Union nurses vote to authorize strike at Michigan Medicine
Nurses at Michigan Medicine, based out of Ann Arbor and affiliated with the University of Michigan, voted last week to authorize a three-day strike “in protest of the University’s unfair labor practices.” No date for the strike has been set, but the vote allows the University of Michigan Professional Nurse Council (UMPNC) bargaining team to submit a 10-day strike notice if they feel it’s necessary, according to the union’s statement. “Our goal is not a work stoppage,” said Katie Oppenheim, RN and chair of UMPNC in the statement. “Our goal is a fair agreement which respects nurses and guarantees safe staffing. The University can remedy this situation immediately, by stopping their unfair labor practices and bargaining in good faith.” Of the approximately 5,000 nurses represented by the UMPNC, an affiliate of the Michigan Nurses Association, more than 4,000 voted last week to authorize a strike. Nurses at the facility have worked without a contract since it expired on June 30 this year. UMPNC and university officials began contract negotiations in January but have struggled to lock down a new agreement. A state mediator joined the bargaining table on July 10 to help parties reach a final agreement, but little progress has been made. “We are disappointed that our UMPNC nurses have voted to approve a strike,” said Mary Masson, director of public relations for Michigan Medicine. “We have been bargaining in good faith since January and have offered a competitive package.” If nurses decide to initiate a strike, the Michigan Medicine legal team is prepared to pursue legal action because “it is illegal for public employees to strike,” the university said in their bargaining update Tuesday. Michigan Medicine is also prepared to bring in temporary nursing staff if a strike notice is issued and “has been developing contingency plans in the event of a strike.” The union main complaints, according to the statement, include: failing to bargain in good faith, including over terms and conditions of employment; making changes in work shifts without notifying or negotiating with the union; and discriminating against union members who are engaged in legally protected speech in support of their right to collective bargaining. UMPNC filed four unfair labor practice charges with the Michigan Employment Relations Commission about these issues on September 12.
Trying To Protect Seniors, The Most Vulnerable, From Formidable Foe Florence
Liz Szabo, Kaiser Health News and JoNel Aleccia, Kaiser Health News and Doug Pardue Perhaps no other population is as vulnerable during a hurricane as frail, older adults, especially those who are homebound or living in nursing homes. With Hurricane Florence predicted to slam the North Carolina coast Friday, health officials are already scrambling to keep older residents safe. Seniors “are not only the most likely to die in hurricanes, but in wildfires and other disasters,” said Dr. Karen DeSalvo, a New Orleans native who served as health commissioner in that city after Hurricane Katrina and went on to be named acting assistant secretary for health at the Department of Health and Human Services for the Obama administration. “The seniors always seem to bear a big brunt of the storms.” Older people may have a harder time evacuating because they don’t have their own cars or are homebound, said Lauren Sauer, director of operations at the Johns Hopkins Office of Critical Event Preparedness and Response in Baltimore. In the aftermath of Hurricane Katrina, an analysis of 986 Louisiana residents who died showed the mean age of victims was 69 and nearly two-thirds were older than 65, DeSalvo said. The dead included 70 people who died in nursing facilities during the storm or just after the storm made landfall. And last year, 12 residents overheated and died at a facility in Hollywood Hills, Fla., in the immediate aftermath of Hurricane Irma, which knocked out the facility’s air conditioning and the temperature climbed to over 95 degrees. The tragedy led Florida to pass legislation requiring nursing homes and assisted living facilities to have backup generators capable of keeping residents cool. “Unfortunately, the best wake-up call is when a tragedy occurs,” said Dara Lieberman, senior government relations manager at the Trust for America’s Health, a nonprofit. “Hopefully, nursing facilities and emergency managers paid attention to the loss of life in the long-term care facility in Florida last year and realize the risks they face by not preparing. Every facility should have a plan.” Some studies suggest communities aren’t