Cruise ships offer minority nurses the opportunity to make paradise their workpl

Cruise ships offer minority nurses the opportunity to make paradise their workplace

By Anne Baye Ericksen

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 vacationor is it your workplace? For hundreds of nurses who set sail on cruise ships each year, exotic tropical environments are not only paradise, it’s where they practice.

Cruises are more than just romantic getaways or luxurious escapes from stressthey’re also unique career opportunities. With more than 5 million people taking cruises in 1999more than a 1,000% increase since 1970, according to the Cruise Line International Associationcruise ships are in great need of competent, skilled and culturally diverse nurses…

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 opportunitiesand an urgencyfor nurses of color on these ships, says Joan Jones, RN/SAC, an African-American nurse who works on the Commodore Cruise Line.

Cultural Bonding

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.

A Floating Community

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 factorssuch 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 levelsor, 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.

Do it Yourself

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 roomsincluding EKGs, x-ray machines, oxygen, IVs and essential medicationsthe 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.

Landing the Job

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 site. 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 settingsan 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.