska, which last year saw the highest increase in travel nurse pay in the country.
Brown heard from a co-worker that the state was a beautiful place with friendly people.
"And of course," she said, "the money was great."
The contract she saw posted for Providence Alaska Medical Center in Anchorage at $3,000 a week was more than twice her pay as a full-time staff nurse in Florida.
She applied online and was offered the job within hours.
Brown is one of hundreds of travel nurses in Alaska, a growing — and essential — out-of-state workforce for hospitals and health care facilities urgently trying to fill vacant positions after exhausted nurses leaving jobs during the pandemic worsened longtime staff shortages. These days, up to a third of the nurses working in emergency rooms here might be from somewhere outside Alaska.
Experts say the state's reliance on travel nurses comes at a cost. The practice is expensive and could both demoralize and lure away permanent full-time workers who traditionally make up the core of hospital care here.
They receive the same level of training as residents, and getting care from health care workers from the Lower 48 is not in itself a bad thing. But health experts and hospital executives say relying on travelers to fill vacancies is a financially unsustainable model that could be contributing to rising health care costs in the state and around the country.
It also may be worsening the existing worker shortage by pushing staff nurses into more lucrative traveling positions elsewhere.
For now, however, travel nurses are the only immediate way to maintain the staff needed to care for Alaska's patients, health care industry officials say.
In Alaska, there are currently close to 6,000 health care job vacancies, according to Jared Kosin, president of Alaska's hospital association. That number includes around 1,400 empty registered nurse positions.
"There's this monster hole we're scrambling to try and fill," Kosin said.
'No end in sight'
Nationally, increased demand has driven up travel nurse pay around the country. But the costs are particularly high here.
A recent Becker's Healthcare report found that over the last year, Alaska experienced the largest average weekly pay increase for travel nurses out of any state — from $2,356 in 2021 to $3,334 in 2022 — a statistic that Kosin said indicates just how dire the staffing situations are at many facilities.
The high pay is reflective of the fact that while hospitals are no longer crushed by an influx of COVID-19 patients, they're still extremely busy and woefully understaffed, Kosin said.
"There's really no end in sight," he said.
At Providence, Alaska's largest hospital, the number of travel nurses has nearly tripled since 2019.
Brown did a three-month stint there last summer and signed on with the same team in February for a new three-month contract, which she renewed in June. The second contract was even more lucrative than the first one, up to $4,500 per week.
"COVID hit a little bit harder, and they knew that if they really needed to get people up here, then they have to offer a little bit more," she said.
'Backbone of the unit'
Some staff nurses in Alaska — like Katie Ward, a nurse in the progressive care unit at Providence who cares for patients a step down from the ICU — welcome the help Lower 48 co-workers provide.
Reached by phone while on a long-awaited vacation to the East Coast, Ward said she'd gotten almost daily texts that week from supervisors asking if she could pick up an extra shift for increased pay due to chronic understaffing.
Being better staffed means less exhausting shifts and more of a break for everyone, she said. "I often see them as kind of like a saving grace."
Still, Ward said, it can be frustrating knowing co-workers doing the same job are being paid significantly more, especially when staff nurses must be available to train new and temporary hires who often stay on for just three months at a time.
"Travel nurses wouldn't be able to do the job without staff nurses being there and answering the millions of questions that a travel nurse has," she said. "We're the backbone of the unit."
Ward estimated between 30% and 40% of her unit are here on temporary contracts.
And she has considered applying for a travel contract, too. It's possible to stay in Alaska and take on a "travel" contract at a different hospital, she said.
A co-worker recently accepted a travel position at a different hospital in Anchorage for about double what she makes at Providence, even without the per diem stipends associated with taking a position that's farther from home, Ward said.
She understands the lure of higher pay and the flexibility a travel contract offers: Instead of having to request a vacation months early that would likely get denied, as a travel nurse she'd be able to include whatever time off she wanted into her contract. She's still not sure she'd make the change, but the prospect is appealing.
"The idea of traveling and making at least two times the amount of pay that a staff nurse makes — why wouldn't you do that?" Ward said. "Any nurse would be lying to you if they told you that they weren't considering a travel assignment."
'Not financially sustainable'
Health care industry experts say too few Alaskans are entering the field of nursing as older, overworked nurses retire or switch careers at high rates.
In 2018 and most of the preceding years, Bartlett Regional Hospital in Juneau rarely had more than five travel nurses at any given time, said Kim McDowell, chief clinical officer with the hospital. Now Bartlett has 24.
McDowell described what she called a "great resignation" that increased the hospital's reliance on travel nurses early on in the pandemic and has yet to be resolved.
During the worst days of the pandemic, hospitals around Alaska were pushed to the brink with an influx of COVID-19 patients and limited resources. Many nurses worked long, traumatic hours on the frontlines of a pandemic for months on end.
McDowell said she thinks the pandemic may have turned off some people who may been considering nursing — and drove others to retire or leave the profession.
"I think that the culmination of being forced to work in a pandemic, not knowing that there's going to be an end in sight and having to witness that level of death and dying really helps invite people out of the nursing career," she said.
McDowell did not say specifically how much increased reliance on traveling staff was costing the hospital. But she said it was "very expensive," and that the facility was working on trying to recruit local nurses.
"Because in the long run, staffing an organization with travelers is not financially sustainable," she said.
Kosin, with the hospital association, said recruiting in-state nursing students who are more likely to stay in Alaska is one of the best solutions to solving the workforce shortage.
But it's not an easy time to enter the profession, said Ward, the full-time Providence nurse. She has friends who just graduated from nursing school and have had an overwhelming, challenging experience completing rotations in hospitals as part of their schooling.
"I think it would have been really intimidating to see the way the hospital and health care was functioning" during the delta COVID-19 surge that filled hospitals with extremely sick patients, she said. "It was a very, very stressful time, and I couldn't imagine going in as a nursing student on top of all the other things that you have going on."
Adventure and a little sacrifice
Flexibility and the opportunity to see new places and make extra money were what attracted Chad Bleich, a 31-year-old RN from upstate New York, to travel nursing.
It was the allure of Alaska that drew him here.
Bleich took a travel nurse position last year in the Providence Kodiak Island Medical Center's emergency room. This year, he returned to the state for a similar position in Anchorage.
He chose Alaska partly for the adventure.
"Mostly it was just kind of random, like, wow, Alaska, I've always wanted to go there, but I can travel there for work, so let's do it," he said.
Bleich said he's never regretted the decision and feels appreciated for the work he does. He's gained new perspective, had adventures and received the flexibility to take time off whenever he needs.
And while he understands why staff nurses might be frustrated by the pay difference, Bleich said it's important to take into consideration all the increased expenses a travel nurse incurs: potentially having to pay for housing back at home and on assignment; shipping or renting a vehicle; and plane tickets home to see loved ones.
"We're also incurring a lot more expenses than a typical typical staff nurse. So there's a lot more to it than just like, 'Oh, we're making much more than them,' " he said.
Brown's experience working as a travel nurse in Alaska has been mostly positive too.
She said her co-workers have been kind to her. She's felt like part of a team, and has been asked by supervisors to consider moving up here for good. She's considered it.
"It's hard though," she said. "My whole family is on the East Coast. And it's a four-hour time difference."
Kosin said keeping travel nurses who come up from the Lower 48 for the long term is challenging. Fewer than a quarter who come decide to stay permanently.
Alaska is far away and the winters are long.
"Getting people to stay, retaining them, that is extremely difficult," he said.
