At first glance, Tracie Padgett seems like any other nurse assigned to the neonatal intensive care unit at Pomona Valley Hospital Medical Center.


She cares for newborns often weighing less than a pound. She works a tiring shift that keeps her constantly busy. She attends to parents worried about the prognosis of their babies.


But Padgett comes at a high price to the community hospital. Recently relocated from Florida, Padgett is a "traveling nurse," a breed of gypsy health care professional which can cost a hospital about 30 percent more than a staff nurse.


"I was working in a small hospital in Daytona Beach and was barely making ends meet," said Padgett. "I'm not in a hurry to go back to a staff job. I love the freedom and the variety and the pay."


It's never been easy for hospitals to staff the right number of nurses each shift to adequately care for patients without blowing payroll. But a nationwide nursing shortage and tougher state staffing requirements have forced hospitals to expand their use of out-of-state nurses, as well as "local" traveling nurses.


That's created an unprecedented seller's market for the nurses, who contract for least 13 weeks and can make $60,000 to nearly $100,000 a year, depending on experience and amount of overtime they're willing to work.


A significant portion of the premium goes to the registry that played matchmaker often by enticing nurses from out-of-state by covering housing and food costs, in addition to the higher per-hour pay. That compares to the lower cost of filling holes with locally-based temps who fill in on a daily basis, as needed.


The Hospital Association of Southern California indicates that spending on registry nurses increased by at least 57 percent between 2003 and 2004, with anecdotal evidence suggesting comparable growth this year.


"All the demographics point to more patients, an aging nursing population that's retiring and not enough training opportunities for new nurses, especially in (California)," said Barry Asin, chief researcher of the trade newsletter Staffing Industry Analysts.


Shifting demands
The traveling nurse workforce tends to concentrate on both ends of the career cycle. Nurses a few years out of college want to expand their experience and check out various cities and hospitals before settling down. Older nurses may decide to wind down their careers or stave off burnout with extended vacations interspersed with three-month assignments.


A few years ago, they were in less demand as hospitals balked at the higher rates for temps at a time of lower patient loads, and as full or part-time staff nurses were more willing to work extra shifts in an uncertain economy.


But a steady growth in patient volume, along with the state's adoption of tougher nurse-to-patient ratios last year, forced greater reliance on the pricey temporary staff.


"Rather than burn out all their nurses through excessive overtime, they've eventually gone back to filling in with temporaries," said Leanne Oakman, vice president of sales and client services in the Irvine office of New York-based Comforce Corp., which serves as a broker between the traveling registries and hospitals.


California, especially Southern California, is considered the industry's most desirable market, with out-of-state nurses regularly requesting assignments here.


"People want to go to Florida or California, but California pays better. Los Angeles and Orange County combined is probably the No. 1 market for traveling nurses," said Alan Braynin, owner of Access Nurses, a San Diego-based staffing firm.


Pomona Valley Hospital Medical Center has 60 open staff positions for registered nurses it would like to fill, if it could find suitable candidates. "If it wasn't for resources like (traveling) registries, I'd be in a world of hurt," said Cherie Rudoll, vice president of nursing and patient care services.


It can cost a hospital at least $40 an hour in pay and benefits to hire a staff registered nurse, compared to closer to $70 an hour for a traveling nurse (with the nurse receiving around $53 of that amount in pay and benefits, according to some estimates).


One of Padgett's colleagues at Pomona Valley is Jennifer Nies, who is about to start her third 13-week contract at the neonatal intensive care unit. A 25-year-old Los Angeles area native, Nies is a "local traveler" who gets the higher pay and a partial housing stipend, but not the full room-and-board that an out-of-state nurse might demand.


Nies isn't quite sure she's ready to settle down with a staff position there or at any other hospital. For one thing, the pay likely would be lower and she'd have less control over her schedule. "For now I like the flexibility and certainly the pay, but I expect that maybe in a couple of years I'd want to settle down at one facility," she said.

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