much better prepared than in the past, however. A 2018 study from the National Academy of Sciences found that “we are only marginally more prepared to evacuate vulnerable populations now than we were during Hurricane Katrina,” Sauer said. Deciding whether to stay or go can be more complicated than it sounds, said J.T. Clark of the Near Southwest Preparedness Alliance, a coalition of hospitals and other public health services in southwestern Virginia. “There is a risk of moving people and there is a risk of staying in place, and you have to weigh those risks,” Clark said. Evacuations pose a number of dangers for fragile patients, some of whom may need oxygen or intravenous medications, said Sauer. She pointed to a 2017 study that found a sharp increase in mortality among nursing home residents who evacuated because of an emergency, compared with those who sheltered in place. She noted that leaving a facility is only part of the challenge; it can be equally difficult to find a safe place prepared to house evacuated nursing home residents for days at a time, she said. Clark said that nursing homes once commonly assumed they could simply transfer their residents to local hospitals. But that can impair a hospital’s ability to care for people who need emergency and urgent care, he said. Many nursing homes in the Carolinas are evacuating residents to areas outside the storm’s direct path. South Carolina had evacuated 32 nursing homes and assisted-living facilities by Wednesday afternoon, said Randy Lee, president of the South Carolina Health Care Association. On the Outer Banks of North Carolina, Sentara Healthcare evacuated 65 residents from a nursing home in Currituck to the company’s medical centers in Hampton Roads, Va., spokesman Dale Gauding said. Hurricane Florence poses risks beyond the coasts, however. Sentara also moved five intensive care patients out of a medical center on the Pasquotank River in Elizabeth City, N.C., because of the risk of flooding. Those patients also went to hospitals in Hampton Roads, Gauding said. With Norfolk, Va., now expected to escape the brunt of the storm, the 88 residents at the Sentara Nursing Center there are sheltering in place, Gauding said. Nursing homes in Charleston, S.C., complied with mandatory evacuation orders, said Kimberly Borts, director of communications and charitable giving for Bishop Gadsden retirement community on Charleston’s James Island. She said the facility conducts annual evacuation drills to continually improve its capability to safely relocate residents and coordinate with the company that provides ambulances. However, Hurricane Florence’s expected landfall caused a slight change in evacuation plans, which were to be completed by Monday, Borts said. The evacuation had to be delayed until Tuesday because the ambulances were diverted to Myrtle Beach, which remained in Hurricane Florence’s sights. As of Wednesday afternoon, New Hanover Regional Medical Center in Wilmington, N.C., was directly in the storm’s path. But hospital officials view the building as strong enough to withstand the storm, said spokeswoman Carolyn Fisher. They were less confident about a building housing a skilled nursing facility in Pender County, N.C., whose residents are being moved away from the hurricane’s projected course. Senior citizens who live at home are also at risk, especially if they lose electricity. More than 2.5 million Medicare recipients — including 204,000 people in Virginia, North Carolina and South Carolina — rely on home ventilators, oxygen concentrators, intravenous infusion pumps and other electrically powered devices, according to the Centers for Medicare & Medicaid Services. The agency has created a tool called emPOWER 3.0 to help states check up on them. Patients who lose electricity may need to go to their local emergency room to power their medical equipment, said Mary Blunt, senior vice president at Sentara Healthcare in Norfolk, Va., and interim president of Sentara Norfolk General Hospital. Patients with kidney failure also may need to receive dialysis at the ER if their regular dialysis center is closed, she said. Virginia, North
Mass. Nurses Argue Pros, Cons of Mandated Ratios In Ads For Ballot Initiative
