Kansas hearings spotlight $40M‑plus annual contract nursing costs and limits of local workforce

State hospital leaders, higher‑education officials and health‑system representatives told a House appropriations subcommittee in Topeka that Kansas’ four state psychiatric hospitals face persistent nursing and clinical staffing shortages and are spending tens of millions of dollars each year on contract nurses to keep beds open.

Deputy Secretary Scott Brunner of the Kansas Department for Aging and Disability Services (KDADS) told the panel that "in fiscal year 2025 we spent a little under $46,100,000" on contract nursing at Larned State Hospital, and that Osawatomie State Hospital spent about $15.4 million in the same period. Brunner said contract nurse pay rates are typically double what the state pays employees, with agencies billing $90–$100 per hour while much smaller shares reach the individual nurses.

Why it matters: Subcommittee members pressed officials for specific, short‑term ways to reduce contract spending while also growing a larger, local health workforce. Witnesses said the problem is not single‑sourced: high vacancy rates for direct‑care positions, the clinical complexity and aging of some patient populations, long travel distances for rural jobs, and limits in how quickly training programs can produce new nurses and behavioral‑health clinicians.

Most relevant facts and figures

- KDADS reported roughly $46.1 million in contract nursing costs at Larned State Hospital in fiscal 2025 and about $15.4 million at Osawatomie State Hospital for the same period. - Brunner said Larned averaged about 232 contract staffers over the fiscal year; Osawatomie averaged about 105. - Vacancy counts cited included about 248 vacant critical patient‑care positions at Larned and 116 at Osawatomie; percentage vacancy rates ranged in the 30s for several hospitals. - Officials said a single contract nurse assignment can cost $90–$100 an hour, while an employee RN salary equivalents begin in the low‑$40s per hour; agencies typically pass roughly 60–65% of their charge rate to individual nurses.

What officials told lawmakers

- KDADS deputy secretary Scott Brunner outlined an array of measures pulled together to try to blunt the contract‑labor trend: bonus pay for sign‑on, retention and pickup shifts; targeted market adjustments for certain positions; and partnerships with colleges to expand clinical training. Brunner also described ARPA investments to expand training slots and new psychiatric beds in Wichita, and said a new South‑Central Regional Mental Health Hospital (104 beds) will open in January 2027.

- Ashley Byram, superintendent of Osawatomie State Hospital, described the facility’s staffing mix and how bonuses and a self‑scheduling program increased the share of state employees on certain day shifts. Byram warned that "If we eliminate those 116 beds, imagine what that list will look like," referring to patients waiting in jails and emergency rooms when beds are unavailable.

- Lindsay Topps, superintendent at Larned State Hospital, stressed patient acuity and safety risks: "We had 301 documented incidents last fiscal year of hands‑on incidents where we had to manually put people in hold, seclusions, [or] use injectable medication to help calm them down," she said, a statistic officials used to explain why staffing flexibility and on‑site expertise remain essential.

- Multiple witnesses said short‑term pay fixes matter but are not a long‑term solution. Blake Flanders of the higher‑education system, Amy Garcia of the Kansas Nursing Workforce Center and others urged policymakers to expand nursing education capacity, remove bottlenecks in instructor supply, and widen pathways (apprenticeships, part‑time and micro‑credential models) so more people can enter and complete clinical programs.

Steps taken and planned

- Bonuses and pay provisos: KDADS said state authority allowed temporary bonus programs that targeted sign‑on, retention at key milestones (six, nine and 12 months) and pickup‑shift payments; officials reported those measures reduced weekly agency spending in some months. - Regulatory and legislative paths: witnesses noted statutory and budget tools are being used or considered — Brunner and others referenced HB 2,277 and language carried in budget provisos on permanent pay plans; representatives asked about making temporary bonus authority permanent in statute. - Workforce investments: ARPA grants and center of excellence funding were highlighted. KDADS and the Kansas Behavioral Health Center of Excellence cited funding to expand medical and psychiatric training slots (including a biomedical campus in Wichita, new child and adolescent psychiatry and addiction fellowships, and a $5 million grant to expand DO residency slots), plus a $25 million contribution to the new South‑Central hospital.

Discussion, outlook and open questions

Committee members and conferees repeatedly separated two problems: (1) the immediate, fiscal pain of paying agencies to staff shifts and (2) the longer‑term pipeline shortage of nurses, LPNs, behavioral‑health clinicians and nursing faculty. Several members pressed for clearer metrics tying past appropriations to measurable outcomes — for example, how many additional workers resulted from each grant or scholarship. Officials replied that some programs track outputs (e.g., additional residency slots, scholarship recipients) but that no single statewide metric presently ties budget provisos to reduced agency nursing use.

What lawmakers asked for next

Members asked KDADS and related agencies to provide: - County‑level origin data for patients awaiting competency evaluation or restoration (the committee heard many such patients wait months for placement); - Clear, apples‑to‑apples comparisons of total per‑hour employer costs (salary + benefits) for hiring state employees versus the full cost of contracted staff; and - An inventory of which educational and credentialing barriers (including instructor degree requirements and clinical placement constraints) are most constraining supply.

Ending

Officials closed by urging a combination of short‑term budget tools and longer‑term investments. KDADS said the department will continue bonuses and targeted pay while expanding training slots and using an ongoing Center of Excellence collaboration to coordinate higher education, hospitals and community mental‑health centers. Committee members said they want concrete fiscal comparisons and clearer program outcome data at the next hearing so the Legislature can better weigh near‑term relief versus structural reforms.

(Quotes in this article come from subcommittee testimony and are attributed to speakers whose names and roles first appear here.)