Heather Norton had long wanted to travel the country, but her schedule -- and salary -- wouldn't permit it.
So last month, Norton took the plunge, leaving her positions at a Raleigh, N.C., hospital and as a part-time nursing instructor at Wake Technical Community College. She signed on as a travel nurse, combining the profession she loves with the change of scenery she craved, boosting her salary in the process.
"Once you decide you want to do travel nursing, recruiters are everywhere," said Norton, who graduated from nursing school a decade ago. "You can have your choice of jobs in every state in the country. This gives me a lot more opportunity."
In the hospital where she worked for the past seven years, Norton "floated," moving among different floors and different specialties such as telemetry or surgery.
As the covid-19 pandemic has worn on, taxing nurses' physical strength and emotional tolerance for bedside work, thousands of travel nursing companies have been luring away hospital staffers.
"The salaries they promise go up almost weekly," said Danny Yoder, emergency department manager at UNC Rex Healthcare. "I just saw an offer for a travel nurse in Florida for $5,200 a week."
In the previous two weeks, Yoder said, the emergency department had hired eight nurses and still had nine openings.
Even with 128 nursing schools whose graduates tend to stay and work in the state, North Carolina has long had to import about half of the nurses needed for hospitals, nursing facilities, doctors' offices, clinics and other settings. The state has been unable to recruit the full number of nurses needed for years, said Erin Fraher, deputy director of the Cecil G. Sheps Center for Health Service Research at UNC.
When the pandemic hit, hospitals in other states had to ramp up their operations, increasing the competition for nurses and worsening the shortage here, Fraher said. While travel nursing predates the pandemic, the industry boomed once it hit. During the delta variant surge this year, agencies offering ever-higher salaries have lured nurses from hospitals all over the country.
Hospitals often are left to fill the gaps using travel nurses, sometimes hiring back their own former employees at a much higher rate.
Travel nursing companies were seen as a solution for many hospitals, a way to get skilled help fast and with a temporary contract that could be dropped at its end when the pandemic eases. But Fraher said she worries about small rural hospitals that aren't attractive to nurses looking for permanent work and don't have enough budget to pay for travel nurses. Even larger hospitals, Fraher said, may find they don't have enough money for other needs later because of having to spend on travel nurses now.
Fraher said the boom in travel nurses shows that hospitals need to find creative ways to retain their permanent staffs. Raises and shift preference are fine, she said.
"People are motivated by money, but also by the quality of their job," Fraher said. For instance, she said, in hospitals where nurses are expected to perform a range of duties, managers should be looking for ways to ease that burden.
"Nurses like to nurse," Fraher said. "They want to be caring for patients."
As travelers, nurses tell recruiters what kind of work they want to do and where, then sign contracts to stay in a place for a few months at a time.
Offers may include money for expenses such as extended stays in hotels or Airbnbs, along with meals and travel costs. During covid-19 surges, extra money was offered for nurses willing to work at hospitals in crisis areas where the number of cases was overwhelming.
Those people will earn their money, Norton said.
"Covid patients, when I worked with them, they could change at the drop of a hat. They could be stable and then literally crash in a matter of minutes, they're that unpredictable. So if you saw their oxygen levels drop just a little bit, you would kind of go on alert.
"And talking to ICU nurses, I would hear them talk about the emotional strain. Some of these patients would be in there for months and the family is worried to death, and you're trying to help them stay connected as much as possible.
"And taking care of them is different," Norton said. "I had one patient one night, their oxygen levels would drop, and I'd gown up and put on all the protective equipment and go in there and get them better. I'd go out, take off the equipment, and then literally five minutes later it would happen again.
"It's exhausting," Norton said, "and you might have four or five patients like that."
That's the environment Katrina Blackmon said she went into at a Durham hospital when she graduated from North Carolina Central University's nursing school last year. Caring almost exclusively for covid-19 patients took its toll, Blackmon said. Each needed so much, but there was always another patient who needed more.
"I wouldn't say we're not giving good care, because we always strive to give excellent care," Blackmon said. "But there's just so much that we don't have time to spend and do those little extra things."
Blackmon said she likes to engage in "therapeutic communication," just talking with patients about their lives and what they've been through.
"That's what brings me joy," Blackmon said.
Blackmon said she had long hoped to do travel nursing but originally thought she would get two or three years of experience as a staff nurse first. But the stress of working in that covid unit accelerated her plans. Almost two months ago, Blackmon left the hospital and went to work for a travel nursing agency. In her first placement, she's working in Charlotte and is enjoying the reduced stress.
"I would also like to go to Texas, Florida, California," Blackmon said. "I'm just open."
In her new job, Norton said, she didn't want to travel too far right away because she has two teenage children at home. So she took an assignment at the same hospital where she started her nursing career, Scotland Memorial in Laurinburg.
Norton usually works three 12-hour shifts a week. She makes the 90-minute drive from her home before the first shift, stays two nights with family or friends in the area, and drives back to Cary after the last shift.
Next summer, she said, when her kids are out of school, Norton would like to take them with her on a travel nursing assignment in Hawaii.
"And once they graduate, we could just sell the house, get an RV, take travel assignments and just travel the world. That's something we've never had the time or the money to do."