An ICU nurse, Susan Suver, BSN, RN, was hooked her first time. So was emergency department nurse Sally van Boheemen, RN. Trauma nurse Laura Vlaardingerbroek, MSN, RN, got the bug while she was with her parents.

CARING FOR THE CREW: Laura Vlaardingerbroek, MSN, RN, lead medical officer on Holland America's ms Zaandam, treats patients and crew members, seeing everything a nurse in a land-based emergency department would, with the exception of motor vehicle accidents. photo courtesy Laura Vlaardingerbroek

No, we're not talking about exotic critical care, but cruise ships, where all three found their vocational true love and made the move away from land-based care to medical centers aboard Holland America cruise liners.

While Suver, now supervisor of fleet medical operations, and van Boheemen, currently fleet medical director, have transitioned to the Seattle-based cruise line's offices, Vlaardingerbroek still works 3 months on, 2 months off as lead medical officer on Holland America's ms Zaandam. A native of Black River Falls, WI, Vlaardingerbroek worked in a level I trauma unit outside of Chicago for 8 years after graduating from the University of Wisconsin Milwaukee School of Nursing. She was happy working in the intense atmosphere, but fate intervened. While she and her family were on a vacation cruise, her father was injured. She went with him to the on-board medical center and was amazed at what the "floating hospital" had to offer and the level of care her father received. The nurse on duty suggested that, with her background, Vlaardingerbroek might like to give cruise nursing a try. She was sold.

"I applied and was hired in a month," she said. "I started part time to see what it was like, but when the first full-time opening came, I grabbed it. My first full-time assignment was a Mediterranean cruise: 10 days, Lisbon to Rome, 10 days, Rome to Istanbul, then 10 days back."

Suver, whose job includes recruiting and scheduling doctors and nurses, said most nurses start part time. Some keep that status, working as few as 2 weeks every year.

"We've had some part-timers with us for 15-16 years," Suver said. "Their families can come, so they vacation while mom or dad works. It's fun for everyone."

Others, like Vlaardingerbroek, trade in life on dry land for adventure at sea, working 240 days a year in 4 months on, 2 months off shifts. But it's not the glamorous life you see in commercials. Ship nurses are on duty 24/7, and they treat much more than sunburn and the occasional slip on the Lido deck.

"Our nurses wear many hats," Suver said. "They are first responders and do everything, from labs to X-rays to respiratory therapy, in critical care or emergency situations. So they have to be prepared to work in that environment.

"To join our team, a nurse must have at least 4 years of recent ED, CCU, ICU, critical care or transport team experience, a current ACLS and a current American or Canadian license," she continued. "We tried related critical care environments, such as telemetry, but found the normal scope of practice is too narrow. Our physicians are all current ED docs and they only work for us part time."

Nurses see the same things on the ship they would see in a land-based ED, with the exception of motor vehicle accidents, and must respond with fewer resources. Passengers can walk in to see the physician in the medical center from 8 a.m. to 6 p.m., but one of the ship's medical officers is always on call when the medical center is closed. Depending on the size of the ship and number of passengers it carries, each medical center is staffed by one full-time and one or two part-time nurses and one physician. Another full-time physician is on board to care for the nearly 600 crew members.

"People bring their illnesses with them on vacation," Vlaardingerbroek said. "Some times we're called on to manage a lot of high acuity patients. For the Hawaii trips, we usually have a lot of seasick passengers the first 2 days, so we're giving out lots of anti-emetics."

Most patients can be cared for on the ship, though Vlaardingerbroek noted at least five generally disembark for medical reasons on any given voyage. While that usually happens on regularly scheduled stops, as on land, true emergencies happen in their own time.