According to those in the know, cruise nursing hasn’t been affected by the current nursing shortage. Is it any wonder? The pay and benefits are excellent; the work environment is modern and up-to-date; the last thing the majority of clients want is to get sick on their vacation and end up in the infirmary, and the scenery’s not that bad either.
Growing at more than 10 percent annually, the cruise industry itself is staggering. Currently, more than 30 cruise lines have hundreds of ships sailing the seven seas to more than 1800 ports of destination. In 2001, the International Council of Cruise Lines reported that the industry provided over a quarter of a million jobs in the United States, generating $10.6 million dollars in wages. Add in goods and sales and the total economic benefit to the US was over $20 billon dollars.
As a total package, the cruise experience is in a class by itself. In addition to shore side excursions in exotic locales to shop and sightsee, the vessels themselves are floating prescriptions for boredom.
Want to get physical? Try rock climbing, ice skating, or a variety of sports and aquatic activities. Need a slower pace? Check out the health spa, relax in a Jacuzzi, or bask in the tropical sun on a deck poolside. Looking for excitement? The night comes alive in casinos and lounges with entertainment in every venue imaginable. Interested in a tax deductible vacation with education? A number of professionals can sign up for lecture cruises.
The major U.S. ports of call are located in Florida, California, New York, Alaska, Washington, Texas and Louisiana. And while cruise nursing isn’t hurting for applicants, there is still room on board for qualified nurses.
A critical first step is having the clinical credentials. In general, ships catering to Americans require licensure in the United States, Canada, or the UK. From two to five years of recent experience in the ER, ICU, or CCU is required, usually with ACLS (Advanced Cardiac Life Support) and/or PALS (Pediatric Advanced Life Support) certification. A current passport is necessary.
Unfortunately, most applicants aren’t qualified. According to Sally Van Boheemen, RN, operations manager for medical services for Holland America Line, the company averages over 1000 applications per year with only about 15 percent meeting qualifications.
"Most are retired nurses wanting to cruise and get paid," she said.
For nurses with the clinic background, a logical second step is preliminary research into the industry itself. (See "The Significant Seven.")
The average cruise ship carries from 2200 to 2700 passengers with 700 to 900 crew members. However, Royal Caribbean and Carnival have some of the largest ships on the ocean, accommodating over 3000 passengers and over 1000 employees. Depending on size, a boat is usually staffed with one physician and two to three nurses. Larger vessels or those with older clientele may sail with a larger medical crew.
Even though only 11 percent of North Americans have ever cruised, the industry has experienced phenomenal growth and the market is considered poised for explosion. Mega-liners are continually being updated and launched, providing ever-expanding job opportunities.
Yale Medical School even offers a four week elective in cruise medicine for senior residents in emergency medicine. And while part time cruise physicians are common, most lines, including Holland America, seek full time nurses but receive a majority of part time applications. "So if someone is qualified and wants full time," Boheemen said. "We are hiring."
The application process can be direct – through the cruise line itself – or indirect – through an agency. Either approach can usually be initiated via the internet.
Major employment agencies include Vanter Cruise Health Services, Cruise Placement Hiring Agency, Cruise Job Line, and Cruise Lines Employment. Their websites have links for job openings; several include nursing positions on unidentified lines. Vanter lists openings on Carnival’s two Disney ships and offers the cruise medical elective in conjunction with Yale. Most agencies require a fee and post on-line applications.
None of the major seven lines posted nursing jobs on their websites, but applications were taken at several.
According to Erik Elvejord, director of public relations for Holland America, the company’s 740 sailing medical personnel are hired and supervised through their Seattle office.
Generally considered to offer the best medical program in the industry, Holland America requires nurses to have four years of recent ER, ICU, or CCU experience, as well as ACLS certification. Elvejord said licensure can be through any state in the US or Canada.
"The best thing to do is call our medical line [206-298-3071] which has a voice box where you leave your address and we then send an application packet out," he said, adding that the company will also accept a cover letter with a resume attached.
Full time positions at Holland America consist of 235 days a year in contracts that are usually four months on and two months off. Elvejord said each assignment requires a new contract that may or may not be for the same ship.
"Normally nurses move around a bit and try different ships and different itineraries," he said. "Nurses can ask for certain ships or certain itineraries and we try to accommodate."
Elvejord also said assignments may be based on a ship’s need or a nurse’s specialization. As an example, he said world cruises sail for 100 days with an older clientele; therefore a geriatric background is helpful.
Most ships have one physician and three nurses; although Elvejord said the ratio is different on several of their ships. In addition to staffing the infirmary from 8 a.m. to 6 p.m., nurses are on call 24 hours a day. Medical personnel also care for the ship’s crew. Although ships aren’t as fully equipped as a hospital, most are comparable to any modern emergency department.
Equipment includes X-ray and laboratory capabilities, EKG, cardiac monitor, pacemaker, ventilator, suction, and oxygen equipment. In addition to a mini-ICU and several in-patient beds, the ship has a well stocked pharmacy and medical supplies common to emergency rooms or clinics.
Interactive telemedicine has been available since 2000, allowing access to any specialist at the University of Texas at Galveston. In addition, since 1995, medical personnel on Holland America ships have been trained in the use of "clot busting" drugs for heart attacks.
The majority of cases are routine, but cardiac events and injuries secondary to falls are common. Treatment and emergency protocols are followed.
Elvejord said "salaries are competitive" at Holland America. In general, websites for cruise nurses list pay ranges from $2200 to $3600 dollars a month. Benefits such as room and board, tax breaks and exemptions, as well as transportation to and from ports of call, can significantly augment the salary’s value.
For adventurous nurses possessing the necessary clinical skills, cruise nursing may hold the cure for turning the blahs into boldness, regrets into reality, fantasies into fulfillment.
The Significant Seven
Carnival: The "Fun Line." Vessels: 18, including two Disney cruise ships. Clientele and personnel: Younger. Salaries: Average to below. Corporately owns Holland America and Costa.
Holland America: A more "mature, stylish line." Clientele: Mature, older, those with special needs. Excellent medical program. Vessels: 12. Salaries: Competitive to above with expectations for service to match.
Royal Caribbean: One of the richest lines. Mid to upscale cruises on some of the largest ships on the ocean. Vessels: 18. Salaries: Good; a preferred employer. Corporately owns Celebrity.
Celebrity: More upscale, deluxe cruises. Vessels: Nine, Leader in fleet innovations. Salaries: Good; a preferred employer.
Costa: Based in Italy, Europe’s number one line. Vessels: Nine. A European/Italian atmosphere.
Norwegian: Targets those with tighter budgets. Clientele: Middle class. Vessels: 12. Salaries: Competitive, trails its competitors.
Princess: Model for the "Love Boat" television series. Clientele: Mature to older. Vessels: 13. Salary: Excellent. A preferred employer.
Most vessels have worldwide itineraries. With exceptions, Carnival and Royal Caribbean are concentrated in the Caribbean. Costa is in the Mediterranean in the summer, Caribbean in the winter.
Source: Cruise Placement Hiring Agency; Cruise Job Line; cruiselinejob.com