Among the issues that Guam’s health care system is dealing with during the pandemic is the lack of qualified nurses. Currently, Guam nurses are “making it work” and “doing the best we can,” Dr. Joleen Aguon, medical director of Guam Memorial Hospital, said at a recent press conference.
But that isn’t very comforting to the frontline workers who are working long hours to keep up with the surge in hospitalized patients.
The demand for experienced, licensed nurses during the pandemic has been felt all over the U.S., and Guam is no exception. As a result, “travel nurses” have been reaping the benefits with staffing agencies and their clients – hospitals, nursing homes, rehabilitation facilities, doctors’ offices and hospices – offering high paying, temporary positions with incentives to lure nurses to work in frontline jobs with Covid patients.
In 1999, the National Council of State Boards of Nursing created two interstate compacts to reduce regulatory barriers to cross-border nursing for licensed practical/vocational nurses, registered nurses, and advanced practice registered
Following the enactment of legislation authored by. Sen. Mary Torres, Guam became the first U.S. territory to enter the Enhanced Nursing Licensure Compact, with partial implementation until 2022. For now, nurses licensed in compact states on the mainland can come to Guam, but the reverse will not be available to Guam’s nurses until next year.
The compact helps solve the urgent need since licensed nurses from compact states can begin working the minute they arrive in Guam.
Close to 30 nurses from compact states have come to Guam so far. Many cite the chance to enjoy a tropical island, water sports, hiking and other advantages of this region of the world while getting paid to do their job.
After working 60 to 80 hours a week on the front-line in Massachusetts and Vermont hospices and rehab facilities, Marise Burgess moved to Guam in early July for "a break and a change of pace."
At the time, Covid was deemed under control and she thought she would not need to work so hard. Burges recently received word from the Board of Nursing that she has been approved for an emergency permit, but is still waiting for the board's endorsement of her New York State license.
Some work as travel nurses on a regular basis while others are choosing to leave their lower-paying staff jobs in their hometowns to hop on the bandwagon and take advantage of the lucrative opportunity to make as much as $60 an hour, often with time-and-a-half overtime.
But this is still much less than some states are offering during the pandemic.
Washington State, for example, is on the higher end of the scale offering upwards of $200 per hour for a 40-hour workweek. However, that doesn’t mean they receive $200 in their pocket.
According to travelnursing.org, “Unlike regular staff nurses, travel nurses are paid a ‘total pay package’ that includes an hourly base wage plus additional monetary incentives that include things like sign-on or referral bonuses, travel reimbursements and stipends for housing, food, mileage, or job-related expenses.”
Earlier this year, GMH officials acknowledged that travel nurses became a major cost factor for the government hospital last year.
At one point during the height of the pandemic late last year, GMH brought in about 51 travel nurses from NuWest recruitment agency, which charged GMH an hourly rate of $145 per nurse.
Indeed.com reports that the average annual salary for a travel nurse is $108,070 in 2021. Compare that to the average salary for staff nurses of $75,330 per year. But that also needs to be compared to the length of the short-term assignments for travel nurses. They rarely work a full 52 weeks per year since the assignments are normally only a few weeks in length.
The exact salary for travel nurses varies widely based on location, nursing position and the length of the contract.
Guam’s Board of Nurse Examiners under the Department of Health and Social Services is attempting to keep up with the demand for Guam Memorial Hospital, Guam regional health centers and Guam Regional Medical City and
At the same time, the private sector is also in need of qualified, licensed, experienced nurses, often in specialty areas such as critical care, ICU, ER, labor and delivery.
The purpose of the board is “to protect the public from unlicensed practitioners,” said Zennia Pecina, the board’s executive officer.
In April 2020, the University of Guam Board of Regents approved the early conferral of nursing degrees to senior nursing students in support of the island’s response to the pandemic. After graduating one month early, the students were allowed to take their exams beginning in June.
Approximately 70 percent of the graduates passed the exam due in part to the experience they gained on the job after graduation, according to Pecina.
The UOG’s School of Health “is doing a great job,” graduating 20 to 30 students in the RN program every year, and another 15 to 20 in the Licensed Practical Nurse program, Pecina said.
However, she added, nurses with the level of experience needed during the Covid crisis are still lacking.
For those who are not from compact states, the board also offers a three-month emergency permit for immediate placement in certain jobs while the applicant’s credentials are verified. But, said Pecina, the verification process can take much longer than three months due to the slow response from some of the nurses’ home states.
“We are fortunate that a lot of our nurses are local and have roots in our community here in Guam. They usually do not want to pick up and leave for the mainland,” Pecina said.
The government seeks to address the challenge of keeping them on board.
Under the 2022 appropriations law, nurse salary increases in the Guam Memorial Hospital Authority, the Department of Public Health and Social Services, and the Guam Behavioral Health and Wellness Center will be funded out of their respective agency budgets in fiscal 2022.
This provision was based on Sen. Mary Torres’ amendments designed to allow adjustments in the nurses’ professional pay structure. Torres proffered the new language to the budget bill after lawmakers failed to appropriate funding from the $35 million set aside for the Healthcare Center of Excellence Facility.
“These amendments do not appropriate additional funding for the nurse pay increases in FY2022, as originally requested, but they at least mandate that a portion of the agency’s current budget be used to fund the adjustments,” Torres said following the signing of the bill. “They also tell front-liners that we put our money where our mouths have been for the past year—ensuring that these long-awaited increases can continue and are not de-prioritized in FY22.”