Nurses resort to extreme commutes for better pay

By the end of 2017, Matt Crecelius decided it was time. He wanted to live somewhere cheaper, with a slower pace. There was a catch, though: He loved his job as a nurse at New York-Presbyterian Hospital in New York City, and he wanted to keep working at a Level 1 trauma center.

“I had looked at living in the Midwest and then maybe flying in and picking up where I used to work,” said Crecelius, who is 29. “I was surprised to see that's more common than I thought.”

Instead Crecelius moved to Farmington, Mo. He now drives about 90 minutes each way, to his job as a cardiovascular ICU nurse at SSM Saint Louis University Hospital. It’s a lengthy commute but one that rarely has traffic. “It's unbelievable to think about,” Crecelius said, about the 600 miles he drives each week. “But when you do it, you just get used to it.”

Crecelius is part of a new wave of nurses who are redefining where and when they will work and live. They are making this work by taking on longer—in some cases, much longer—commutes. These nurses want better pay, to live where they choose, and maintain the flexibility to work in care settings that challenge them professionally. The trade-off is a commute that can exceed 60, 100 or even thousands of miles a day. 

But such commutes can pay off handsomely. The average commute in the U.S. is 25 minutes each way, but workers who commute longer than 90 minutes make 20% more money than those who don’t have super commutes, according to a new report from ApartmentList. An estimated 3.5 million Americans have extreme commutes.

Nurses who take on super commutes face risk factors that are unique to workers who engage in shift work and who are also responsible for the lives of others. Are the costs of commuting worth it? Does commuting increase burnout? And is it safe to travel such distances after a 12- or 16-hour shift?

“Five years ago, I never would have dreamed of doing this,” said Deb Ebersole, an advanced practice nurse who lives in Winter Park, Fla., and works in Boston, a 1,200-mile commute. “But it's really just become a routine now for me, and it's not anything out of the ordinary.”

There are three primary reasons why nurses choose longer commutes: better pay, working in a culture where they feel supported (with colleagues they respect), and getting to do the kind of work that challenges them professionally.

Ebersole considered two of those factors—pay and work environment—when she decided to ask her supervisor at Tufts Medical Center in Boston about commuting when her husband got a job offer in Florida in 2017.

She loved the job she had just started, as an administrative nursing supervisor who manages the patient flow of the hospital from its “command center.” But the idea of moving her family somewhere different—with palm trees and year-round sunshine—also appealed to her.

Now, every two weeks, Ebersole, who is 54, flies to Boston. She works three 16-hour shifts separated by eight-hour breaks she uses to sleep in a call room she shares with another nurse, who commutes from Maine. “It's cheaper to fly," she said. "That has really helped people be more mobile. And so [nurses are] not limited to positions that are right within their geographical area.”

In fact, 5.9% of Tufts’s 1,301 nurses cross state lines for work. That includes neighboring states like New Hampshire and Rhode Island, as well as Florida, Delaware, and Maine.

“I don't think we're specifically targeting the long-distance population,” said Eric Anketell, Ebersole’s supervisor and Tuft’s director of clinical operations for patient care services. “We’re in a hypercompetitive market right now. So, nurses can choose to work, basically, wherever they want.”

That newfound leverage is creating new career directions for many nurses at a time when the hiring landscape for the profession is changing.

Since 2010, there have been 100-some closures of rural hospitals, according to the NC Rural Health Research Program. “It's not as common for a nurse to have a hospital directly in his or her community,” Sheff said.

And over the last decade, hospitals have been cutting staff to offset cost pressures, and that means that nurses may be responsible for caring for more patients during their shifts. As a result, some choose to work only in environments where they feel supported.

Factor in a recently revamped licensing agreement that lets nurses in certain states work across state lines, and more nurses may start to consider longer commutes to counter some of these issues. “Yes,” said Christine Kovner, a nurse educator at New York University. “I think that is likely.”

But at the top of this list are regional nursing shortages, which have created a competitive market for talent, with more financially secure hospitals being able to better recruit and retain nurses. As a result, the most experienced, specialized nursing professionals are discovering they can live and work where they want, at the pay they demand.

“I am valuable,” said Michael Kearse, a registered nurse who lives in Atlanta and has been working in Northern California for the last year and a half. “Do I accept this $35 an hour? Or do I go and get paid $100 an hour?”

Kearse keeps a two-bedroom, two-bathroom rental apartment in Oakland, Calif., which he shares with another commuter nurse. But the 32-year-old estimates that, even with added commuting costs, he still made almost three times as much money in 2018 as he did in 2017— and he only worked a total of five months last year. Kearse said he and his wife have discussed moving to the West Coast, but the cost of living there would negate the salary increase he is seeing now.