Already know all about Question 1 in Massachusetts? Click here to read about how this could impact travel nursing in the state. Massachusetts nurses are arguing on both sides of the fence in the first wave of TV advertisements about a ballot initiative that would regulate nurse staffing ratios in the state, according to a Boston Globe report. The Massachusetts Nurses Association, which sponsored the initiative, supports the Committee to Ensure Safe Patient Care along with many other local labor unions both in and out of the state. The committee argues that safe staffing ratios in non-ICU units will cut down on patient complications, readmissions, errors and potentially life-threatening risks. The Coalition To Protect Patient Safety, an anti-initiative group backed by state hospital groups and local chambers of commerce, argue that adopting a rigid proposal will “take decision-making power out of the hands of healthcare professionals” and negatively impact hospital costs and quality of care. While both groups stances on Question 1 are clearly opposed, their similar advertising and marketing strategies could cause confusion for uninformed voters, according to the Globe report. Both groups have similar names, use nurse testimonials in their website advertisements, feature similarly designed lawn signs and even have nearly identical Twitter handles. (Pro-initiative @PatientSafetyMA and anti-initiative @MAPatientSafety) Both groups are ramping up advertising efforts ahead of the Nov. 6 midterm elections. If approved by voters, the initiative would establish patient limits determined by the type of medical unit or patient with whom a nurse is working, and the limit would be applied at all times, according to the Massachusetts Secretary of State website. Civil penalties for hospitals that don’t comply with the mandated ratios could go up to $25,000 per violation, along with $250-2,500 in fines per day for facilities that don’t have information about the limits in all patient rooms, units and patient areas. How “Yes” On Question 1 Could Affect Travelers In short, mandated nurse-to-patient ratios across the state could sharply increase nurse recruiting and retention efforts by hospitals, which in turn could increase the amount of travel nurse needs. While multiple states have laws relating to nurse staffing ratios, only California has both passed and implemented mandatory statewide ratios. The state passed the law in 1999, implemented it completely by 2004, and since then has been the source of numerous studies about the impact of mandated ratios. Most studies found positive benefits for patient outcomes, significantly lower mortality rates and reduced nurse burnout, but several also point to greatly increased staffing efforts leading up to and after implementation. A 2008 study submitted to the Journal of Hospital Medicine found that nurse staffing in California remained unchanged from 1993 to 1999, but facilities significantly increased staffing efforts between 1999 and 2004. As of 2017, the state had the highest number of registered nurses in the U.S. at 282,290, according to Bureau of Labor Statistics data. It also holds the top spot for the number of active nursing licenses with more than 432,000 as of Sept. 8, according to National Council of State Boards of Nursing data. There are other factors to consider when determining why California brings in so many nurses—geographic diversity, lots of rural communities, high paying contracts—but many staff and travel nurses cite mandated ratios as a positive benefit of working in the state, which could help with hospital recruiting.
Rhode Island Healthcare Workers Strike Begins; Lifespan Spends $10M On Temp Staff
Last-minute negotiations failed for a third time early Monday morning between Providence-based healthcare system Lifespan and healthcare union workers in the midst of a planned 3 p.m. strike. United Nurses and Allied Health Professionals Local 5098 rejected the contract proposal from Providence-based healthcare company Lifespan early Monday morning. The Rhode Island healthcare workers strike is planned to end on July 26 at 3 p.m. Negotiations between Lifespan and the union are scheduled to continue while the strike is underway. “This is a difficult day for all of us,” said UNAP Local 5098 president Frank Sims in a press release. “Lifespan is a broken system where wealthy executives make millions and front line caregivers are ordered to do more with less, and until that changes, patient care will continue to be adversely impacted.” Lifespan officials have planned for the strikes at Rhode Island and Hasbro Children’s hospitals for weeks, hiring temporary workers costing at least $10 million to cover needs at the facilities. The Department of Health activated an “incident command center” to monitor staffing levels, patient care and possible surges due to patient diversions to other hospitals, director Dr. Nicole Alexander-Scott said in a Monday morning press conference. “Rhode Island Hospital’s emergency department will continue to accept all walk-ins,” Alexander-Scott said. “However, EMS throughout the state will only be transporting trauma, burn, cardiac and respiratory arrest and pediatric cases to the Rhode Island Hospital and Hasbro’s hospital EDs. [EMS] will transport other patients to the other hospitals [EDs] throughout the state.” You can view live coverage of the ongoing strikes from the Twitter feed below. This story will be updated as it develops. Tweets by WeAreUNAP
