Always on the move

When registered nurse Patricia Pitts gets called to fill in at a hospital far from her Georgia home, she makes sure to pack the essentials first—a frying pan, a rice cooker, a slow cooker and two ball gowns.

“I never go anywhere without them,” said Pitts, 53, an obstetrics nurse born and raised in Guyana on the northern coast of South America. “I need to have my stews and curries. They are a touch of home.”

As for the ball gowns, Pitts, a former competitive ballroom dancer who likes to keep her moves sharp, said that she never knows when an opportunity to fox trot might present itself. “You want to be ready,” she said.

For the past 20 years, Pitts has been loading up her car and heading across the country to work in hospitals in need of skilled, short-term nursing help. She's worked in New York, Texas, Michigan, Pennsylvania, Minnesota and Washington, D.C., and is often gone for months at a time.

“I'm having so much fun,” said Pitts, currently doing a three-month stint at Nantucket (Mass.) Cottage Hospital. “My job is a working vacation. I pick a location, and sometimes I may not even know where it is. I told my agent that I was going to drive all the way to Nantucket, and she said, 'No, Pat, you can't. It's an island.' ”

Pitts is one of thousands of registered nurses, licensed practical nurses and nurse practitioners in the U.S. who travel around the country and sometimes the world, filling in at hospitals, nursing homes, dialysis clinics and other healthcare facilities looking for experienced temporary nurses.

They are known as traveling nurses, and the demand for their services is growing, said Gene Scott, spokesman for the National Association of Traveling Healthcare Organizations. Reasons for that growth include the number of aging baby boomers, the shortage of primary-care doctors and the increasing need for preventive care, he said. Also fueling the demand is the new federal requirement that nearly all Americans have health insurance starting in 2014, he said. Experts predict a huge influx of newly insured patients, many with chronic conditions.

A growing number of hospitals are tapping traveling nurses to fill in while staff nurses train on new electronic health-record systems, said Scott, who also is CEO of Travel Nurse Across America, a staffing agency in Little Rock, Ark.

In addition, some healthcare facilities hire traveling nurses to fill in during labor disputes with staff nurses. That may lead staff nurses to eye travel nurses with suspicion. “Our perspective is the patients don't go on strike,” said Joe Gira, director of marketing at Fastaff Travel Nursing, an agency in Greenwood Village, Colo. “We're there to help while hospitals work out their labor issues.”

Lorraine Seidel, CEO of the National Federation of Nurses in Washington, said bringing in travel nurses during a strike only stokes resentment and animosity toward them.

“Sometimes the hospital sets us up against each other,” she said. “A lot of strike-breaking nurses are money oriented. They get top wages, food allowances and they come in and say they want to work six days in a row, and the hospitals say they must comply under their contract. It becomes a pull and tug.”

But Seidel noted that not all traveling nurses are willing to work during labor disputes, and that most traveling nurses are skilled and dedicated to their profession and to their patients.

The American Hospital Association declined to comment for this article.

Demand for traveling nurses dipped significantly during the Great Recession. But Joe Boshart, CEO at Cross Country Healthcare, said the industry has been slowly rebounding. In 2012, annual revenue for the travel nurse market was estimated at $1.5 billion, according to an analysis by Staffing Industry Analysts, a research firm owned by Crain Communications, the publisher of Modern Healthcare. The three largest firms—AMN Healthcare, Cross Country Healthcare and Aureus Medical Group—represent about half of the market.

While the number of traveling nurses is hard to pin down, Gira estimated that there are 25,000 actively working today, but he expects that number to grow.

The most common reason why healthcare facilities turn to traveling nurses is seasonal demand, according to the 2011 U.S. Hospital Nursing Labor Costs Study by accounting firm KPMG. About 45% of hospitals surveyed said seasonal influxes in places such as Arizona or Florida, where large numbers of retirees flock every winter, led them to hire traveling nurses. About 41% cited nursing shortages, and 28% pointed to facility expansion. Traveling nurses also have been called in to help after disasters.

In a different type of emergency, the Aug. 1 opening of a new free-standing emergency department at the University of Florida Shands Hospital in Gainesville prompted hospital officials to hire traveling nurses this summer, said Gayla Beach, director of employment and recruiting at Shands. The hospital currently employs 21 travel nurses.

“We're moving our experienced staff nurses to that facility and bringing in travelers to help staff our existing ER,” Beach said.

