Search

Insights^

Find our analysis on legislation, regulations, MedPAC meetings, and more. 

Travel Nurses Come to the Rescue, but at What Cost?

When it’s a global pandemic and you’re facing a shortage of health care workers, who you gonna call? Travel nurses.  This has been the answer for many health care providers, as travel nurses temporarily fill in gaps where there is a shortage of staff nurses. As the pandemic has changed how businesses operate, how will this impact the future for travel nurses and providers?

Why be a travel nurse?  Compared to staff nurses, travel nurses receive better compensation and attractive benefits like housing and per diem.  Many nurses are attracted to this lifestyle for the ability to travel and the opportunity to help pay off the cost of their nursing education.  Staffing agencies, not health care facilities, employ travel nurses and place them with providers.

Supply and Demand

The market for travel nurses was hot even before the COVID-19 pandemic due to an aging US population and other public health crisis like the opioid epidemic.  And now the pandemic has driven the demand for travel nurses even higher.  A recent poll of hospital executives by Avant Healthcare Professionals found 90% of respondents used travel nurses in 2020, compared to less than 60% in 2019.  Increasing demand has caused compensation for travel nurses to rise in tandem, with contracts for some front-line workers reaching $10,000 per week.

Travel nurses still face plenty of challenges.  Throughout the pandemic, both travel nurses and staff nurses have struggled to make do with a shortage of personal protective equipment, experienced burnout, and encountered emotional trauma from treating seriously ill COVID patients.  Problems have gotten so bad that many nurses are considering leaving the professional altogether.  Plus, since a great deal of travel nurses are geographically separated from family and friends, they lack the emotional support networks that are more readily available to their staff nurse counterparts.

There are downsides for providers, too.  Sure, travel nurses can alleviate staffing shortages at hospitals and nursing homes, but they can create headaches of their own.

  • Cost.  Higher compensation for travel nurses means higher labor costs for providers, which includes an extra cost of paying a commission to the staffing agency.  And don’t forget, many providers have already been facing financial pressures of their own during the pandemic.
  • Competition.  Some nurses employed with hospitals and long-term care facilities are leaving their jobs to pursue more lucrative opportunities as travel nurses, exacerbating the industry’s workforce shortage.   Staff nurses who train travel nurses new to a health care provider may also find themselves frustrated with the fact that they are making less money than their trainees, causing morale to fall and potentially providing another reason for staff nurses to seek greener pastures.
  • The rural factor.  Larger hospitals near metropolitan areas are better able to weather staff shortages due to their more robust financial position, which allows them to afford travel nurses.  Plus, the higher staff sizes of hospitals in urban and suburban areas means they’re not as severely affected by a couple of unfilled nursing positions.  However, it’s a different story for rural health care providers, where just a shortage of just a few nurses can make a big difference on providing care.Additionally, smaller rural hospitals cannot afford to pay nurses as competitive of a salary as their larger, urban counterparts, meaning they’re at greater risk of losing nurses to better-paying travel roles.

Still, travel nurses aren’t going away anytime soon.  Even when the pandemic ends, an aging population will continue to drive up demand,  while a growing number of nurses retiring, made worse by the public health emergency, will leave many positions unfilled.  Although projections vary widely across the country, many states face a projected shortfall of thousands of nurses by 2030, impacting the amount and quality of care a provider can provide.  While travel nurses may be an imperfect solution, health care providers will have no choice but to fill staffing shortages with temporary workers for the years to come.

Continue Reading
pexels-rodnae-productions-6129681-scaled

What Happened, What You Missed: September 27-October 1

  • Posted In FDA

Pfizer Submits Initial Data on COVID-19 Vaccine in Kids

On September 28, Pfizer submitted initial data to the Food and Drug Administration (FDA) that shows its COVID-19 vaccine generates “robust” protection in children aged 5-11.  The announcement came just a week after Pfizer announced positive topline results in its clinical trials for children.  Pfizer says it will formally apply for Emergency Use Authorization for children in that age range “in the coming weeks,” teeing up FDA authorization potentially by the end of October.  Pfizer also announced that it is expected to have topline results for children under 5 in the fourth quarter of this year.