Rhode Island Healthcare Union Delivers Strike Notice, Sets Date
United Nurses & Allied Professionals Local 5098 issued a 10-day strike notice on Friday to Rhode Island and Hasbro Children’s hospitals and plan to strike starting July 23, according to a press release from the union. Healthcare professionals with the union plan to strike for three days, ending at 3 p.m. on July 26 with an unconditional agreement to return to work. UNAP Local 5098 represents 2,400 healthcare workers at the two Lifespan facilities, according to the release. Lifespan owns both Rhode Island and Hasbro Children’s hospitals and is the state’s largest hospital system. “We do not take this step lightly and urge Lifespan executives to return to the bargaining table as quickly as possible so that a fair and competitive deal may be reached,” Local union president Frank Sims said in the press release. UNAP Local 5098 has issued a 10-day strike notice to @RIHospital pic.twitter.com/YxIr2PVZNs — UNAP (@WeAreUNAP) July 13, 2018 Rhode Island Hospital issued a statement in response to the strike notice to “assure” state residents that “Rhode Island Hospital is fully prepared for this possible work action.” “Patient care is our highest priority,” the statement reads. “In the event of a strike, we will have contract labor to assist us in meeting our commitment to our patients and our community.” UNAP Local 5098 issued the strike notice as a result of last Thursday’s rejection of a contract proposal between the union and Lifespan. In the rejection statement, Sims said unions members rejected a deal that “devalues the critical role they play in providing world-class healthcare at Rhode Island’s only Level I trauma hospital.” “Lifespan’s short-sighted and punitive policies on everything from safe staffing to sick time have a direct correlation to the remarkably high turnover rate we experience at Rhode Island Hospital,” Sims said. “Health professionals are leaving at unprecedented rates because Lifespan fails to give caregivers the tools we need to do our jobs and offers a compensation and benefit package that is not fair to all healthcare workers.” Union nurses and technical staff at Rhode Island Hospital are among the highest compensated in the state, according to the hospital website. Currently, UNAP members with 10 years of experience or less are guaranteed 3.5 or 4 percent annual salary increases as part of the hospital’s compensation program. In the rejected proposal, the hospital planned to add another 3.5 percent in the first year of the contract, 2.25 percent in the second year and two percent in the third year. The hospital brought in a federal mediator to help reach a potential agreement before the strike date, according to their statement.
Rhode Island Hospital Workers To Submit Strike Notice After Rejecting Contract Proposal
Unionized healthcare professionals at Rhode Island Hospital and Hasbro Children’s Hospital voted Thursday to reject a contract proposal from their parent company Lifespan and plan to issue a 10-day strike notice, according to a report from Providence Journal. Members of United Nurses and Allied Professionals Local 5098 sent out a press release about Thursday’s vote to reject the tentative contract proposal. UNAP Local 5098 president Frank Sims said in the release that voting members rejected a “deal that devalues the critical role they play in providing world-class healthcare at Rhode Island’s only Level I trauma hospital.” UNAP Local 5098 members have voted to reject the contract offer from Lifespan and will issue a 10-day strike notice in the coming days. pic.twitter.com/ijwaWs0pKN — UNAP (@WeAreUNAP) July 13, 2018 Hospital officials responded Friday morning in a statement to Providence Journal and said they are “disappointed” by the vote on the three-year contract proposal, but that the hospital is “fully prepared to adequately staff our hospital and meet the needs of our patients.” Rhode Island Hospital and Hasbro Children’s Hospital represent two of the largest acute-care facilities in the state. Additionally, Hasbro is the only Level 1 Trauma facility in the region, according to their website. You can read the full Providence Journal report here.