Working in new surroundings with different operations every few months means that traveling nurses must be quick studies, Gira said. The level of training that facilities offer varies, he added. “Some hospitals will simply orient the travel nurse during their first shift,” he said. “Other hospitals will have a three-day orientation that covers hospital policy and procedures, testing and unit training.”

The challenges don't seem to deter new recruits, he said. Many are lured by the promise of adventure and big paychecks. Gira said that some of his top nurses make more than $150,000 a year. As staff employees, Fastaff nurses also get medical, dental and vision benefits and a 401(k) with a company match, although those offerings are fairly standard in the industry, he said.

The average pay for a traveling R.N. is $25 to $50 an hour, compared with $35 an hour for a staff R.N., according to the KPMG study. Traveling nurses in high-demand specialties, such as ICU or labor and delivery, can make more.

But Scott said the numbers overstate actual take-home pay. The wages touted by many staffing agencies factor in tax breaks on housing and meals, and monthly stipends provided by the agency to help nurses cover rent or mortgage payments while they travel, he said.

Sometimes a traveling nurse decides to stay on permanently, something that most staffing agencies say they are fine with. A few, such as Cross Country, charge facilities a small fee for hiring a traveling nurse permanently. It's likely that more permanent nurses will decide to hit the highway as the demand for traveling nurses grows, Boshart said. “The higher the level of unmet demand, the more likely a nurse is to be willing to give up the security of a staff position.”

Thanks to social media, traveling nurses have formed a tight-knit community. Candy Treft, 43, launched her website, thegypsynurse.com, last year to provide practical information to new and aspiring traveling nurses, such as how to travel with pets. Three months ago, she also launched the Gypsy Nurse Facebook page.

Treft, a registered nurse, is homeless by choice. A divorced empty nester with two children, she gave up her official residence in Indiana nine years ago. When she's not working, she stays with friends and family. She said that given the amount of time she spends traveling, keeping her old three-bedroom house didn't make financial sense. Now everything she owns, aside from the photographs and mementos she stores at her father's farmhouse, fits into six Rubbermaid tote boxes that she takes with her.

It is not a line of work for the emotionally needy. “It takes someone with a sense of humor who can take the worst situation and turn it into an adventure,” Treft said. “There's going to be hard times.”

In addition to spending a lot of time alone and driving long distances to unfamiliar places, traveling nurses sometimes encounter hostility from staff nurses who fear losing their jobs, or have a low opinion of their itinerant cousins.

“I've worked at hospitals where staff nurses were absolutely thrilled to have me onboard, while at others, it was animosity,” Treft said. “They think that you're making the big bucks, so they make you do the hard work. Several years ago, travel nurses had a very bad name. We were viewed as nurses who couldn't hold down a job or were druggies. You have to prove yourself.”

Occasional reports about misconduct and patient care problems involving traveling nurses haven't helped their image. In June, four traveling nurses at a hospital in Watertown, N.Y., were arrested on allegations of illegally dispensing drugs. In 2011, a traveling nurse in California was accused of causing a patient's death through a medication error.

But Linda Aiken, an R.N. and a professor at the University of Pennsylvania School of Nursing, said the idea that traveling nurses are less qualified than those on staff is wrong. Her 2012 study showed no link between traveling nurses and patient mortality. “We find that if anything, they are more qualified,” she said. “They're more likely to have a specialty, they tend to be younger, which is a positive because they are closer to their education, and they tend to be more diverse.”

Angela Osborne, 50, became an R.N. more than 20 years ago after a divorce left her to raise two young children alone. She remarried in 2000, but her husband died eight years later. “My son was in college and I was alone,” said Osborne, who hails from Indiana. “I had always wanted to travel, and my son's girlfriend saw a sign advertising for traveling nurses. So I called it.” That was in 2011.

A few weeks later, she was flying to Hawaii. “I was so excited,” she said. “I knew that this was going to be something I loved. My grandma had been to Hawaii five times in her life, but I hadn't been anywhere. When we landed, I went to Waikiki beach and I thought of her.”

It was her first time on an airplane. Since then, she's been to 37 states and is shooting for all 50, she said. The best part, she said, is loading up her red Ford pickup, popping in a CD and hitting the highway. “As soon as I start driving, it's like woo-hoo! I'm on my way.”

Rita Pyrillis is a freelance writer based in Evanston, Ill.