Overworked and saddled with debt, nurses turn to side gigs to make ends meet

Cherie Jennings picked up and moved her family across the country to Great Falls, Montana, this summer. She had been living in Franklin, N.C., working as a nurse anesthetist, one of the highest paid advanced practice nursing jobs in the U.S.

But when the hospital she worked for changed her role from contract to full-time, she faced a $51,000 cut in salary and paid vacation time, all to do the same job. The hospital’s offer to provide retirement and health benefits did little to stem her concerns. She already receives those benefits from the U.S. Army.

After two decades working as a nurse, the 44-year-old says she is fed up with the long hours and stressful work environment. She now plans to turn a side job selling Rodan and Fields skincare products into a full-time career within the next two years.

“I realized money was not as important than missing out on my children growing up or seeing my marriage fall apart because I was never home,” Jennings said.

Nursing is one of the most in-demand jobs in the U.S. But those in the field say that stagnant pay, a high-pressure work culture, student loan debt and emotional burnout have made the profession increasingly unattractive. And the timing is tough, as the U.S. contends with regional nursing shortages that call for an estimated 1.1 million additional nurses in the workforce by 2026.

That dissatisfaction has pushed some nurses to seek out additional work to make ends meet or, in some cases, build careers that mean they can leave the grind of patient care.

In public comments and interviews, dozens of nursing professionals told LinkedIn that they are struggling to get by, as they turn to gig economy jobs, pick up per diem shifts or work overtime on a regular basis to make ends meet. Some nurses drive Uber during football weekends in cities like Lexington, Ky., while others knit scarves to sell on Etsy. They work 60-hour weeks until their children graduate from high school, provide wellness coaching services and take consulting gigs with medical supply companies.

Nurses working side jobs or taking overtime shifts isn’t anything new. But today’s nurses say they feel increasingly overworked and stressed as they face higher patient loads and are asked to work longer hours to make up for staffing shortages.

In many ways, the trend mirrors the same issues faced by teachers, another predominantly female workforce that has also struggled with stagnant pay and a worsening work environment. An Airbnb report from August found that 45,000 teachers in the U.S. rent out their homes, earning an additional $6,500 in extra income on average. A spokeswoman for home-sharing platform said the company doesn’t track data on nurse hosts.

Up to 14% of nurses who started their careers between 2006 and 2016 have a second job of any kind, according to research conducted by Amy Witkoski Stimpfel, a registered nurse and assistant professor at New York University. Roughly one out of 15 of the nurses surveyed signed up for extra work within 18 months of starting their careers.

That’s a comparable finding to a government survey fielded in 2008 that found 12.8% of nurses who graduated prior to 2001 had a secondary nursing job.

Stimpfel, who plans to publish a study on this topic next year, cites rising rates of student loan debt and the one-time costs associated with being a young adult—such as buying your first house or car—as reasons nurses are taking such side jobs.

“Every nurse I know who gets a second job? It’s always about money,” said Janine Kelbach, a 34-year-old registered nurse in Cleveland who also works as a freelance health writer.

Like many recent graduates, debt among nurses is a problem. The average student loan debt for a registered nurse often tops $30,000, according to a 2014 study published in Nursing Economics. Another survey found that the vast majority (69%) of advanced practice nurses have taken out graduate loans ranging between $40,000 and $55,000.

Katherine McCusker, a nurse practitioner in a critical care unit in Seattle, usually works between 24 and 36 extra hours per month to help pay off the $90,000 in student loans she took out to get her master’s degree. The extra hours also help cover the cost of living in Seattle, a city where rents are 80% higher than the national average.

“If I didn’t have the loans I have, I certainly wouldn’t be per diem,” she said.

I asked her if she worries about working such long hours. “I worry about burnout, not necessarily from the hours, but the emotional toll it takes to work in these intense environments,” she said. “It’s probably more emotionally troubling to think about my loans.”

For many nurses, the stress of the profession simply isn’t worth it. One-quarter of the 600 nurses who responded to a 2017 survey conducted by the travel nursing company RNnetwork said they are overworked.

“Nurses who are working two jobs, with two different schedules — there’s no opportunity for self-care,” said Stimpfel. “They are working back-to-back in these demanding environments.”

Some nurses who choose to pursue non-health care side jobs benefit from “turning off” their medical brains and stepping away from patient care, according to Katherine Feldman, a 33-year-old registered pediatric nurse in Chicago who used to drive for Uber Eats. (She recently stopped driving to spend more time with her family.) “I deliver groceries, get quiet time, and there’s no monitors beeping,” she said in August.

Taking on extra hours, though, can exact a toll. Nurses who work even one extra hour of overtime are less likely to collaborate with other clinicians, according to a study published this year in the Journal of Nursing Administration. Other research has found that patients who are cared for by these nurses are less satisfied and hiring nurses who frequently job hop can adds thousands of dollars in turnover costs to the balance sheets of cash-strapped hospitals.

A 2014 study found that 17.5% of new RNs leave their first nursing job within a year and 33.5% leave that job within two years. (The average turnover rate for all U.S. workers is 18%.)

For nurses who work in understaffed hospital units, such staff shortages can lead to shifts that extend beyond 12 hours for the remaining nurses, sometimes without the opportunity to eat or take a bathroom break. There’s little room to process the trauma of caring for sick and dying patients. And, for some, all that work doesn’t come close to addressing their financial worries.

After 13 years as an emergency room nurse in New York City, Sara Choi considered quitting. It wasn’t just the staffing challenges or the emotional toll of caring for sick patients. Half of her paycheck goes to rent in pricey New York City, the other half to bills and loans. Choi makes about $110,000 a year. The 35-year-old knows entry-level nurses who are hired at a $98,000 starting salary. “It’s frustrating,” she said. “It took me 12 years to get there.”

To make more money, she considered clinical nurse management, a role she describes as paper-pushing. Instead, Choi went back to school at the Pacific College of Oriental Medicine and opened a wellness coaching practice. She continues to work in the ER part-time until her business gets off the ground.

“That is the future of nursing, getting out there on YouTube and doing health coaching,” Choi said.

To ease some of the workload burden for nurses, some in the field have begun to advocate for patient-to-nurse staffing ratios that would limit the amount of patients nurses care for in a given shift.

So far, such proposals haven’t received much traction. California is the only state so far to mandate staffing ratios for nurses. A midterm election proposal nixed by 70% of voters in Massachusetts would have created stricter ratios than what the Golden State requires. A successful opposition campaign led by the Massachusetts Health and Hospital Association—and supported by some nursing organizations—argued that the “one-size-fits-all” requirement would have added billions of dollars in costs to hospitals.

The debate about ratios highlights just how strenuous the nursing staffing model can be for frontline nurses. Nurses still work in shifts. They don’t have professional development days. Their pay is relatively flat unless they go back to school and the pathway to leadership is narrow. And nurses often lack autonomy in their working relationships with doctors and administrators even though they provide the bulk of patient care.

Experts say that nurses traditionally don’t leave the profession altogether. If anything, they stop working in direct patient care, taking roles in management or with health insurers or companies that market health products.

“It’s much more gratifying,” said Jennings, “and it’s better than punching a timecard for a hospital that gives two cents about me.”

An earlier version of this article incorrectly described Sara Choi's coaching practice. She works with all individuals, not just health care professionals.

Nurses, do you have a similar story? Share your thoughts in the comments about having a side job or working overtime and how that affects you both at work and at home.