TravCon 2018: Organizers see strong early registrations for September conference
Signups for TravCon 2018, one of the largest annual conferences for traveling healthcare professionals, remain steady after a strong burst of early registrations in April, TravCon event coordinator Michelle Freitag said. “650 attendees have signed up so far, which is a little less than last year at this point,” Freitag said. “It’s very common for us to have an initial rush of registrations, and then a lot of signups at the very end.” At the 10th annual conference last year, 1,250 travelers attended marking the largest year ever for the event, according to the official conference website. The event has grown exponentially in the past five years in both the number of attendees and the diversity of classes, events and exhibitors it offers, Freitag said. Participation from allied health travelers at last year’s conference greatly increased, so organizers have added classes specifically for allied professionals. “60 percent of our [educational sessions] are new this year,” Freitag said. “We have a traveler self-defense class, a Destination: Guam class which we’ve never done before…and three new panels that will be very interesting. We have a CEO panel with a Q-and-A talking about the state of the healthcare industry.” Attendees can learn from travel healthcare experts at 40 educational sessions over three days and meet in person with travel healthcare staffing companies from around the country. Travel nurses, physical therapists and occupational therapists can also receive upwards of 17 CEU credits to help maintain their professional licenses. Out of the 105 registered exhibitors this year, 78 of them are staffing companies, Freitag said. One of the main draws of TravCon every year is for travelers to meet with their favorite agencies—possibly for the first time. “Generally travelers may never meet their recruiter or company, so we bring them together so that you can meet your company or to find your future company,” Freitag said. “It’s a great way to get together professionally to find your next job or who you want to work for.” The conference will take place from Sept. 9-11 at Bally’s Hotel in Las Vegas, Nevada, which is located on the Vegas Strip. Attendees can arrive early for the unofficial meet and greets and other pre-conference events, according to the TravCon website schedule. Registration for TravCon 2018 is open until Sept. 6. You will also be able to buy conference passes at the door, but availability will be limited. Those interested can learn more by visiting the TravCon website.
Healthcare Burnout: Why It Happens And How To Avoid It
Healthcare burnout is both regularly talked about among the community and widely studied among academic institutions. Just last week, the Medical Group Management Association (MGMA) released a survey which asked healthcare leaders if they felt burnt out at their job. The results were predictable—45 percent of 1,746 respondents said they feel burnout, 28 percent said they felt “somewhat” burnt out and 27 percent reported no burnout. Healthcare burnout is just as prevalent in the nursing realm, where unsafe staffing ratios, a projected nursing shortage and emotional hurdles create an environment of exhaustion. A quick search of “burnout” on nursing social media forums reveals numerous stories of personal struggles to stay motivated. Addressing this issue is a major concern for industry leaders. Healthcare burnout has a measurable impact on quality of care, costs and safety in healthcare environments, according to a study from the National Academy of Sciences. Travelers have the added challenge of being in a high-burnout profession while also dealing with life on the road, which can sometimes make them feel isolated from their family or peers. But what are the factors that contribute to this, and how can healthcare professionals manage their burnout to avoid quitting? Main factors that contribute to healthcare burnout Studies looking at healthcare burnout have focused on a wide variety of factors, but several large studies have these three in common: High-stress workplace environments Working in healthcare means working in a constantly changing, fast-paced environment. Employees have to adapt to new policies and procedures on a daily basis. Healthcare documenting and treatment technology changes just as quickly. Many healthcare professionals work in literal life-or-death situations where split-second decision making is crucial, so workplace stress is a major issue. Lack of personal agency How many times have you heard someone who works in healthcare say, “I wish I could just take care of my patients instead of dealing with…” or “I feel like my manager doesn’t even listen to what I have to say.” That’s called depersonalization, which refers to the feeling of not being able to focus on providing quality care because of outside forces. Those factors can be a number of different issues like problems with management or even personal conflicts with patients. Many professionals cite issues dealing with confusing or unnecessary documenting programs as a factor of this, although studies show that trend is