On my first assignment, I was scared to death,” recalls Mona Steele, R.N., who left a hospital staff position she had held for 10 years to take up work as a traveling nurse in critical care two years ago. “You don’t know what to expect or what’s going on. When you work in one hospital, things are one way—but when you get to another hospital, things are totally different.”
Yet that same variation is one of the things Steele likes about life as a travel nurse. “It’s nice to see what other hospitals are doing,” she notes. “Basically, the care is the same, but hospitals use different ways of medicating patients.”
Steele represents a growing trend among nurses—those who choose a career in travel nursing, accepting short-term work assignments in health care facilities across the country. Last year, the Nursing Executive Center estimated that although travelers comprised less than 1% of nurses working in a hospital setting, the demand for their flexibility is rising in every region of the country. Agencies such as TravCorps, American Mobile Healthcare and StarMed boast thousands of openings across the country on any given day. The nursing shortage that is driving so much demand in various cities is also largely responsible for the buzz around travel nursing. Hospitals, faced with fluctuating patient populations and increased pressure to cut labor costs, are turning to travelers to fill temporary vacancies in nurse staffing.
“We have thousands of jobs,” says Michelle Roberts, sales manager for recruiting at StarMed in Lowell, Mass. She notes that regional and seasonal variations in demand prompt considerable travel activity. “People tend to have elective surgeries in the winter, for example, because they don’t want to recuperate in the summer. Then there are the snowbirds who flock to Florida, Arizona and California from November until April. Hospitals in those states will contact travel nurse agencies to fill their needs for these few months…but we are busy every month of the year.”
Despite the undeniable opportunities, relatively few minority nurses appear to be taking the leap to travel nursing. The reasons are unclear, but the added pressures of cultural assimilation in a new city may deter African Americans, Hispanics, Asians and Native Americans. Nurses like Steele, who is African American, do note occasional difficulties related to prejudice. However, even factoring in these negatives, they believe traveling can provide a fulfilling change that leads to personal enrichment and professional development.
Oh, the Places You’ll Go!
The multitude of travel nursing agencies gives testament to the vast number of opportunities in this field. The largest firm is Cross Country Staffing, based in Boca Raton, Fla., and destined to become even larger pending its completed merger with TravCorps. Tracey Nichols, client manager for the firm, cites the nursing shortage as the primary driver behind hospitals’ increased use of travel nurses. Yet the benefits of traveling are surely drawing more nurses to this industry: “It’s an opportunity not only to go someplace where they’ve never been before, but to get themselves exposed to different facilities, such as a research facility like Johns Hopkins or the Cleveland Clinic.”
While the lure of adventure coupled with career development may call out to some nurses, travel nurse agencies are heightening their appeal with benefits that rival those found at any employer: 401(k) plans; free medical, dental and malpractice insurance; free housing and significant career development and educational opportunities.
“We are luring people away from what they know—from the security of home—to go to a different atmosphere, and that’s scary,” Nichols says in explaining the generosity of Cross Country’s benefits package. “This is a big career change.
Even though you’re utilizing the same skills, you are going into these facilities with minimal orientation and you’re expected to be above and beyond [the nurses] they have. We need to do something to make people want to do it, and these benefits help.”
Giving nurses a great deal of choice in their travel destination also helps. An employee of Cross Country, Steele has accepted two assignments in Atlanta, including her current one at Emory University’s Crawford Long Hospital. She says she’s looking forward to a job in Houston this fall.
“We don’t dictate where they go,” affirms Roberts. “We just let them know where the jobs are.”
Once a nurse expresses interest in a particular job, he or she will generally speak by phone to a recruiter or nurse manager at the facility, who will interview the candidate to establish a rapport and determine individual needs and compatibility. Once both parties agree to the assignment, the agency will typically coordinate the nurse’s housing. Most firms cover shared housing completely, but offer subsidies to pay for private living arrangements.
“We pay for their apartment, which is furnished, and the utilities,” Roberts notes of StarMed’s benefits. In addition, the agency reimburses for mileage (travelers are encouraged to drive to their assignments), food and hotel accommodations, if necessary, up to $500. “If they’re going from Boston to California, they may have to kick in a little of their own money,” she admits.
Assignments average 13 weeks in length, but shorter or longer terms are frequently available. The agencies surveyed by Minority Nurse quoted a range of salaries, generally tied to specialty and location of assignment. Roberts notes that in states with jobs that are hard to fill, pay can reach $23 an hour.
Medical Express, a service based in Colorado, cites figures from $18 to $30 an hour. Many employers also offer bonuses upon completion of an assignment—some as high as $3,000.
