Before the COVID-19 pandemic, Addison Frasch worked as an intensive care nurse in his native Georgia, making about $900 a week.

Now Frasch is a travel nurse on a crisis assignment at a rural hospital near El Centro that is inundated with COVID patients. The 23-year-old is earning $6,200 a week as a float ICU nurse under a statewide contract that he landed through San Diego’s Aya Healthcare.

Frasch knows that he won’t be paid like this forever. His contract is lucrative in part because ICU nurses are in short supply and because the contract allows for him to be relocated to any hospital in California at a moment’s notice.

But it is also a sign of the times.

“When you add the staffing shortages and the influx of patients on top of that, there is nowhere to go but up for the pay because everyone is competing for you to come to their hospital,” he said.

The upswell of COVID-19 cases nationwide this fall has sparked surging demand for travel health care workers — mostly nurses who take temporary assignments outside of their hometowns.

ICU nurses are needed the most and command the highest pay. But telemetry and medical-surgical nurses are also in demand, followed by emergency department nurses and respiratory therapists.

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Hospitals facing the toughest COVID-related labor shortages are now paying $4,000 to $8,000 per week for clinicians with highly sought skills such as ICU training, said Alan Braynin, chief executive of Aya Healthcare, a staffing agency for travel health professionals.

“I would say for certain specialties nothing has changed, but if you’re in ICU, telemetry or med-surg, rates could be up 80 percent to 100 percent,” he said. “I can think of three (hospital) systems where rates are up 200 percent.”

Hospitals for years have used travel nurses to fill holes in their workforces without having to hire permanent staff. Early in the pandemic, travel nurses from California and other relatively safe regions flew to hot spots such as New York, Connecticut, Arizona and Texas to take assignments.

Now, much of the country is experiencing surging COVID cases and hospitalizations — especially California, which has 20,000 COVID patients in hospital beds and zero ICU availability in the Southern California and the San Joaquin Valley regions under state public health officials’ weighted formula for calculating capacity. So, the competition for travel nurses has become fierce.

“Back in the spring and summer, it was a regional situation, not a national situation,” said Chris Van Gorder, head of Scripps Health, at a news conference just before Christmas. “Back then, we could get travelers. Today, this is a national situation, and we can’t recruit travelers.”

In May, Scripps Mercy Hospital in Chula Vista hired travel nurses to expand its ICU capacity by 100 percent during a spike in South Bay COVID cases, said Mary Ellen Doyle, corporate vice president of nursing operations at Scripps Health.

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But demand is so great across the country today that “we currently are using a smaller number of travel nurses than we were in May simply because we can’t hire as many as we need now,” she said.

Job openings for travel clinicians on Aya Healthcare’s online platform topped 40,000 this week. That’s up from about 16,000 in March, said Braynin.

Staffing shortages can be particularly harsh for rural hospitals that lack resources to compete in a nationwide bidding war for health care talent.

“These are incredibly difficult times (for hospitals) where we’re hearing about record levels of vacancy in their permanent labor force as they’ve had attrition and probably weren’t hiring a lot earlier in the year,” said Brian Scott, chief financial officer of AMN Healthcare, in a presentation to investors last month. “They are running very lean. They can’t really ask more of their labor force, and they’re coming to us.”

Health care staffing agencies are scrambling to find a supply of travelers to fill in. San Diego is home to a cluster of these companies — including Aya and Host Healthcare. AMN, one of the nation’s largest health staffing firms, was previously based in San Diego but moved its headquarters to Texas about a year ago. It still has a substantial employee base in the region, however.

To help fill positions, Aya added technology early this year to get more jobs in front of travel clinicians faster.

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Traditionally, recruiters work directly with travel nurses to discuss jobs. Starting in March, Aya launched a web-based platform that allows nurses to find positions, see pay rates, learn about the hospital, get recommendations and express interest in an assignment online.

Earlier this month, about 36,000 people viewed more than 370,000 jobs in aggregate on Aya’s website during a one-week period.

“When we were testing this at the tail end of 2019, there was internal resistance because recruiters don’t want to be replaced with software,” said Braynin. “But when we got our first order for 3,000 clinicians from New York and they needed them in one week, there is just no way to handle that unless you re-invent your systems. So we said, we’re going live with this platform.”

Aya now has 13,000 clinicians in the field, up from 6,000 in March. The company expects that number to swell to 17,000 on assignment by mid-January as it continues to recruit travel nurses. And the company is tapping subcontractors to place an additional 4,500 nurses in jobs.

While positions are plentiful and pay is rising today for certain specialties, that can change quickly in the boom or bust travel nurse industry.

In April, emergency room nurse Emily Drabek had a contract in Denver canceled because the hospital was not as busy as projected. The same thing happened in Seattle in June three days before she was scheduled to start.

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A Michigan native, Drabek, 26, found an alternative assignment in Seattle that lasted through November. Now she is working at Sharp Grossmont Hospital in La Mesa with a group of other travel nurses, several of whom have extended their contracts.

“A lot them have been there for a while because they like working at Grossmont,” she said. “I would say that I do feel supported. This staff is very close, like a family. That is probably why so many travelers stay.”

These days, Drabek is seeing more COVID patients than she ever has in her career. The hospital is at or near capacity. The result is admitted patients sometimes wait 15 hours or longer in emergency department rooms before beds become available in appropriate units upstairs.

Drabek makes $2,100 a week for the non-crisis assignment. It’s more than she was earning in Seattle. She is considering picking up an additional shift, working 48 hours a week. And competition between travel nurse staffing agencies may result in a pay hike.

“All the travelers talk,” she said. “We are all from different agencies. A nurse from another agency said they were offering more. So I talked to my recruiter and said hey, could you match that? He said sure, as long as the details were the same, the same hours and so on.”

Frasch, the ICU nurse working near El Centro, also spoke with his recruiter about matching an $11,500 per week package that he saw advertised for an ICU position at his hospital. The last-minute posting was for an assignment that started on Christmas Eve.

“I worked Christmas. I work all the holidays,” he said. “I get that we should be grateful, but dang, that is probably the highest I have seen on a pay package.”

It turned out that a pay match wasn’t available for that specific assignment, said Frasch. He understands that it’s intended for cover for staff shortages during the holidays, and he said his current contract “is still a lot of money compared with what we are going to be making in the future if COVID slows down.”

This story originally appeared in San Diego Union-Tribune.