Karen Feury has wintered in Florida and summered on Martha's Vineyard, Mass. Jennifer Meyer enjoyed the warm weather near the beach in North Carolina and may someday enjoy a rent-free gig in sunny Arizona.
When Tammy Long and her husband moved to Baltimore in June, they got a rent-free apartment in Owings Mills.
These women can make these deals because they are very much in demand. They are among the estimated 35,000 traveling nurses who roam America, earning top salaries and often free housing in exchange for a three-month contract.
While they make up only 1 percent of the overall registered nursing population, traveling nurses help ease a severe shortage in virtually every hospital in Maryland - and most other states.
"We're a small segment of the nursing industry, but we are a significant segment," said Franklin Shaffer, executive vice president and chief nursing officer at Cross Country Staffing, one of the nation's largest nurse staffing agencies.
For nurses who are young and footloose, or middle-aged and footloose, traveling for a nursing agency is a great way to see America and make good money at the same time.
"You can work pretty much anywhere in the country, anytime," said Meyer, 28, who recently took a full-time nursing position at Sinai Hospital after several years as a traveler.
Meyer estimates that her earnings jumped from about $40,000 to $60,000 when she became a traveler, just three years out of nursing school. "A lot of what's behind it is income," she said.
Meyer earned an associate's degree in nursing from Hagerstown Junior College in the 1990s and worked at the University of Maryland Medical Center for three years before signing up with a staffing agency in 2002. The agency paid the rent on a furnished apartment about 10 minutes from the beach in Wilmington, N.C. She covered the telephone bill and electricity.
She loved it and stayed five months, leaving only because the New Hanover Regional Medical Center set a five-month maximum stay for travelers - to encourage them to join the staff. She then worked a three-month stint at Duke University Hospital in Durham, N.C., before returning to Maryland to be closer to her family in Hagerstown.
The increasing use of travelers stems from a severe nationwide nursing shortage. The United States is short 168,000 nurses, an 8 percent deficit, according to federal projections. Because of an increasing elderly population and nurse retirements, the shortage is expected to reach 808,000 nurses, a deficit of 29 percent, by 2020, according to the U.S. Health Resources and Services Administration.
More nurses needed
There were 1,500 nursing vacancies at Maryland's 50 hospitals in 2004, according to the Maryland Hospital Association. Federal projections show that there are about 38,000 registered nurses in the state's hospitals, nursing homes and other facilities and that Maryland is likely to be short 18,900 nurses by 2020.
Hospitals often use travelers to fill in when staff nurses take vacations. They also help hospitals handle seasonal populations, or to increase staff during a busy stretch, such as when the flu hits in the fall.
The nurses say it is a great way to roam the country.
"I could never have afforded to live on Martha's Vineyard in the summertime," said Feury, a Hunt Valley native who earned a bachelor's degree in nursing in 1998.
She spent 18 months working at St. Joseph Medical Center in Towson before she decided to become a traveler and found herself on the upscale shores of Martha's Vineyard.
She spent her first summer there sharing a six-bedroom house near the beach with six other nurses and hospital staffers. During the next several years, she worked at hospitals in Newport, R.I., Rockledge, Fla., Rutland, Vt., Portsmouth N.H., and Falmouth, Mass. She made repeat appearances each summer on Martha's Vineyard and spent several winters at St. Joseph's.
In addition to hiring travelers, hospitals contract to use staffing agencies to provide temporary fill-ins for staff nurses who are out for a day or two. But "per diems," as they are known, have less time and incentive to familiarize themselves with a hospital's routines, experts say. So many hospitals prefer travelers, and vice versa.
"With the traveler, it's a way for nurses to shop around and find a place they might like to stay," said Karen Haller, vice president of nursing at Johns Hopkins Hospital.
Travelers tend to be in their 20s and early 30s - without spouses and children to tie them down. But some are also empty nesters looking for adventure. With more nurses expected to retire in the years ahead, experts say the shortage of regular staff nurses will get worse - but the number of travelers is likely to increase, too.
For Richmond, Va., native Tammy Long, 25, signing up with an agency as a traveler made good sense after she married a University of Maryland pharmacy student in June.
With a bachelor's degree and two years of nursing experience in Richmond, she got a choice of positions at either Sinai or Johns Hopkins Bayview Medical Center. And the agency provided her with a two-bedroom apartment in Owings Mills that would rent for anywhere from $1,000 to $1,600 a month.
She decided on Sinai because it meant day shifts. She's making up to $10,000 a year more than she did in Richmond, and says as a teaching hospital, Sinai has a more dynamic atmosphere than her old hospital in Virginia.
"Questions are encouraged there, so you learn more, and I appreciate that," she said.
At nursing agencies, recruiters say it usually takes one to three weeks to find a traveler to fill a hospital vacancy. But Maryland has no problem attracting them, they say.
"Maryland is a good draw. It's close to Washington, it's very attractive and you have a lot of good hospitals," said Cross Country Staffing's Shaffer.
No single region stands out as the most desirable, but San Diego, San Francisco, Seattle and New York are among the cities where many nurses want to work, Shaffer said.
Getting a nurse to move to the Midwest can be a tough sell in the winter. But nurses also can be turned off by the cost of living in sought-after places such Hawaii and California.
"There's not a lot of risk when it comes to quality," said Peter Buerhaus, a professor at Vanderbilt University School of Nursing. "These traveling nurses tend to be pretty good."
Using travelers actually helps reduce problems with patient care, including medical errors, dispensing the wrong medication and the spread of infections, said Linda Aiken, a professor of nursing and sociology at the University of Pennsylvania who has studied the practice.
Positive patient outcomes
Such problems often result from understaffing or poor work environments that stem from mismanagement, she said.
"You have problems where the staff turnover rate is high, where productivity of the nurses is being undermined by a chaotic environment," Aiken said. "But use of per diems or travelers seem to have a positive effect on patient outcomes."
Costs to hospitals for travelers vary, experts say.
Hospital staff nurses earn an average of about $25 to $27 an hour here, while traveling nurses get $30 to $31 an hour, said Howard Goldman, a spokesman for Cross Country. Subsidized housing for travelers is probably worth an additional $6 to $8 an hour.
A staff nurse with years of training and experience at Johns Hopkins can earn $100,000 a year, Haller said, so if the hospital replaces a highly experienced nurse with a traveler it can actually save money. But Hopkins and most other hospitals have rules about the use of travelers. "We always have a senior Hopkins nurse in charge. An agency nurse is never in charge of a unit," she said.
Travelers work for the agency that signs them to a contract - not the hospital where they are assigned. That means they can specify whether they will work day or night shifts and the days of the week they want off.
But travelers say there can be disadvantages to the life - the loneliness and uncertainty inherent in being new to a job in an unfamiliar city. Some travelers also tire of not knowing where they are going to be in three months.
Travelers also lose out on sick leave, vacation pay and other benefits that hospitals offer to staff nurses, such as tuition reimbursement.
Meyer, for example, accepted a staff position at Sinai after working there as a traveler because Sinai pays tuition benefits. She wants to earn bachelor's and master's degrees in nursing and is taking classes at Villa Julie College.
But she may return to traveling someday and is eyeing Arizona.
"I've lived in Hagerstown all my life, but I've got to say, I don't like the snow," she said.