Photo courtesy of Carnival Cruise Lines	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Cruise ship nurses typically come from emergency or critical care backgrounds. (From left) Senior fleet physician Iain Hamish MacLeod, MD, ship's nurse Marie France Ouimette, RN, and lead nurse Katrina Smith from Carnival Cruise Lines.

On a typical shift, Melissa Holder, RN, sees patients with colds and flu, chronic illnesses and an occasional work-related injury. Sometimes, patients need X-rays. After work, Holder completes paperwork and clips on a pager, which sometimes summons her back for urgent cases-all pretty typical for a nurse.

But Holder's days off are anything but typical.

She often catches a launch to shore for a few hours of scuba diving, relaxing on the beach or shopping. Holder is a lead nurse on the Carnival Ecstasy cruise ship, sailing from Long Beach, Calif., to exotic ports such as Puerto Vallarta and Cabo San Lucas in Mexico. She's also been on Alaskan cruises and sailed out of New York to Halifax and Nova Scotia in Canada.

"During the day, our infirmary runs like anything from a doctor's office to an urgent care clinic to the emergency room," Holder said. "The ship has 900 crewmembers and 2,500 passengers, so it's like a small town. We're primary care for crew members.

"Outside main clinic hours are paperwork and clerical duties. We don't have clerical staff. There are three nurses. The day nurse works 8 a.m. to 5 p.m., and another nurse comes on from 5 to 8 p.m. The day nurse takes call from 8 p.m. to 8 a.m., then has the next day off. Then you can go ashore, and there are lots of things to do."

Holder frequently scuba dives in warmer locations. On Alaskan tours, she has gone ice trekking and sea kayaking. Groups of crew members often get together and organize tours or go to dinner.

'Frontier medicine'

Susie Lilly, RN, is a lead nurse for Holland America Line. "Nursing on a cruise ship is kind of like frontier medicine. You don't have the ancillary personnel on a ship. We're respiratory therapists, X-ray techs, lab techs, critical care nurses and mother to about 700 crew. Anything can come through the doors-except motor vehicle collisions, which are rare. The crew work with different types of machinery and equipment, and accidents can and do happen."

Cruise ship nurses are typically from emergency or critical care backgrounds. Holland America nurses are U.S. or Canadian licensed with at least four years of ER, ICU or CCU experience, said Sally Van Boheemen, head of Holland America's medical department, and most nurses have 10 years of experience or more in emergency. Full-time nurses are employees of the cruise line with benefits, and work four months on and two off.

A minimum of five years of experience in emergency or critical care is required at Vanter Cruise Health Services, an Alexandria, Va.-based company that provides health services for the cruise line industry, including Disney Cruise Line. Vanter recruits from the United States as well as other countries like Canada and the United Kingdom. Nurses are independent contractors with terms of one to six months.

"Typically, nurses do 16 weeks at a time, then go off for a break and then come back on contract," said Patricia McAllister, vice president at Vanter. "We have nurses who have been with us for three or four years on repeated contracts."

Carnival Cruise Lines also hires predominantly from the emergency department, said Steve Williams, director of medical operations. The cruise line hires nurses from England, New Zealand, South Africa, Canada and Europe, as well as from the United States. Salaries aren't generally competitive with other nursing salaries in the United States, Williams said, so a majority of Carnival's nurses are from other countries.

Next Page