Just how far would you go to make ends meet?
For one nurse, it means traveling 5,200 miles across the Atlantic from Europe to work a NICU gig in San Francisco.
American nurse Courtney El Refai, 31, commutes from Sweden to San Francisco for work, and she told Daily Mail the transatlantic grind is worth it for her $116-an-hour paycheck.
Just one 12-hour shift is enough to cover her monthly rent in Stockholm, where she lives with her Swedish husband Rami, 39, a student, and their two-year-old daughter.
The family moved from the US to Sweden in 2022, but Courtney quickly began to miss her career as a registered nurse. It wasn’t until after she gave birth in January 2023 that the couple began splitting time between the US and Europe.
And following a 19-month return to the US, Courtney secured a role as a NICU nurse at a hospital in the San Francisco Bay Area during the summer of 2024.
She then returned to Sweden in December 2024 and committed to a 5,200-mile and 11-hour journey to work from her home in Stockholm, racking up 30,000 miles and spending $1,500 so far since January.
On a per-diem schedule, Courtney works just four eight-hour shifts every month and can cluster her schedule to allow for a six-week break between work.
But although the travel time and different time zones may seem like an obstacle to acquiring more revenue, Courtney told Daily Mail: ‘To be honest, I’m not struggling with jet lag as much as I thought I would.
‘I earn more part-time as a nurse with travel included than a full-time nurse in Sweden.
‘If I worked one 12-hour shift in California, I can pay for one month’s rent here.
‘Lots of nurses work 12 hours, but our hospital is different. we work eight but have the opportunity to work twelve hours with overtime.’
After taking the 11-hour flight to the States, Courtney rents a room from another nurse for $50-per-night to sleep between shifts and leaves her scrubs and car at the property when in Sweden.
Courtney believes her commute ‘feels sustainable for quite a while’ and has no plans to ‘change anything anytime soon’.
She said: ‘If I work weekends, I get extra, and if I’m training other nurses too, we get paid 25 percent more than normal staff.
‘My work life balance is so much better now, I’m so far away I don’t feel the urge or obligation to pick up extra shifts.
‘It feels like a mini vacation flying away to work because I’m flying away from my obligations at home and can catch up with my friends in the US.
‘The downsides are the time difference; it’s nine hours, and it’s hard to chat to my daughter and be away from my family for 10 days.’
Courtney previously flew a much shorter one-hour flight from Vancouver, Washington, to San Francisco for her current job before moving across the Atlantic.
With up to six weeks off in between her scheduled shifts, Courtney has lots of time to spare, feeling ‘well rested’ and missing her work after six weeks off leaves her ‘restless’.
She is working on obtaining her Swedish citizenship and is learning the language in her free time as well as spending quality time with her little girl.
Courtney pays around $500 for her return flights every time she visits the US and, once she’s paid for her accommodation, says she brings back roughly $5,000 in total after every eight-day stint working in the US.
She said: ‘I pay for the commute myself and I book out at least two flights in advance.
‘Since I’m flexible with when I work, I check the flights first to see what is cheapest and then book them.
‘Those days I’ve booked, I make my monthly schedule fit around them.’
Courtney is often asked why she is not a nurse in Sweden, but she insists there is ‘quite a lengthy approval process’.
She said: ‘I don’t have a license to work as a nurse in Sweden and, to be honest, I’m not quite sure if I’ll pursue that, the pay is quite a drastic difference.
‘In the US, nurses are paid differently; in the San Francisco Bay Area, they have the highest-paid nurses in the country, and we have a nurses’ union, which a lot of other countries don’t have.
‘It feels financially not worth it.
‘From what I’ve looked at it’s the high end of $30 per hour to work as a nurse in Sweden.
‘The cost of living is so different here from the US, especially in San Francisco.
‘Here my rent is $1,350 per month, and in Washington I was paying $2,600, so basically double.
‘I also now have the benefits of living in Sweden, my daughter gets to go to day care almost for free, and healthcare is free.
‘I do have to pay tax in both countries, but we have a double taxation treaty, so I don’t have to pay tax on both monies twice.’