CDC: Side Effects from Booster Shots Are Mild

A third “booster” shot from Pfizer’s mRNA COVID-19 vaccine produces side effects consistent with the side effects individuals experienced after their second shot, according to a report posted Tuesday by the Centers for Disease Control and Prevention (CDC).  The report found side effects usually appeared the day after the injection, with the most common side effects being mild-to-moderate arm pain, fatigue, and headache.  According to the White House, over 400,000 Americans have received a third Pfizer shot over the past week, including President Joe Biden, who was administered his booster shot during a live event on Monday.  Both the FDA and the CDC approved booster shots for senior citizens, high-risk workers, and people with chronic medical conditions last week.

Gallup: Delta Variant Likely Prompted More Americans to Get Vaccinated

According to a Gallup poll released on September 29, the percentage of US adults who reported being vaccinated for COVID-19 grew to 75%, largely due to growing concerns of being infected with the virus as the Delta variant continues to take its toll.  The poll also found that a rise in vaccine mandates from employers and the FDA fully approving the Pfizer vaccine may have also contributed to higher vaccination rates.  Additionally, for the first time, Gallup found that a majority of adults who identify as Republican say they have been administered at least one vaccine dose.

Congress Averts Shutdown, but Leaves Debt Limit Unresolved

President Biden signed a continuing resolution (CR) late Thursday to fund the government through December 3, averting a government shutdown that otherwise would have begun on October 1.  The standalone CR was fast-tracked through Congress after Senate Republicans initially blocked a measure that paired government funding with a debt ceiling increase on Tuesday.  Earlier this week, Treasury Secretary Janet Yellen sent a letter to congressional leadership saying that without any action to raise or suspend the debt ceiling, the government could default on its debt obligations as soon as October 18.  Senate Republicans want Democrats to address the debt ceiling through the budget reconciliation process, but Senate Majority Leader Chuck Schumer (D-NY) has so far refused to do so, setting up a standoff between the two parties for the next few weeks.

ICYMI: DC’s “Cat Census” Estimates 200,000 Felines in the District

There are about 200,000 cats residing in Washington, DC according to the DC Cat Count, the first-ever project to conduct a census on felines in a major US city.  The project estimates that the overwhelming majority of the District’s cats are owned or cared for while about 3,000 are feral.  Of the cats who receive at least some care from humans, half are indoor-only, while the other half have some access to the outdoors.  To conduct the cat census, the Human Research Alliance collaborated with the Smithsonian to place over 1,500 motion-sensor cameras in locations across the District, resulting in about 1.2 million cat photos.

Continue Reading
jesse-paul-z5Bx31kQ2Pw-unsplash-scaled

The Senate Parliamentarian, Explained

On September 19, Democrats’ plans to offer undocumented immigrants a legal pathway to permanent residency was torpedoed when the Senate Parliamentarian ruled against including immigration reform in their $3.5 trillion human infrastructure package.   As Democrats attempt to advance key priorities via budget reconciliation, the role of the Senate Parliamentarian has garnered much attention.

Background: Democrats have long been seeking a way to offer permanent residency to Dreamers, who are undocumented immigrants who were brought to the US at a young age and have lived most of their lives in America. Currently, many Dreamers do not have a clear path to gain legal permanent residence status, which would then allow them to pursue citizenship.

The role: The Senate parliamentarian interprets the Senate’s often complicated rules.  The position of the Senate Parliamentarian is strictly non-partisan, and individuals are traditionally appointed to the role from senior staff in the Parliamentarian office. There have only been six Senate Parliamentarians since the position was created in 1935.  Senate Parliamentarians have no defined term length and serve at the pleasure of the Majority Leader.  The current Parliamentarian is Elizabeth MacDonough, who was appointed by then-Majority Leader Harry Reid (D-NV) as the first woman to hold the position in 2012.

Did you know?  The Senate Parliamentarian’s salary is $171,315 per year, as of 2019.

Some of the things the Senate Parliamentarian might do include:

  • Advising the Senate’s presiding officer, or Majority Leader, on the appropriate procedure, statements, and responses of the Senate.
  • Offering written guidance on procedural questions.
  • Recommending the referral of measures to relevant committees.
  • Maintaining and publishing procedural rules.

It’s not just the Senate: The House of Representatives has its own Parliamentarian, too, with a similar salary and responsibilities.  The current House Parliamentarian is Jason Smith (not to be confused with the Missouri Congressman), who was appointed in 2010.