He plans to enroll in a nurse anesthesia program, and he is using this time to save money and pay off debt. But he also says that the decision to work on the West Coast has been a lesson in professional risk-taking, giving him a chance to apply an entrepreneurial approach to his career.

“A lot of time we don’t work the situation,” he said. “I’m jumping through hoops, and I’m out of my comfort zone by taking this 2,800-mile flight. Yes, I have to get an apartment. And, yes, I have to rent a car when I’m out there, but to make $100,000 in the South.”

On sites like AllNurses.com, LinkedIn, and Reddit, nurses debate the trade-off between a long commute and a better salary, such as the story that came out in 2017 about a Pennsylvania nurse who commutes to Oakland. “Very common for RNs from states with the crappiest wages, i.e. southeastern states,” one nurse wrote on Reddit last year. “Lots of southern twang in Bay Area [emergency departments].”

Traditionally, nurses have not been a very mobile workforce. A 2011 study found that roughly 52% of new registered nurses worked within 40 miles of their high schools, and the vast majority (75%) of nurses with associate’s and bachelor’s degrees worked in the states where they went to high school.

A 2015 study examining nurses in rural Washington state found commuter nurses tend to be male, have advanced degrees and to be older (between the ages of 41 and 60 years old). A similar analysis from 2012 found that commuting registered nurses who live in rural communities found that they had slightly higher salaries.

“Pay is the story,” Susan Skillman, senior deputy director of the Center for Health Workforce Studies in Seattle, said by email. “The data couldn’t confirm this—but I believe with RNs it’s likely that a sizable portion chose to go to a larger hospital and work three 12-hour shifts, then come home to their rural residence for four days.”

Not all nurses are willing to travel such long distances for work, no matter how good the money may be.

Nursing remains a predominantly female workforce—about 85% of nurses today are women—and commutes can be difficult to maintain while raising children or taking care of family members, with or without the support of a partner.

Emily Sheff, an assistant professor of nursing and partnership liaison at Project REEP at Rivier University in Nashua, N.H., used to commute 53 miles from Bedford, N.H., to Boston, a trip that can take anywhere from 70 minutes to more than two hours, depending on traffic.

When Sheff realized that her commute into Boston for her work as a nurse educator was cutting into her time with her family, she considered a change. “Every year for New Year's we make a list of our own goals,” the 40-year-old said. “My personal goals were to be with the kids more… A big component of me not being able to be engaged with my kids [was] because I was constantly worrying about that commute or that distance.”

Safety is another concern. Studies have also found that long commutes can put nurses at a higher risk of car crashes and making medical errors on the job.

“That’s where the danger comes in,” said NYU's Kovner and co-author of the 2011 study. “If they work 12-hours shifts, judgment declines. Then they have to drive home, there’s a real worry.”

But some nurses don't have much choice but to travel farther to work in order to support themselves and their families at a time when nursing salaries are often flat and the cost of living is rising. While nursing shortages have led to competitive pay packages, signing bonuses and student loan forgiveness for some nurses, not all hospitals can afford to pay their workers like that.

The average salary for a registered nurse in the U.S. is $72,000. But there is a lot of variation when you drill down into the regional data. RNs in San Francisco earn $128,990 per year, for example, according to the Bureau of Labor Statistics. But doing the same job in Orlando nets about $63,270 per year. In Atlanta, it’s $70,540. In Dallas, $74,140.

For many nurses, year-over-year salary growth can stall. A 2018 Medscape survey found that 29% of registered nurses said their pay didn’t change at all from 2016 to 2017.

Sharon Vaughns, 47, a registered nurse who lives in Blakely, Ga., drives about 70 miles each way to her job in Columbus. Back in 2004, when she was working as a licensed practice nurse in her hometown, she realized she could make $17 more an hour if she started working as a travel nurse in her own state. (Travel nurses, for the most part, are a segment of nurses who travel for short-term assignments.)

Making more money was the driving factor in taking on a longer commute. “I want to be able to do what I want to do and not struggle from paycheck to paycheck, because I have been there,” said Vaughns.

Now that her three sons are no longer living at home, Vaughns plans to pursue a career in real estate, aiming for a more flexible schedule, less stress, and time to travel with her husband. “Nursing is getting harder than it used to be,” Vaughns said.

If you work in health care and have a long commute to work, let me know why you made that choice. Was it pay? A better place to live? Or is there another reason? Tell me your commute story, in the comments using #NursesOnLinkedIn.