Iowa extends nurses' contract as COVID-19 hospitalizations surge

As COVID-19 hospitalizations reach levels not seen in Iowa for more than a year, the state has extended a contract for 100 out-of-state nurses and respiratory therapists to alleviate staff shortages at major medical centers.

Iowa Department of Public Health spokesperson Sarah Ekstrand confirmed to Bleeding Heartland via email that the state has twice extended the six-week contract signed with Kansas company Favorite Healthcare Staffing in early December—first to run through January 28, and more recently to run through February 11.

Ekstrand added that the state recently accepted bids “to establish a statewide hospital bed transfer line. The goal is to establish a call center to help relieve pressure on hospital staff in order for them to be able to spend more time caring for ill patients.”


According to the state’s official website, total coronavirus hospitalizations reached 923 on January 12, a roughly 20 percent increase since the traveling nurses and respiratory therapists arrived last month. The last time more than 900 Iowans were receiving hospital treatment for COVID-19 was during the first week of December 2020. UPDATE: As of January 13, total hospitalizations reached 998, according to the state’s website.

New daily hospital admissions for COVID-19 in Iowa have exceeded 100 every day for the last two weeks. The latest official figures show 190 Iowans were receiving intensive care treatment for COVID-19 on January 9, dropping slightly to 178 as of January 12. The state hasn’t experienced that level of daily admissions or ICU numbers since early December 2020.

ICU beds were in short supply around Iowa even when COVID-19 hospitalizations hovered in the 500s in late August and early September. The rapid spread of the Omicron variant has sickened many health care workers, exacerbating staffing problems at medical facilities.

Suresh Gunasekaran, CEO of the University of Iowa’s network of hospitals and clinics, told reporters on January 13, “There are more delays today for the average Iowan than there were at any other time during the pandemic,” due to high numbers of COVID-19 patients needing hospital care and many staff either out sick or needing to care for loved ones at home.


The state distributed the traveling nurses and respiratory therapists among seventeen facilities “that provide 1, 2, and 3 Trauma Level care.” According to Ekstrand, the number of staff assigned to each hospital “tends to change every few days.” Here is the current allocation, as of January 13:

  • Genesis Medical Center in Davenport: 13
  • UnityPoint Health-Iowa Methodist Medical Center in Des Moines: 9
  • University of Iowa Hospitals and Clinics in Iowa City: 9
  • MercyOne Des Moines Medical Center in Des Moines: 7
  • MercyOne North Iowa Medical Center in Mason City: 7
  • St. Luke’s Methodist Hospital in Cedar Rapids: 6
  • Mercy Medical Center in Cedar Rapids: 6
  • MercyOne Dubuque Medical Center in Dubuque: 5
  • UnityPoint Health-Allen Memorial Hospital in Waterloo: 8
  • Jennie Edmundson Memorial Hospital in Council Bluffs: 2
  • UnityPoint Health Finley Hospital in Dubuque: 6
  • CHI Health Mercy Council Bluffs: 4
  • Mary Greeley Medical Center in Ames: 6
  • MercyOne Waterloo Medical Center in Waterloo: 3
  • MercyOne Siouxland Medical Center in Sioux City: 4
  • St. Luke’s Regional Medical Center in Sioux City: 3
  • Mercy Iowa City: 2

Iowa intends to use federal funds “from the most appropriate allowable funding source” to cover the cost of the contract, Ekstrand said. According to contract terms enclosed in full below, the state is paying Favorite Healthcare $220 per hour per employee for the first 40 hours and $330 for the remaining 20 hours of each work week.

When advertising the opportunity to nurses last month, Favorite offered pay of $125 per hour for intensive care nurses, $120 per hour for emergency room nurses, and $110 per hour for medical-surgical nurses. For 20 hours of each 60-hour work week, the nurses or respiratory therapists would receive time-and-a-half. The company also provides hotel accommodations and a one-time transportation bonus for each temporary employee.

The contract requires Favorite to recruit from outside the state, to avoid giving Iowa-based nurses an incentive to quit their jobs for much higher pay on a temporary assignment.


The state is evaluating bids to “to provide and operate a statewide hospital resource call center,” according to a request for proposals Ekstrand provided to Bleeding Heartland. Bidding was open from December 23 to January 10.