Why the Senate parliamentarian is getting so much attention this year:  The Democratic majority is using the budget reconciliation process to accomplish their policy goals and bypass the need for Republican support. Therefore, enter the Parliamentarian, who decides what can and can’t be included in legislation passed under this process. The Parliamentarian uses the Byrd Rule to analyze legislation and makes a determination on whether a provision produces a change in spending or revenues and does not increase the deficit within a set period.

This isn’t the first time where the Parliamentarian says no to a Democrat policy: Back in March, top Senate Democrats were upset by the Parliamentarian’s decision to not include a minimum wage increase in the American Rescue Plan due to an “incidental” impact on the federal budget.

What Could Senate Democrats Do? The Senate Majority Leader does have the authority to fire the Senate Parliamentarian.  This last happened in 2001, when then-Majority Leader Trent Lott (R-MS) fired then-Parliamentarian Robert Dover after he interpreted Senate rules in way that would have made it difficult to pass then-President George W. Bush’s tax cut proposal through budget reconciliation.

However, MacDonough’s job seems safe for now.  While Majority Leader Chuck Schumer (D-NY) has expressed disappointment with her recent rulings, he has yet to call for the Parliamentarian to be replaced.  Senate Majority Whip Dick Durbin (D-IL) has similarly indicated he doesn’t think MacDonough should be dismissed.  Instead, Senate Democrats have expressed a willingness to advance immigration reform and other priorities that can’t be included in budget reconciliation through regular order, even if the chances of doing so are slim to none.

Senate Democrats could also overrule MacDonough’s ruling with the support of all 50 Senate Democrats and Vice President Harris, but this won’t be happening, either.  Both Sens. Joe Manchin (D-WV) and Kyrsten Sinema  (D-AZ) have previously stated they won’t overrule the parliamentarian, while Sens. Dick Durbin (D-IL) and Bob Menendez (D-NJ) have thrown cold water on the idea.

Continue Reading
harold-mendoza-6xafY_AE1LM-unsplash1-1920x1280

What Employers Need to Know About the New Vaccine Mandate

The White House says it’s time for the unvaccinated to roll up their sleeves.  To help boost vaccination rates as the Delta variant continues to take its destructive toll across the nation, President Biden laid out a new COVID-19 action plan with some new requirements for private businesses.

How it works: The Biden administration is directing the Occupational Safety and Health Administration (OSHA) to develop a rule that will require all private sector employers with 100 or more employees to ensure their workforce is fully vaccinated and require any unvaccinated workers who remain unvaccinated to show a negative test result at least once a week.  Furthermore, the administration says it will require private employers to provide paid time off for employees to go get vaccinated.  OSHA will issue the rule through an emergency temporary standard (ETS) that will take effect immediately upon publication in the Federal Register.

This requirement is expected to impact 80 million workers in the private sector.

Can OSHA do this?  OSHA has the authority to issue an ETS if it’s been determined that:

  1.  “Employees are exposed to grave danger from exposure to substances or agents determined to be toxic or physically harmful or from new hazards,” and
  2. The ETS is “necessary to protect employees from such danger.”

Remember: OSHA mandated that certain health care workers be vaccinated via an ETS issued in June 2021.

And yes, the mandate is constitutional.  In 1905, the Supreme Court ruled 7-2 to uphold a $5 fine for failing to be vaccinated against smallpox in Jacobson v. Massachusetts.  According to the high court, an individual cannot deprive his or her neighbors of their own liberty by allowing the spread of disease.

What happens next? White House Coronavirus Response Coordinator Jeffrey Zients said on September 10 that the ETS will be drafted “over the coming weeks.”  This means OSHA will release the rule much sooner than the ETS for health care workers, which was in development for six months before being published in June of this year.

What employers should do.  While OSHA spends the next few weeks developing an ETS, private businesses can do several things to be prepared.

  • Plan for potential costs, including the cost of testing and time off to be tested.
  • Prepare processes to collect vaccination information.  Put in place a system to request, collect, and maintain vaccination information, and designate a group of employees to verify evidence of vaccination status.
  • Create a testing policy.  Figure out whether your organization will offer on-site testing to workers, allow workers to self-administer tests at home, or get tested by a third party.
  • Consider a mandatory vaccine policy that goes further than the ETS and allows your business to forgo the weekly testing option.
  • Prepare for accommodation requests for employees who do not want to be vaccinated for health or religious reasons.