fading away. Emotional baggage Dealing with sick or dying individuals on a daily basis can impose a heavy emotional toll on healthcare professionals. Violent or aggressive patients can also cause stress, as workplace violence is a major concern in the healthcare industry. According to the Occupational Safety and Health Administration, incidents of serious workplace violence were four times more common in healthcare than in the private industry on average. Ways to avoid healthcare burnout Recognize the signs of burnout early The most dangerous thing you can do as a healthcare professional is ignoring when you feel stressed, overworked, undervalued or exhausted. Knowing the factors of what causes burnout is the first step to addressing those issues. Taking mental breaks to figure out why you are feeling this way can help you identify possible solutions to the problem. You may not be able to take these breaks on the job, so take some time at home to reflect. Consciously avoid distracting activities like watching TV or scrolling through your phone. Plan time for yourself Even the most experienced healthcare worker knows there are some things you can’t control on the job. That’s why it’s important to regularly and intentionally plan your time off to focus on relaxation and recovery. Planning for fun is especially important for travelers as any time off needs to be negotiated through your recruiter before accepting a position at a facility. Experienced travelers also typically take at least one to two months off for vacations, holidays or family time. Talk it out As mentioned by HCT Today contributing writer Natalie Newman, talking about your feelings and experiences with friends, family or professional counselors can help ease the emotional burden of working in healthcare.
As Maine Medicaid expansion stalls, hospitals and enrollees are left in limbo
Maine’s Medicaid-eligible residents, which make up more than 70,000 people, were set to enroll on July 2 as part of the expansion plan approved by nearly 59 percent of voters last November. But after a month of battles between advocacy groups and stonewalling efforts by Gov. Paul LePage’s administration, the enrollment date has passed and hospitals are left waiting for an influx of patients and staffing needs that may not come anytime soon. “A hospital representative I work with said they all have their fingers crossed that [the expansion] gets approved and it all goes smoothly, but she agreed it is a mess currently,” said Larry Jenkins, a sales team member for staffing agency LiquidAgents Healthcare. “There are no plans for additional staff at this time.” For clarity, here’s a timeline of where Maine’s Medicaid expansion plan stands: November 2017: Maine voters approve Medicaid expansion under provisions outlined in the Affordable Care Act, making Maine the first state to approve expansion by referendum. The Maine Department of Health and Human Services is required to file a plan by April 3, 2018 April 3, 2018: No plan is filed by Maine DHHS. LePage said he would not move forward with a plan until adequate funding is approved by the legislature to support expansion efforts. April 30, 2018: Advocacy group Maine Equal Justice Partners sue Maine DHHS to force the administration to submit a plan, citing a $130 million surplus fund that could be used to fund the expansion for 2019. June 4, 2018: Superior Court Justice Michaela Murphy rules in favor of Maine Equal Justice Partners, citing a “complete failure to act” by Maine DHHS in missing the April 3 deadline. They are ordered to submit a plan by June 11. June 7, 2018: LePage’s administration files an appeal for the decision, and requests to not file a plan by June 11 while the appeal is considered. June 18, 2018: Justice Murphy denies the appeal and orders DHHS again to file a plan with the federal government. Gov. LePage’s legal team appeals the order to the Maine Supreme Judicial Court to delay the deadline while the original appeal is considered. Arguments are scheduled for July 18. June 29, 2018: Gov. LePage vetos a potential expansion funding bill. Lawmakers must decide to override or uphold the veto on July 9. July 2, 2018: Maine Equal Justice Partners encourage eligible residents to apply for Medicaid anyways despite ongoing litigation. July 9, 2018: Conservative legislators uphold the veto in an 85-58 House vote. LePage and House Republicans criticize “one-time” funding sources included in the plan, saying Maine needs a long-term funding plan. Monday’s vote on the veto of Maine’s Medicaid expansion funding bill marks the sixth time LePage has stopped expansion legislation through the use of veto during his two terms of office. The final verdict on Maine’s Medicaid expansion efforts may set the precedent for lawmakers in Idaho, Nebraska and Utah. Advocacy groups submitted similar ballot initiatives after successful petitions to let voters decide the fate of Medicaid in their states this November. Utah’s ballot initiative passed state scrutiny and was added to the fall ballot. Secretaries of state in Nebraska and Idaho are reviewing petition signatures to confirm they represent a specific percentage of voters in each state.
