Journey Into the Unknown

Travel nurses find adventure while employing their skills far from home.

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Laura Kretzmer, '19, explores the sandstone walls of Antelope Canyon in Arizona.

Nursing graduate Mary Alexander
Mary Alexander, ‘12, BSN ‘15, is an avid hiker, and spends many of her weekends out on the trails in central California.

Mary Alexander, ’12, BSN ’15, lives by a simple philosophy: On the other side of fear is freedom.

It’s what motivated her to become a travel nurse and work in parts of the United States where she had never been before, far from her family and friends. “Instead of running away from fear, you walk with fear hand in hand,” Alexander says.

It’s a feeling shared by other travel nurses, who say each assignment is often a leap into the unknown, requiring no small amount of self-motivation to succeed. Yet travel nursing provides rewards – adventure, good pay, exposure to different work environments – that can enrich a nurse’s skills, says April Hansen, executive vice president of Aya Healthcare, a national travel nursing agency.

“As much as we strive for practices and policies that look a lot the same in health care, experiencing health care in different organizations across the country really gives you a more well-rounded view of what’s out there,” says Hansen.

That was a motivating factor for Alexander when she learned about travel nursing while she was a student. She knew immediately she wanted to try it.

“It lit a fire in me,” she says. “I just wanted to experience what it’s like to work in different places. They pay you to travel and do the job that you already love doing.”

Getting started

A fairly low-key industry when it started in the 1990s, travel nursing has grown as a sector of the overall temporary staffing industry, Hansen says, and is currently about a $5.4 billion business. She notes it attracts nurses at all stages of their careers, from those who are young and seeking adventure to those who are semi-retired and seeking the occasional job.

“As a whole in nursing, we do see the largest generation of nurses in the workforce is the millennial generation, and I think we see that in travel nursing as well,” Hansen says. “But it’s certainly not off limits for any particular demographic.”

As with other nursing jobs, travel nursing requires some experience, with at least a year of clinical work expected for many jobs. Alexander, who had opted not to work at a hospital during her nursing program, took a year and a half after graduation to build up her resume with a job in the telemetry and stroke unit at Mary Black Hospital. She then felt ready to apply with a travel nursing agency she found online.

Lian Carvajal, ‘13, has been doing a lot of hiking while a travel nurse in Kauai for the past year. One of the most scenic hikes she tackled was the 11-mile Kalalau Trail along the coast of Kauai.

Key for any travel nurse is the recruiter who works with them. At some agencies, nurses can search job listings themselves and ask the recruiter for additional help with the details. Conversely, recruiters also look for jobs based on a nurse’s location and salary preferences and help them apply. The more highly desirable the job location, the more experience will likely be required.

Alexander’s first travel nursing assignment was in her fifth-ranked location, St. Louis. But Lian Carvajal, ’13, who had worked in labor and delivery for two years at Mary Black Hospital and had spent a month in Central America on a medical mission, found work in her first choice city, Seattle, Washington.

“I love hiking, so I chose Seattle because of the hikes and the area,” Carvajal says.

Ultimately, having a good recruiter can be key in landing a prime assignment. Laura Kretzmer, ’19, who was a travel nurse for a year and a half, says at one point she worked with five different recruiters to find the job she wanted. Alexander, too, advises asking around – in talking to other nurses, she discovered she could be making better pay than she was earning, so she switched to a friend’s recruiter.

“It’s just knowing your worth and knowing not to get cheated out of something that, if you just knew how to negotiate or knew how the system worked, you could do a little better for yourself,” she says.

Plunging in

Laura Kretzmer, ‘19, right, and a friend explore the desert landscape around Mesa, Arizona.

Nursing assignments typically last 12-13 weeks, though often a contract will be extended if a hospital has ongoing need and likes the work a nurse has been doing. That was the case for Carvajal, who ended up staying in Seattle for almost a year. The job also was a launching pad to other assignments on the West Coast, including Monterey and Stanford in California.

