Close your eyes and feel the sweet ocean breeze gently passing over you. Breathe in the salty air. Feel the tropical sun warm your body.
Is this your vision of a picture-perfect vacation—or is it your workplace? For hundreds of nurses who set sail on cruise ships each year, exotic tropical environments and exotic locations are not only paradise, it’s where they practice.
Cruises are more than just romantic getaways or luxurious escapes from stress—they’re also unique career opportunities. With more than 5 million people taking cruises in 1999—more than a 1,000% increase since 1970, according to the Cruise Line International Association—cruise ships are in great need of competent, skilled and culturally diverse nurses. With today’s mega-sized ocean liners that can host more than 3,000 passengers, plus crew members, there are bound to be medical necessities—not to mention emergencies—that demand the presence of experienced health care staff.
Because cruise line passengers and crew are an extremely international group, representing many different cultures from all over the world, being a person of color can be a distinct advantage to nurses interested in cruise ship careers. While the majority of cruise line medical staff is still white, according to cruise ship company representatives and nurses who work in this field, having minority nurses on board can prove to be an asset in providing culturally competent care to such a highly diverse group of patients.
“There are definitely opportunities—and an urgency—for nurses of color on these ships," says Joan Jones, RN/SAC, an African-American nurse who works on the Commodore Cruise Line.
An ocean-bound health-care practice, as you can imagine, differs quite a bit from the standard hospital setting. At its most basic level, on-board nursing is emergency nursing; an unexpected fall or bout of seasickness may bring passengers to the infirmary. Cruise ship nursing, however, involves much more than just wrapping swollen ankles or dishing out seasickness medications. There are times when serious medical emergencies occur that can challenge your nursing skills.
"There are so many medical issues that can arise. You have to know how to respond," Jones emphasizes. For example, she says, you may find yourself dispensing insulin or other life-supporting medications or stabilizing a passenger with appendicitis.
"There can be heart attacks on board as well,” adds Marie Murray, RN, an African-American nurse who has worked with Carnival Cruise Lines for nearly five years.
Because of this potential for serious health problems to occur on ships at sea that may be miles from the nearest hospital, the International Council of Cruise Lines (ICCL), the industry's governing body, requires all cruise ship nurses to be certified in, or have equivalent training in, advanced cardiac life support. Individual cruise lines may also expect their medical staffs to have substantial emergency or critical-care experience.
"ER and ICU experience is a must," explains Murray. "You have to be able to function autonomously. If an emergency arises, you have to be able to handle the problem until assistance arrives."
Both Murray and Jones emphasize that establishing a rapport with the often ethnically diverse crew is essential to providing culturally competent health care on the ship. Minority nurses, they agree, bring cultural perspectives that can help open the lines of communication and allow bonds to form more quickly between the nurse and the patient.
"I think my being a minority does make a difference,” says Jones. “The crew members are more relaxed with me because many of them are also minorities.”
“Cruise ship nursing is a rare instance where my skin color has aided me in providing care to patients," asserts Murray. “It doesn't matter to me what country the crew is from, because they're all my babies, but there are some members who tend to feel more comfortable with nurses of color. I have had crew members come to the infirmary and ask specifically for me. If I'm not there, they will wait until I'm back on duty. Once you have that rapport with them, they trust you."
This trust is essential when it comes to working with non-English-speaking crew members and passengers. The number of languages spoken on board can be astonishing. "There could be 30 to 40 languages spoken on the ship at any one time," Murray notes. As a result, there is strong demand for minority cruise ship nurses who are bilingual or multilingual, as well as nurses who can learn to communicate beyond cultural and linguistic barriers.
When a nurse and a crew member do not speak the same language, another crew member often acts as an interpreter. However, there is always the chance of mistranslation or of nurses receiving incomplete information. Jones points to one case involving an injured worker who didn't speak English. "I could tell that he didn't necessarily want to tell the [interpreter] what was going on with him. If I had spoken his language, he could have confided in me more," she explains.
Because nurses don’t just handle passengers' emergency needs but also help maintain the health of the crew, cruise ship nursing is, in a sense, a community health practice. Crew members, who sign on to work for a minimum of one year, are typically required to have a physical every three months. Ships’ nurses are responsible for establishing and providing health care programs for all crew members.
“We're there for the crew,” says Murray. “The passengers go home after the cruise, but for the crew, we're their health care provider.”
The biggest challenge for nurses is providing care that is sensitive to the ethnic, cultural, linguistic and medical diversity of the crew. While a ship's home port may be Miami or Vancouver, people from all over the world fill the crew positions. It's not unusual for engine, kitchen and hotel workers to come from the Philippines, Southeast Asia, Latin America and even the republics of the former Soviet Union.
Providing culturally competent nursing care in this situation requires nurses to be aware of many different factors—such as diet and the cultural context in which patients view health care. Some foreign crew members may be open to "Westernized" health care; for others, it may be an unfamiliar and frightening experience. Additionally, many cruise line employees come from impoverished villages and could come aboard with undiagnosed or untreated conditions.
