Texas health leaders question sustainability of ‘traveler model’ for nurse workforce


Eli Kirshbaum


Adam Maurer, chief operating officer at OrthoLoneStar, believes workforce and staffing issues are the biggest post-pandemic challenges the Texas health care system faces. In particular, the state’s burnout-induced nurse shortage is threatening the health system’s capacity to care for patients as the Delta variant continues to spread.

“It strikes me that nursing has got to really be the linchpin of what we need within the hospital environment right now, and where the shortages seem to be the most acute …”


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The state’s approach to solving the issue, however, is neither equitable nor sustainable, according to Maurer. The market-driven “traveler model,” which pays nurses from other states to relocate and work at facilities in Texas, isn’t financially viable, he said during a panel at last week’s 2021 North Texas State of Reform Health Policy Conference.

This nurse shortage has made the market more competitive and caused nurse salaries in the state to skyrocket. In Aug. 2021, there were over 20,000 more available jobs for registered nurses than there were people seeking to fill them, according to the Texas Workforce Commission.

Maurer thinks the high compensation given to out-of-state nurses raises equity concerns. Having a situation where two nurses work alongside each other and perform the same responsibilities, but where one compensated three times higher than the other, isn’t optimal, he said. He thinks the state should explore flatter compensation models that prioritize each nurse’s contribution and are more equitable. 

“The market’s got to respond to that, and I think it will flatten and normalize, but I know that there’s going to be significant upward wage pressure …”

Winjie Miao, SVP & chief experience officer at Texas Health Resources, agreed with her fellow panelist.

“I think the state has been helpful and supportive in bringing temporary staffing to health care settings, and those … staff have been an essential part of our pandemic response … With [Texas] bringing in staff, and the traveler model, contract labor has gone up significantly and that’s not sustainable.”

Miao said facilities should develop ways to “re-recruit” their own staff and provide incentives like retention or preceptor bonuses to ensure staff feel valued and stay with the facility.

“[We need] to ensure that our existing staff who are sticking with us know that we are just as appreciative [of them] and they are just as valuable as the contract staff coming to work side by side with them.”

Maurer and Miao both think getting more nurses licensed and credentialed needs to be a “key policy effort” for Texas. While nursing school enrollment has remained somewhat steady and graduate nursing pipelines are “just as robust as ever,” Miao said Texas needs to focus on career development and retention for nurses who are already in the state. She referred to the work of Dallas Thrives, an organization with the goal of doubling Dallas’s living wage attainment in a single generation.