Mirroring the national nursing shortage, travel nurse agencies are most desperately seeking nurses in ICU, OR and PICU, although recruiters note that numerous jobs are available in every specialty. Given hospitals’ demands for practiced nursing professionals, however, agencies do tend to hire nurses with at least one year of experience in their specialty. Most facilities will provide some form of orientation for the nurse, but Roberts admits that most assignments require a nurse who needs little training.
“Hospitals need somebody to show up Monday morning and be up and running,” she says. “Young people just out of nursing school generally don’t have the clinical experience, but we have been able to use people with six months of experience.”
Successful travel nurses also possess a desire to learn and expand their professional horizons. Steele notes, “I worked on an ICU for 17 years and one day, I started to feel that I just wasn’t getting ahead, that my career wasn’t going anywhere. I felt like I didn’t know enough.”
Traveling offered her what she was looking for in terms of clinical expertise, and also taught Steele to balance independence with the ability to integrate into a variety of settings. “In traveling, you may be working in a place where they do surgeries you’ve never seen before. Even though your nursing is the same, you have to be able to work with people who are a lot more knowledgeable about these things than you are. When you travel, you have to depend on other people to help you out with the policies and procedures.”
Steele cites her flexibility as a major contributor to her success—an attribute named by nearly every agency when queried about the qualities they desire in candidates. “You have to be good with change, because each facility functions differently,” explains Nichols. “Some facilities have a lot of paperwork, some are totally computer-literate, others aren’t quite in tune with that yet.”
Fish Out of Water?
Being flexible may be an even more important attribute for minority nurses who pursue careers as travelers. Perhaps you’re yearning to practice under the big skies of Montana but are concerned about being the only minority in a facility there. Uprooting oneself to live and work in a new city is bound to stir some anxiety; having additional issues of cultural assimilation to deal with may be steering minority nurses away from this career path where, by all accounts, African-American, Hispanic, Asian and Native American nurses are truly in the minority.
“I don’t think there are many minority travelers, and I don’t know why,” says Roberts. “I have had up to 65 travelers on assignment at one time and not one minority, which isn’t good.”
Steele agrees that she meets few fellow minority nurses who are travelers. She theorizes that deep familial ties common among some cultures may keep them close to home and admits that being away from home is the hardest part of traveling. “A lot of black nurses have said to me, ‘Why would you want to travel?’ Well, growing up I was always the one to venture out and meet people, but a lot of people aren’t like that. A lot of nurses…don’t like to be away from their families.”
Steele says that for the most part, being a minority nurse makes no difference in her travels, though she cites a few instances of prejudice from patients. “I have found that some patients, especially in the South, are uncomfortable being treated by a minority nurse,” she says. “I don’t know if it’s that they don’t want you taking care of them—though there’s certainly some who don’t. But if you present yourself as a professional and show them that you know what you’re talking about, then most of the time they come around. Some black nurses I’ve talked to don’t feel that way. It depends on what you went through growing up and how you were raised, because there are a lot of radicals out there.”
Steele says she always queries her recruiter on the demographics of any new city before she accepts an assignment there. “You always ask about an area and whether it’s [ethnically] mixed,” she says. She relates the story of a fellow African-American nurse who was traveling with her daughter through Alabama. Pulling into a gas station nearly proved fatal, as the woman became the target of a small mob that came after her with chains and baseball bats. “Most of the [nurses] I room with are white,” Steele adds, “and they know nothing about things like that.”
Though no agency surveyed for this article offered a cultural training program per se for its nurses, Roberts notes that StarMed has options for helping nurses who are apprehensive about moving to any city where, for example, they may be the only minority. “If I were a recruiter who had a black nurse interested in going to Vermont, and she wanted to speak to another black nurse there, I would send an e-mail to the [hospital’s] recruiting department. We would patch them through to a nurse who’s already there and could put them at ease.”
Similarly, Cross Country taps into its resources to brief nurses on the demographics and conditions across the country, from conveying the size of a city to knowing where the Ku Klux Klan is active. “As a company, our job is to give you information about what a city is like,” Nichols says. “Being a minority, I really zone in on that.”
Nichols notes that Cross Country has also taken significant steps to attract more minorities to its ranks. “There is such a pool out there of good, qualified minority nurses,” she says. “We need to find them through conventions, seminars, whatever ways we can…We want to expose more people to this [industry] so that everybody will be able to partake of it.”
For those nurses who are already reaping the benefits of a career in travel nursing, many consider it a long-term commitment. Others, like Steele, say the ride is great, but they eventually look to plant roots: “Probably in the next five years I’ll settle down, if I find somewhere I like. If not, I’ll keep traveling.”
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