Both Murray and Jones agree that education is a big part of their work with crew members. This might entail teaching about diabetes and how to test and read blood-sugar levels—or, as is often the case, teaching about sexually transmitted diseases.
"We do a lot of sex education with the crew," comments Jones. "There was one woman who thought she had fever blisters, and we found out it was herpes. We had to educate her about the disease and the transmission risks."
When crew members need emergency or extended care, nurses follow the same procedures as with passengers: arrangements are made to transport the patient to a land-based hospital. Depending on the severity of the employee’s condition, he or she could be sent home until they are fully recuperated and able to resume their shipboard duties. Because crew members represent so many different nationalities, nurses are often responsible for conferring with port agents regarding passports and immigration status. This is also true when patients are sent into port for treatments that can't be done on board, such as dentistry.
"There are different specialties for different ports; one for dental and another for cardiology, for example. And while most ports can handle any type of emergency, some ports are better than others for treating certain kinds of conditions," notes Murray.
The key to cruise ship nursing is autonomy. While each vessel has a physician certified by the American College of Emergency Physicians (ACEP) and several nurses assigned to a voyage, the actual number of nursing staff on board depends on the size of the ship. Oftentimes you could find yourself in charge of a clinic.
As in hospitals, cruise line nurses work in shifts, including on-call rotations. If you're not scheduled for duty, your time is your own. You're free to roam the ship, partake in the entertainment or even go ashore. When in port, a ship’s medical staff may work with port communities, assisting them with health care delivery. At those times, the nurse on duty may be the only medical personnel on the ship. If an emergency arises, you have to be able to handle a major medical situation on your own, Murray explains.
Fortunately, each cruise line has established emergency protocols, which may include transporting passengers-turned-patients to a land-based facility. Although ships' infirmaries are equipped like smaller versions of emergency rooms—including EKGs, x-ray machines, oxygen, IVs and essential medications—the staff may still be limited in the extent of care it can provide.
"In cruise nursing, you don't have the auxiliary personnel like you have in the hospital," Murray points out. "If we need to, the captain will divert the ship to another port, airlift the patient to land or call the Coast Guard to transport the patient. On board, we work to maintain and stabilize patients until we can get them to a land facility."
If cruise ship nursing sounds like your dream job, how do you get started in this field? Compared to hospitals, nurse recruiting within the cruise industry takes place on a much smaller scale. Therefore, the best strategy is for you to make the first move. Both Jones and Murray took it upon themselves to seek out cruise ship opportunities.
Interested nurses can either contact cruise line medical departments directly at the company headquarters or through the company’s Web sites. Indeed, the Internet is emerging as the avenue of choice for many applicants. There are also employment agencies that specialize in staffing cruise ships. The actual recruitment process is much like that of traditional health care settings—an application, interviews, reference and credential checks, etc. The biggest difference is that in the cruise industry, much of this is done over the phone.
Once you sign on, the medical director assigns you to a ship. Your length of duty varies from line to line, but typically the initial period is a six-month commitment.
"You need that much time for the first voyage because you're learning the ship and its rules and regulations," says Murray. "Once you’ve learned all that, you can step onto any other ship and be able to do your job."
From there, your commitment is up to you and the cruise line. Some nurses opt for full-time positions; others work as fill-in staff. Jones, for example, works on a ship when she is on vacation from her regular position at the Veterans Administration Hospital in New Orleans. "It can be like a working vacation," she says. "It is far less stressful than a hospital environment."
However, ship-based nursing differs from hospital-based work in perks and benefits, such as compensation. Cruise line pay averages out to $700 per week, according to Maritime Health Systems, an independent employment agency that works with cruise lines. While this is substantially lower than hospital compensation, during your tenure on board you become a crew member, which entitles you to free room and board. Murray says this arrangement helps even out the pay discrepancy, because she doesn't have land-based bills, such as rent, utilities and food.
Before sailing off to her next adventure in the sun, Murray adds that cruise line nursing has been one of her best career choices. "It's the best [job] you could have,” she says, “because it makes nursing a rewarding experience."
Want to find out more about a career that feels like a “working vacation” on the high seas? Check out some of these cruise line companies and employment agencies that specialize in cruise ship placements:
Carnival Cruise Lines
3655 NW 87th Avenue
Miami, FL 33178-2428
Commodore Cruise Line
c/o Maritime Medical Systems (employment agency)
Millerville, MD 21108
Disney Cruise Line
210 Celebration Place
Celebration, FL 24747
Holland America Line
300 Elliott Avenue West
Seattle, WA 98119
10100 Santa Monica Boulevard
Los Angeles, CA 90067
Royal Caribbean Cruise Line
P.O. Box 340 Skoyen
0212 Oslo, Norway