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Travel Nursing in Big Cities vs Small

October 29, 2014

The variety of living in Los Angeles versus a small Cape Cod town; or San Antonio versus Boston, or Washington state wine country versus Washington D.C. can be intoxicating – our country is so versatile. From big bustling cities to small quaint towns and everything in between; this is why we travel. We get to experience it ALL!

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Size does matter when it comes to availability

Travel Nursing: Big Cities Vs SmallMy husband and I both grew up in very small towns in Missouri. Especially at the beginning of our travel nursing journey, all of the excitement was in experiencing living in large cities for the first time. However, as time has gone on we have ended up with quite the variety of assignments ranging from a 52 bed facility to a 927 bed facility – and everything in between.

I would say that hospitals in almost all (if not all) major US cities use travel nurses quite frequently. There seems to always be travel nurse positions in NYC, LA, San Francisco, Houston, Phoenix, San Diego, Dallas, etc. The facilities in these cities are often large as well and commonly part of a large hospital system with several sister facilities and/or a teaching hospital.

Smaller towns and smaller facilities are also in abundance, but probably more sporadic. For instance, as a traveler at any given time you can say I want a job in Los Angeles and there will be options no doubt. However, if you want something in your hometown of say, Joplin, MO – that can be pretty hit or miss. There are assignments there sometimes, but not on an ongoing basis that you can count on. Plus, when there is a position available it might literally be ONE position, not several. In LA you can typically weed down the assignments based on unit, shift, pay, etc. But in the smaller towns/facilities it’s more of a take what you can get type of scenario.

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Things to be aware of when choosing a smaller facility

The major differences between larger and small cities are pretty obvious. Larger facilities are typically used to seeing lots of travel nurses whereas smaller ones may not get that many. I wouldn’t say that means one is more traveler friendly than the other though, it all depends on the facility and people there. Getting called off is more likely to happen at a smaller facility though, for obvious reasons. They don’t typically take as many or as extreme cases and therefore don’t always stay as full.

The smallest hospital my husband (Skyler) has worked at was in a little beach community on the edge of Cape Cod, MA. The main thing he says was different working there versus many of the other facilities he has worked at was that since they didn’t have much experience working with travelers we had a few issues with them disregarding his contract. Most issues involved scheduling. Their idea of having a traveler was to use him when/wherever they needed him, be it a 4 hour evening shift or a 16 hour shift…yeah, it was nuts! He is used to working 12 hour days, period. So that was an interesting situation, but very atypical. He has worked at other small facilities with zero issues. One small hospital in Washington was probably one of the best to work with schedule wise actually. So again, I think it has much more to do with the facility and manager versus the size of the hospital/city.

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Frequently Asked Questions

Q: Does one pay more than the other?

A: I don’t think there really is a good rule of thumb regarding pay in travel nursing. I feel like it can be all over the place, honestly. However, in general, larger cities/facilities tend to pay more than smaller ones. That being said, sometimes a small town that is undesirable to most, especially if it’s during their bad weather season, can pay more. One thing we have found to be true though is that states where nurses are part of a union do tend to pay travelers more.

Q: Are there certain specialties that are more common for travel nurses in either a big facilities vs smaller facilities?

A: Yes. Highly specialized positions will typically not be offered in smaller towns/facilities (CVICU, NICU, Neuro ICU, etc.). Small hospitals generally can’t support such specialized units. This is probably why we have taken more assignments in large cities (Skyler is a CVICU nurse).

Q: What are the housing differences?

A: Housing in small towns is typically quite a bit cheaper than it is in large cities (although your housing allowance should reflect that). However, smaller towns tend to have fewer housing options. In a large city you will have lots to choose from. But in a smaller town there might not even be an apartment community. You might even have to live in a different town and commute. We have never taken an assignment in a super small town where there were zero options. However in Cape Cod our company rented us a house because there were no apartment communities. It was pretty awesome though actually!

Q: Is there a difference in cost of living?

A: I’m sure there is somewhat, but I don’t feel like it affects a traveler too much if your agency is providing housing. I feel like housing is where cost of living is felt the most, and so if that isn’t an issue we don’t really feel the effects of cost of living too much. It is typically going to cost more to eat out or maybe even to get gas or groceries in a larger city, but for us at least it isn’t so significant to persuade our decision either way.

Know what you want and do your research

The debate of big versus small, when comparing travel nurse positions at least, is a matter of personal preference. Skyler and I tend to prefer the larger cities, or if it’s a smaller town one that is very close to a large city. However, another ex-traveler I know specifically sought out small communities. And to that effect – we almost always choose warm locations, and they almost always chose the mountains. As you are trying to decide what assignment to take, get online and do a little bit of research and/or speak to the nurse manager at the facility about what there is to do in the area, the size of the hospital and unit, the housing market, etc. Get a feel for the area and hospital to help you make your decision on what is right for you.

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By Kelli Leach

Traveling Nurse House

Kelli Leach and her husband Skyler have been traveling since July 2010. Skyler is a CVICU RN and Kelli is a writer. They are from Missouri and had a baby boy in November 2013 so they are now a traveling family of 3! Connect with Kelli on Facebook.