Prepare for enforcement.  OSHA inspections can be conducted without notice, and the agency has a robust system in place to handle whistleblower-style complaints from employees.

Get ready for lawsuits. The debate over vaccine mandates won’t end after the ETS is issued.  Arizona became the first state to file a lawsuit against the administration on September 16, and 24 Republican state attorneys general threatened to take legal action in a September 16 letter.  Still, employers should continue preparing for the new ETS as OSHA continues to move forward full steam ahead.

Continue Reading
pexels-daria-shevtsova-1560932-1920x1280

What Happened, What You Missed: September 20-24

Walensky Overrides CDC Advisory Panel, Approves Booster Doses for At-Risk Workers

Late Thursday, Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky  took the unusual step of overriding a recommendation from the Advisory Committee on Immunization Practices (ACIP) on whether adults aged 18-64 with frequent exposure to the virus should receive a COVID-19 booster shot.  While ACIP members felt there is not enough data to show that boosters are necessary for at-risk workers like nurses and teachers, Walensky said providing boosters for these individuals would help the US prepare for the “next stage in the pandemic.”  She also pointed out that the decision would align the CDC with an FDA decision made earlier this week on boosters for high-risk workers.  Walensky did however approve other recommendations made by ACIP to allow individuals over age 65 and people with chronic health conditions to receive a third booster dose.

Pfizer Releases Vaccine Data for Kids, J&J Posts Booster Shot Data

Pfizer announced on September 20 that a two-dose regiment of its COVID-19 vaccine administered three weeks apartment generated a strong immune response in children aged 5-11, according to topline results from a phase 2/3 clinical trial.  The trial used a third of the vaccine dose that is currently approved for people 12 and older.  Pfizer plans to file the full results to the FDA soon, teeing up an emergency use authorization for children within the next several weeks.  The following day, Johnson & Johnson announced that a second “booster” dose of its single-dose COVID-19 vaccine generated a strong immune response.

House Advances Doomed Appropriations, Debt Ceiling Bill

On September 21, the House approved legislation to fund the federal government through December 3, 2021 and suspend the debt ceiling through December 22, 2022.  The combined appropriations-debt ceiling bill, which passed on a 220-211 party line vote, could be considered in the Senate as soon as Monday, September 27.  However, the measure is certain to fail in the upper chamber due to a lack of support from Republican Senators.  Instead, Republicans are urging Democrats to pass a debt ceiling suspension by attaching it to the human infrastructure package , which Democrats say is not possible due to “parliamentary obstacles.”  Government funding expires on October 1, while Treasury Secretary Janet Yellen says the government could begin to default on its debt sometime next month.

CMS Final Rule Extends Open Enrollment, Boosts User Fees

In its third part of its 2022 Notice of Benefit and Payment Parameters rule, the Center for Medicare and Medicaid Services (CMS) finalized proposals to extend the open enrollment deadline for Affordable Care Act (ACA) plans through January 15, 2022 and create a new monthly special enrollment period geared toward low-income individuals.  The final rule also increases the user fee for 2022 to 2.75% for insurers in the federally run exchange and 2.25% for state-based exchanges..  According to CMS, the user fees are intended to support consumer outreach activities, including the Navigator program.

ICYMI: Capitol Fence Goes Up, Capitol Fence Goes Down

Metal fencing that was erected in advance of a rally last Saturday went down almost as quickly as it came up.  The rally, which was organized to support the hundreds of people arrested for the January 6 riot, ultimately attracted more law enforcement and news media than actual protestors.  Work crew began to disassemble the fencing on Sunday afternoon, and by Monday afternoon, the fencing was completely gone.

Continue Reading
cdc-IFKv3LESkVg-unsplash-scaled
Load More

Subscribe to Us Now!

Be a DC insider by getting our updates straight to your inbox

Subscribe

Links

Services

Case Studies

Stay Up To Date

Be a DC insider by getting our updates straight to your inbox
Be a DC insider by getting our updates straight to your inbox

Copyright 2026. Chamber Hill Strategies. All Rights Reserved