BOSTON — Temporary staffing costs at the state’s hospitals are skyrocketing amid a chronic shortage of nurses and other health care workers.

That’s according to a new report by the Massachusetts Health and Hospital Association, which found that hospitals spent more than $1.5 billion on staffing costs in 2022, a more than 150% increase over the previous year. More than 77% of payroll costs were for temporary registered nurses, the report said.

That represents a more than 600% increase over the $204 million hospitals spent on temporary workers in 2019, before the COVID-19 pandemic, the report said.

Traveler workers such as registered nurses are generally paid higher hourly wages — at least two or three times more than what an on-staff clinician would earn. Many often receive signing bonuses. But chronic staffing shortages have required many hospitals to enlist them to help provide critical care.

Hospital Association CEO Steve Walsh said the health care staffing system has been “upended” in recent years and will require a collective effort to ensure that hospitals have enough workers to manage healthcare needs of their patients.

“The traveler agencies and temporary-worker trend has introduced a highly volatile variable in the budgeting and forecasting models hospitals use to remain financially stable and accessible to patients,” he said in a statement. “This is a trend that demands our collective policy focus.”

Walsh urged Beacon Hill policymakers to consider the “dramatic shift” as they work to cut health care costs by imposing new restrictions on hospitals.

Last year, a report by the association found that hospitals are down about 19,000 workers, which is driving up wait times for care, forcing patients to be boarded in emergency rooms and driving up hospitals’ payroll costs.

“The effect on access and costs is real,” the report’s authors wrote. “These challenges, which are resulting in care delays and reduced access to services, are now evident to many patients and families entering a healthcare facility or trying to address their care needs.”

Hospitals cite a number of reasons for the vacancies, ranging from an aging workforce to job burnout, and nurses leaving staff positions to take higher-paying jobs with staffing agencies.

Labor unions representing nurses and other hospital workers argue that poor working conditions are forcing workers to leave the profession for other employment opportunities.

On Beacon Hill, lawmakers have filed dozens of bills for consideration in the upcoming session that seek to deal with workforce shortages in health care and other industries.

Gov. Maura Healey has proposed new funding and programs aimed at recruiting and retaining more workers to the state's healthcare labor force, as part of her $55.5 billion budget proposal for the next fiscal year.

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at

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