And with regard to the shortage of critical care providers, the sky is not the limit.

Air Ambulance Care Flight International Inc. in Clearwater struggles to find enough qualified doctors and nurses to staff its five Lear jets on trips to Canada, the Caribbean, South America and Europe, said Dr. Kenneth Kreye, president.

The fixed-wing air ambulance company advertises in medical association newsletters seeking doctors and nurses with experience in emergency rooms, intensive care units or critical care.

"It's hard to find the quality we need," he said.

Stringent demands face flight nurses. The nurses need critical care experience with training in cardiac, trauma, pediatrics, surgery and flight physiology, said Diana Burgess, chief flight nurse.

Burgess -- a registered nurse, a critical care registered nurse and a certified flight registered nurse -- recruits only those with five years of critical care experience, advanced cardiac life support training and prefers other CCRNs.

"That narrows the playing field way down," she said. "Plus, they have to be willing to fly all over the world. They have to be spontaneous."

Many nurses strive to work in such specialized environments, matching their skills with demanding jobs, said Cathy Allman, vice president of the Florida Hospital Association's Center for Nursing. When a company such as Care Flight encounters difficulty filling those positions, it's a strong indication that the shortages have affected almost every aspect of the industry, she said.

"This just shows the state that we're in," she said. "There's a shortage nationally and internationally. In my opinion, when such a specialized, prestigious area is having trouble that says everyone is having trouble."

Hospitals have a more urgent need for critical care nurses than Care Flight because nurses seek flight careers, said Burgess.

"Nurses are kind of drawn to it," Burgess said. "It's another career avenue for nurses with high-level critical care skills."

Many nurses with honed critical care skills work in a mobile environment without hospital-based resources because they consider them exciting and challenging positions, Allman said.

"Nurses with those skills gravitate to those areas," Allman said. "In times without a shortage, there's usually a waiting list."

But now, hospitals are so desperate, they're willing to pay more to keep nurses who'll work overtime. That makes recruiting more difficult for companies like Care Flight, which typically pays $200 to $250 per diem on a contract basis.

Burgess would like to double her roster of 20 to 25 nurses available for flights within a two-hour window. If all five Lear jets are called into duty, she may not be able to form a crew for each flight.

"If we have three to five flights out, I can eat through that list pretty quickly," she said. "I haven't had to give up a flight yet because I couldn't find a nurse. But it could reach that point. Turning away business doesn't go over well."

The flight nurses must live within an hour or two of the St. Petersburg-Clearwater International Airport. Her roster includes nurses in Sarasota and Hillsborough counties, but most live in Pinellas County, she said.