MILWAUKEE – Kristina Starcevic grew up listening to stories from her dad, a former newspaperman, about the adventures he had hitchhiking in his 20s. She wanted to have the types of stories he did.
“How can I travel but still make it safe?" she asked herself. "And nursing was it for sure.”
It usually doesn’t spring to mind when people seek out an occupation with “opportunity for travel,” Starcevic, 33, acknowledged. But she begs to differ.
And the numbers back her up. Staffing Industry Analysts, an independent research and advisory firm, estimates there are between 40,000 and 50,000 traveling nurses on any given day. Generally, they travel a minimum distance from their own home, such as 50 miles, and work 13-week contracts. But some go across the country or even overseas for a year at a time.
Openings for these nurses, who virtually become itinerant laborers, increase during flu season and from July through October to handle the annual surge in newborns. They head to rural and urban areas alike, and sometimes they rush toward calamity: New Orleans for Hurricane Katrina, the Midwest for flooding, California for any number of wildfires.
And now, they typify a booming labor niche during the COVID-19 pandemic.
Starcevic has been helping respond to COVID-19 since March. The ability of health care systems to handle the virus varies widely, and in hot spots, many administrators are struggling to fill the gap left by front-line health care workers who have become sick or need to be quarantined. Those like Starcevic – as well as doctors and technicians – have gone to New York City, Seattle, New Jersey and other epicenters to ply their trades.
Right now, Starcevic is in Houston, working for the first time as an ICU flex nurse. Her job: Hop from unit to unit, from 7 P.M. to 7 A.M., four days a week, 13 weeks at a time, while tending to only the sickest of COVID-19 patients.
From Nevada to Wisconsin to Texas
Starcevic became a registered nurse in 2011 and spent her first seven years in her hometown of Reno, Nevada, always on the night shift.
She moved to Wisconsin a couple of years ago to be with her boyfriend after they started dating in Reno.
She started taking travel jobs around the state. Her first assignment was in a rural Wisconsin hospital, and her second was in Appleton, a city of roughly 75,000. She enjoyed the latter so much she stayed for another 13 weeks.
“If I didn't want to go to Texas so bad, I probably would have extended – again,” she said.
For Starcevic, the appeal of bouncing around lies in experiencing new cultures, becoming better rounded as a nurse and seeing how different hospitals operate. There’s also the feeling that comes with not being tied to a place.
“I can switch out and you have a lighter heart,” she said.
Starcevic is now on her fourth tour as a traveler, this time in Houston; her previous contract was in Dallas. She was drawn to the Lone Star State because of Austin’s storied music scene, but she stayed for its attitude.
“People here just have time for you,” she said.
Starcevic found her position through Fastaff Travel Nursing, an agency that specializes in getting nurses to crisis centers quickly.
"They have to have their license up to date; they have to be ready to scramble; they have to have a bag packed," said Lauren Pasquale Bartlett, Fastaff's VP of marketing.
There are around 800 health care staffing agencies in the country, and many place nurses, according to Bartlett. Staffing Industry Analysts projects the travel nursing market to reach $6.4 billion in 2020, a 5% increase over last year's revenue.
In March and April, Fastaff sent out three times as many nurses as it did the same time last year. In Texas, it multiplied by 10. The highest demand is for ICU nurses, Bartlett said.
Early this year, the average salary for a travel nurse was about $1,700 a week, according to the staffing agency NurseFly. By March, that wage had increased by 76% to more than $3,000 a week. In some places, pay more than doubled. It's typical for travelers to receive relocation, accommodation and meal stipends as well.
Travel nursing has been made more accessible by licensing agreements between states. There are currently 33 of them – including Wisconsin – that fully take part in the enhanced Nurse Licensure Compact, which allows nurses holding a valid license in one of these states to practice freely between the rest. Nurse Licensure Compact bills await legislative approval in six more states.
In response to the pandemic, travel nursing was bolstered further by a slew of executive orders that relaxed licensing regulations.
Starcevic was in Dallas when the first cases of novel coronavirus started showing up. Her hospital created a 20-bed ICU to deal with these patients, and she spent her remaining 10 weeks treating them. Starcevic, along with the other nurses, provided 100% of the care in her unit, she said – respiratory therapy, physical therapy and lab work.
Now she works in Houston’s Texas Medical Center, treating more COVID-19 patients. At 2.1 square miles, it’s the biggest medical complex in the world. Starcevic was accepted the same day as her interview and had one week to find somewhere to live.
Some travelers prefer to stay in hotels or rent out empty houses or apartments and fill them with rented furniture. Others choose to live in RVs and trailers. Starcevic prefers to rent out furnished places. She said travel nursing can get lonely, but in Houston, she has a roommate, the owner of the house, and they "really click."
Despite its danger, Starcevic and her ICU colleagues prefer working on the COVID floors. In these areas of the hospital, N95 masks are worn at all times, with the exception of lunch breaks.
"I’m dealing with the sick of the sick,” she said. “One moment your heart is ticking, you got a good heart rate, good blood pressure and the next moment you’re crashing.”
She has resigned herself to the likelihood of getting infected, saying, “It’s not if, but when."
In the event she becomes debilitated, she's given over power of attorney to a good friend of hers, another ICU nurse.
Starcevic has seen patients intubated for more than a month on end. The worst off are those that come to her with preexisting conditions, like hypertension, high cholesterol and diabetes.
She said her hospital was adequately staffed for the first four to five weeks, but not so much anymore. Some of her colleagues have experienced burnout, and others have taken leaves of absence due to deaths in their families caused by COVID-19.
“To see so many deaths can really take a toll on a soul,” Starcevic said.
For her, the worst part of the job is tending to family members who don’t understand or accept the dying process. But she understands that they're writhing in agony.
“All my life, I had always wondered what it would be like to be a nurse in war or in a pandemic,” she said. “When the pandemic was announced, I wasn't even scared. It was more of a ‘Let's do this.’”
The mission has been worthwhile, and she’s thinking of extending her stay in Houston. But first, after her contract is up in October, she wants to take a couple of weeks off, at least, to see her boyfriend. He is currently on a travel assignment in Colorado.