We keep hearing the mantra "Healthcare is recession proof. It's the one bright spot in a dark economy". Indeed, according to the U.S. Bureau of Labor Statistics (BLS), healthcare employment rose by 32,000 new jobs in December 2008 alone. This breaks down to 14,000 jobs gained in ambulatory services and 12,000 new workers hired in hospitals. In all of 2008, healthcare added 372,000 new jobs. But despite these impressive statistics, the recession is taking its toll on U.S. hospitals and these rosy numbers may in fact bode poorly for travelers. Here are the facts:

• Hospital revenue has decreased. According to a report from the American Hospital Association (AHA), nearly 40 percent of 736 hospitals surveyed reported a drop in admissions. Why? The total number of jobs lost in the recession so far totals a staggering 2.59 million. As the pink slips fly, families are losing vital health coverage and are forced to make tough choices about their family budgets - including postponing needed healthcare. Even if still employed, many workers are finding their insurance coverage is being eroded. Deductables and co-pays are rising. Most of the hospitals surveyed reported the double whammy of declining admissions and an increase in patients unable to pay for their care.
• Investment income has tanked. Like most institutions, hospitals rely on investment income to make ends meet. But the recent fiasco in the stock market has turned endowment income into losses.
• Credit has tightened. The financial meltdown has also increased the cost and availability of borrowed money that hospitals use to finance facility and technology upgrades. Uncertain access to capital has cancelled or postponed many plans for expansion.

The harsh reality is that most travel positions are hospital based and temporary positions are among the first to go when hospitals tighten their belts. Further, although there are no statistics available to quantify this presumption, some of the nursing jobs reflected in the job growth statistics result from travelers and per diem nurses taking full time positions to ride out the recession. This simultaneously adds a job to the upbeat BLS statistics while eliminating a travel position that you could fill.

In addition, many hospitals cut non-clinical jobs when financially pressed. Staff/patient educators, patient liaisons, chart auditors, case managers, discharge planners, utilization review and quality improvement nurses may find they have to take a bedside position to remain employed. New internal registries also account for a significant portion of lost traveler positions at some hospitals. All of these factors together result in the current reduction of temporary job orders we are experiencing. According to the CEO of one major agency, job orders have dropped by around 50% - more in some markets.

Even worse numbers come from HCA, the dominant hospital chain in Florida. Jobs posted to independent agencies have dropped by 90 percent from similar periods two years ago. Medefis, a variant of a prime vendor with exclusive contracts at some 250 hospitals has had job orders drop by around 80 percent since last year.

But it's not all gloom and doom. There are good reasons to expect healthcare travel to rebound in the coming months. Healthcare is less sensitive to the overall health of the economy when compared to many industries. People will continue to experience illness and hospitals will continue to care for them. One way or another, people will return to hospitals and clinics to have their medical needs tended to.

Nurse staffing cuts have already reached or exceeded the limit in many hospitals. Although few states have staffing ratio regulations, there is an inherent limit to the workload nurses can endure. If it is exceeded for any length of time nurses will eventually flee the profession. Hospitals, at least good ones, know this and they will inevitably return to the practice of supplementing their nursing staff with travelers.

And if universal healthcare comes to fruition with the new administration, the number of hospital admissions will immediately increase, at least in the short term, as people address previously neglected health issues. Hospitals will have to scramble to care for the influx of patients and fill staffing shortages with travelers.

Here are some strategies to improve your chances of weathering this storm unscathed.

• First, if you are currently working a contract and you are offered an extension, don't be too quick to say no. A contract in hand is a valuable item right now. 
• Be the consummate professional. In the past the demand for warm bodies to fill empty nursing slots was so acute that hospitals might have overlooked infractions like tardiness or frequent sick calls. If pre-employment tests were not passed with flying colors, educators would try remediation and then re-test the new traveler. Those days are over. With many profiles being submitted for each open travel position, managers will cancel contracts for infractions that previously would have been tolerated. Even minor personality clashes can unexpectedly end your assignment. Do your best to be respected and liked by your co-workers and bite your tongue if you're tempted to whine or complain about minor problems.
• Flexibility is more important than ever. Expand your criteria. Consider taking an assignment even if the job pays a little less than your customary rate or even if the job is not on your customary shift. The law of supply and demand has dropped many bill rates.
• Add a license. Start the process of obtaining at least one new license to add to your portfolio - and give extra consideration to states in which licenses are considered difficult to get. Compact licenses are great if you are lucky enough to have one, but job orders in these states will be filled much more quickly simply due to the larger pool of applicants.
• Go someplace unusual. This recession is the perfect time to broaden your horizons. Look at assignments in places you've never considered before. It's easy to get stuck in a rut. People develop a comfort zone quickly. But every region has something unique and beautiful to offer. Start looking at some of that "fly-over country". Be a real traveler. Look north! According to a recent survey, staffing agencies are reporting stronger demand in the Pacific Northwest and the upper Midwest. There is decreased demand in California, Arizona, Texas and the Southeast - particularly Florida.
• Put your agency under a microscope. It is inevitable that a number of agencies will fail during this recession so it is crucial that you perform due diligence on the financial health of your own agency. If your agency is late on a check, take that as a warning signal. Be prepared to quickly notify your hospital staffing office if you suspect trouble. Hospitals takes such things very seriously and may consider switching you over to another agency to resolve this issue.
• Be aggressive in your job search. Sign up fully with at least three agencies. Six is better. Make certain your agencies have current copies of your licenses. Having all the necessary paperwork completed including drug screens and background checks will make you more attractive to hospitals. Start your job searches earlier than in previous years. Be relentless in following up with any job leads and staying in touch with your recruiters.
• Enhance your marketability. Keep your certifications up to date and consider adding any that will improve your professional credentials. Update your resume and work history. Keep your entire professional profile complete, polished and ready to be sent at a moment's notice.
• And network. Often you hear of open assignments first from colleagues, not agencies. Keep in contact with those you have meet at work and professional events such as the Travelers Conference. Print some business cards and have them with you to hand to healthcare contacts you meet in daily life.
• Lastly, build an emergency fund. If your attention is consumed by an acute financial emergency, it is difficult to make the best decisions. Make a goal of saving thirteen weeks' worth of living expenses as soon as possible. The emergency fund does not have to equal 3 months worth of your income, but just what you need to pay the rent or mortgage, repay debt, buy food and pay your other bills for 3 months.