Because of the short duration, however, nurses are expected to hit the ground running when they arrive for an assignment. “You don’t get much of an orientation,” says Kretzmer. “Usually, you just get a day or two. You have to build confidence in your skills, because you might not always have help.”

Alexander says she found it helpful to keep things in perspective. While every new assignment can seem scary or overwhelming, “You’re not alone,” she says. “You have nurses there you can ask questions of, and you’re not the only nurse on the floor. You’re not expected to know everything.”

Developing a support network eased Carvajal’s jitters at her first assignment in Seattle. “During orientation I connected with other travel nurses hired at the hospital and made friends,” she says.

At the end of an assignment, travel nurses have flexibility in what they do next. In between St. Louis and her second assignment in Oregon, Alexander returned home for the holidays and worked at Mary Black for a few months. Kretzmer asked for and received a shorter contract for her first assignment in Charlotte so she could go on a nursing school trip to Africa. And Carvajal has taken periodic breaks to visit Central America, where she sponsors three children.

“The flexibility of travel nursing is awesome,” says Kretzmer. “You can take time off in between assignments if you don’t want to work for a couple weeks or a couple months.”

Expect the unexpected

Mary Alexander, ‘12, BSN ‘15, loves getting out in nature when she takes on a new assignment.

Travel nursing is not without risks. At the start of the COVID-19 pandemic, many hospitals put in large orders for travel nurses, expecting patient caseloads that initially did not materialize. That resulted in several nurses being let go early without another assignment to go to. Kretzmer says while she was lucky enough to complete the contract she had in Arizona, she knew other nurses who weren’t so fortunate.

“Patients just weren’t coming in,” she says. “That was an odd time, which made it hard for jobs.”

Hansen says hospitals have since gotten much better at gauging need, and agencies know the kinds of questions to ask now when a large order comes in. “We spend a lot of time investigating with them,” says Hansen.

The pandemic itself has also created obvious dangers for front-line health care workers. Alexander had a close call during a shift at Stanford Medical Center in California when a patient tested positive a few days after being admitted. Alexander was one of the nurses who had close contact with the patient during that period. While some of the nurses became infected, Alexander did not, but she admits the experience was scary.

Ordinarily, however, the biggest challenge a travel nurse may face is personal. Because jobs are short term, many nurses are constantly looking for their next assignment. While most look forward to planning a new adventure, not everyone is comfortable with uncertainty, Hansen says.

“There’s this personal assessment that has to go into it,” she says. “Do you really know what you signed up to do, and are you happy with that choice? More cases than not, the answer is absolutely yes.”

Ticket to paradise

For Alexander, the experience has been life-changing in more ways than one. Her temporary job in the telemetry and stroke unit at Stanford Medical Center has now become a permanent one, something that still amazes her.

“It’s a dream come true,” she says. “I remember thinking, this is not real life, this is not happening. Stanford is just the crème de la crème in my mind. That is the hospital to work for.”

While she anticipates traveling again someday – Arizona is high on her bucket list – she’s enjoying hiking and exploring in California.

Carvajal, too, is realizing some dreams. She is currently wrapping up a year-long assignment in Hawaii, where she stayed on when the pandemic upended her plans to do a medical mission in Samoa this past summer. She’s enjoyed many breathtaking hikes, and has returned to school to become a family nurse practitioner. But one of her favorite memories is from a previous assignment in Nevada.

“My patient was having her first child and she’d been pushing for 30 hours,” Carvajal recalls. “She had to have a C-section, but being there for her, to encourage her, was amazing.”

Now, Carvajal says, the mother regularly texts her to share photos and updates about her baby.

While Kretzmer says her travel days are done now, and she’s settling back into her job with Prisma Health, Carvajal is looking ahead to her next adventure – perhaps Nepal, when she finishes her family nurse practitioner program. Like Alexander, she isn’t afraid to face the unknown.

“I would tell people, just go for it, and don’t be scared for change,” she says.