This contractor will, at a minimum, assist in the coordination and identification of available hospital resources (with a focus on bed availability) by receiving calls from requesting facilities regarding the resource needed and then placing calls on behalf of the requesting facility to possible receiving facilities until such time the needed resource is identified.

The concept is for hospitals to have “one number to contact for locating available hospital resources,” rather than having to reach out to many facilities in search of an available bed. The state intends for the call center to “allow providers at transferring facilities to spend more time on patient care,” the RFP says.

One optional objective is for the vendor to assist “transferring facilities unable to transfer patients with virtual triage and clinical consultation, guidance and support for patient management in lieu of or until the patient can be transferred.”

The shortage of hospital beds affects Iowans needing care for any number of critical conditions. The Des Moines Register’s Tony Leys recently profiled Dale Weeks, who died in November of complications from a septic infection. He had spent fifteen days at a hospital in Newton, awaiting a chance to transfer to a larger facility. Weeks’ grieving children “think he might have survived if he’d been admitted immediately to a large medical center, where he could have received advanced testing and prompt surgery.”

Federal government data indicate that at least 8,214 Iowans have died of COVID-19 since March 2020. On average, more than 100 Iowans have died of the virus every week since early October 2021, according to the state website, which lists fatalities by date on the death certificate.

Those statistics don’t reflect how many Iowans died of unrelated conditions because an ICU bed was not available when they needed one.

Appendix: Information provided by the Iowa Department of Public Health on January 13. Words in bold were emphasized in the original email. The “attached contract” (originally signed with Favorite Healthcare Staffing in July 2020) can be downloaded here.

The attached contract remains in place with the same terms and conditions but with each new requisition for staff under the contract, special terms and rates are negotiated. The terms and rates for the current requisition (extended through 2/11/2022) are outlined below. Federal funds from the most appropriate allowable funding source will be used.

The State of Iowa will be entering a series of requisitions in the coming days, totaling (100) Temporary Healthcare Personnel (THP) to be assigned across (17) facilities.  Each requisition will specify the quantity and specialty type (ER RN, ICU RN, MS/Tele RN, Respiratory Therapist) of THP to be assigned to each facility and will also be accompanied with a WebEOC Mission Task number that should be associated with the assigned THPs on any invoicing.  Each requisition will include the address of the assigned facility as well as a POC with the facility that should be contacted immediately to facilitate placement of the THPs.  We are requesting rapid (48 – 72 hours from requisition) placement of THPs under these requisitions.

All requisitions issued under this initiative will be for an initial (6) week duration, with the potential to extend an additional (2) weeks as needed.  Each requisition under this initiative will be initiated via email to the following Favorite staff. Each requisition is understood to be subject to the following rates and terms:

All THPs under these requisitions must be recruited from outside the State of Iowa. 

The hourly rate for the requisition is $220, with an expected work week of 60 hours.  The overtime rate for this requisition is $330/hour (hourly rate x 1.5, per the terms of the contract) and will apply to all hours worked over 40 hours per week.

These personnel will serve as supplemental staffing to support trauma level 1, 2, and 3 hospitals across the state with their COVID patient load.  Assigned shifts could include days, mids, nights, and weekends.  Once the requisition is recruited, please provide access to a listing (roster) of THPs assigned to the requisition grouped by requisition/Mission Task number, including the facility to which they are assigned, the first report date for each THP, etc.  Favorite is expected to work with the POC at each assigned facility to automatically back-fill any THPs that are dropped from the requisition for any reason.

Quarantine/Isolation Pay Per our existing contract, the State of Iowa agrees to pay the Tier 1 hourly rate for (40) hours in a work week for any THP under this requisition placed in quarantine/isolation for exposure to or contraction of COVID-19 for the duration of the the quarantine period (not to exceed 14 days)/isolation period (not to exceed 10 days) while on assignment to our facilities.

Special Billing Contacts/Frequency
We request weekly invoicing under these requisitions.  Additionally, we request the Favorite billing/operations team provide access to a shared spreadsheet/document that will allow rapid reference of assigned THPs (both current and past THPs in instances where a THP is dropped from a requisition) for the purposes of rapid reconciliation and payment of invoices.

Top photo of Genesis Health System hospital in Davenport originally published on the health organization’s Facebook page in 2017.

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