Travel Jobs: Top 10 States for June, July Market Predictions
In our June traveler job market predictions, we talked about the “summer stall”—less new job postings, more competition for every job and more interest in atypical summer job states. Based on StaffDNA job board data, two of our predictions were on target. Job application volume increase by nearly 20 percent from May to June, marking the most active month since January. What we didn’t expect was for supply to match pace with demand. Hospital systems in many states, including popular summer destinations like California and Virginia, bounced back after the late-May and early-June slump. Part of this can be linked to vacation plans for permanent hospital staff, according to travel agency sales staff sources. As the regular staff takes off for the summer or cuts back on hours, that provides opportunities for travelers to fill the gaps. We expect for this market momentum to stay strong in July, as travelers who took time off in June will be planning ahead for the start of the school season in August or to find a fall contract in September. The back-to-school rush marks a yearly milestone for many travelers with children or grandchildren. They will typically take a break during the summer for childcare, and return to hospitals once the kids are back in school. “The experienced travelers know it can take four to six weeks to find and start a job, so they start the search for an agency and position mid-summer,” said Kate Quinn of LiquidAgents Healthcare. Let’s take a look at what we learned from our top markets for June. Rankings barely shift as travelers settle in for the summer While April and May saw a lot of “movement” in terms of where healthcare travelers applied across the country, ranking shifts were much more conservative in June, despite the high application volume. Most states moved up or down the list by 5 ranks or less, and five states—North Carolina, Pennsylvania, Nevada, Wisconsin and Washington—didn’t move at all. We expect the list to remain mostly stable for July, August and potentially in early fall, as traveler won’t start making big moves until we get closer to the holiday season. Michigan, Missouri, Virginia enter the Top 10 For the first time this year, Missouri joined the likes of Texas, California and Florida in the top 10, moving up two spots from May to No. 9. Virginia moved back up as anticipated, jumping up five ranks to No. 10 on the list. The state is both a top travel destination for summer 2018 and one of the top five highest paying travel nurse states in the U.S. Montana, Wyoming climb the charts; Connecticut drops to dead last Montana and Wyoming both moved up seven ranks to take the No. 41 and 42 slots, respectively, while Connecticut dropped 16 spots to the bottom of our list. Connecticut has consistently ranked in the bottom half of the list for job board applications. It’s also one of the most expensive states to work in as a traveler because of the high regional cost of living and low average pay packages. Interest in Maine uncertain as Medicaid expansion remains in flux Enrollment for the voter-approved Medicaid expansion was supposed to roll out on July 2, which would have provided a $500 million shot in the arm for healthcare funding in the state and coverage for more than 70,000 eligible recipients. Pending litigation surrounding the expansion has left the issue in limbo. A Maine judge forced Gov. Paul LePage to submit an expansion plan to the federal government by June 11, but LePage’s administration submitted an appeal for the ruling. While the appeal is pending, LePage also vetoed the expansion bill this week. Because of the political turmoil, it’s uncertain whether the expansion will have an impact on the Maine traveler job market as expected. June’s Top Markets Florida California Texas North Carolina Georgia South Carolina Michigan Pennsylvania Missouri Virginia Illinois Indiana Kentucky Tennessee Arkansas Arizona Nevada Idaho Oklahoma Iowa Wisconsin West Virginia New Mexico Maine Oregon Colorado Washington Hawaii Ohio Alabama Louisiana Maryland Mississippi New Jersey Alaska Utah Kansas Montana Wyoming Minnesota Massachusetts North Dakota New York District of Columbia Delaware Nebraska New Hampshire Rhode Island South Dakota Vermont Connecticut