I have a full time job in an ICU, but have started to work a few extra agency shifts here and there for some extra money. I prefer to work ICU on my extra shifts, but occasionally it's not available on the one day that week i can pick up a shift, so i'll take a stepdown unit. My icu experiences are quite varied thus far, from exceptionally cordial, helpful nurses, to cold, passive agressive ones. The nicer ICU's tend to be sure you have a "ok" assignment, while i suspect that the cranky ones give you the bottom of the barrel on purpose. In the stepdown, it's generally been an ok experience, a change in gears for me, being used to 2 patients, vents, gtts, etc; although once i was on a "stepdown" with 6 tele patients which was really sucky.
So anyhow, here's my latest experience: I recently worked on a step down at a hospital i had never before been to; received report on a 4 patient assignment at 11:15 pm and began to make rounds, assess everyone by 11:45. I did not have any computer access, which was a little tricky since that's where the nurses chart all of their i/o's, vs, assessments, etc, and i also did not have access to the medication dispense system. By 1230 I was moving on to patient #3, writing assessment stuff and VS, i/o on my working paper at that point b/c the charge nurse could not find paper flow sheets yet. That's when i found out that i was getting an ER admission. two other nurses on the unit had 4 and 5 patients respectively and the charge nurse had no assignment, as she was precepting an experienced nurse (somewhat new to the hospital), almost done w/ orientation, who had 3 patients. i felt a little overwhelmed, only in the door for a little over an hour, had never worked there before, hadn't even seen all 4 patients, hadn't even seen a flowsheet, and was already getting an admission, for whom i could not even complete the necessary paperwork without a computer code. this drastically differs from other experiences where a nurse has given me one of her patients and taken an admission, rather than giving it to me. like i said, the hospitals are all quite different. The admission turned out to be ok, the ER nurse rocked and held her a little while while I at least checked everyone out and documented some VS, and overall the night was without any lasting scars.
So, what I am wondering is what your experiences have been related to being agency staff (particularly when new to a facility)and receiving admissions. i'm also wondering about experiences with equality in patient ratios, whether or not you feel you get a fair deal, etc. Do you more often feel that people go out of their way to be fair and helpul, want you to have a good experience and come back, or that they view you as the hired hand for the next 8-12 hours, likely never to be seen again and therefore not worthy of concern?
Last edit by yodakelly on Apr 1, '03
Apr 2, '03
When I worked at the hopsital and we used agency we never gave them any admissions. We also gave them the easy patients so they would come back. They also would get breaks whereas alot of times we did not.
Apr 2, '03
It really varies in my experience. I usually do pper diem in a large city floating from facility to facility on a med/surg floor. Those places that treat me worse then their regular staff do not get the good fortune of mycoming back. In general you can write them off as "Not Agency Friendly" and I do just that... I DO NOT GO BACK...
Most places I frequent treet just like their regualr staff. I honestly do not get treated better unless it is say my first time and they know I am new and unfamiliar.
It is up to us as a licensed professional to accept or decline an assignment. YOur assignment worked thanks to your hardwork etc.. It may be necessary "someday" to decline a new admit or assignment because you know it is not safe.
I have declined assignments just like any good nurse would when I know I am in over my head. When a new nurse asks me about Agency work, I always stress this important aspect of good nursing critical thinking of knowing what we can handle and what is safe. I know this is not your question but more for other readers to evaluate.
Right now I am on a short term travel assignment. I had one day of orientation and wham I am on my own "just like everyone else". My bones ache from all the running around. I still do not have computer access or all the tools to work with like the regular
staff and it does make my job harder. To my credit, I am much more flexible then the regular staff and just smile when I hear them fuss about changes and things that would not bother me in the least as a nonemployee.
Apr 2, '03
Where I work we are usually not given admissions but of course help get the new patient settled in. I view my job like this, I figure I can survive 8 or 12 hours of anything, and if it is a horrible unit I just won't go back, it is their loss. I have only done that one time in 3 years, I feared for the patients safety and my license, I told my agency I would never return there, not a problem, didn't miss a day of work. I think there is a higher degree of working satisfaction when you are agency, just take care of the patients, get paid well, take off on all holidays if you choose to, work when and where you want, no mandatory overtime, no hassles. It is truely the best of both worlds.
Apr 2, '03
I would just echo what others said. If they treat you bad don't go back. Was the charge nurse aware it was your first time there? At my regular staff job I try not to give agnecy nurses admissions if they are not familiar with the paperwork since it just means I have to spend more time helping them. Working agency does mean you have to adapt quickly. My advice would be or you to find one of two hospitals you like and stick to them.
Apr 2, '03
I agree with "nurseandmom". You have to adapt quickly to a new place. That's why many don't like agency work. There will be friendly places that you will enjoy and then, there will be the occasional place that treats agency nurses poorly. I have 2 places that I do not go and my agency is aware. As far as admissions go, I want to know, in report, if I have an admission. If I am familiar with the place, I have no real problems; however, if I am new there, I make it known that I want help. So far, there has always been help to get things going smoothly. I will tell you one story that happened to me, last year. I took an evening shift at a place, not realizing that the whole place was full of agency nurses only! Somehow, there was no regular employee there. On top of that, I had 2 surprise admits come in! I couldn't reach the doctors that late in the evening, and I couldn't reach anyone for what specifically needed to be done. I ended up doing an admit note and an assessement only, because I couldn't find the paperwork. It worked out okay though; the agency got a nice report on me. LOL. Anyway, good luck. It's challenging but enjoyable.
Apr 2, '03
We don't give an agency nurse @ our hospital admits for the first few times working .Only after they have worked say 5-6 times on a particular floor do they get an admit.I mean it's kinda silly to give somebody who doesn't know the floor routine/paperwork an admit if you have to actually do it anyway to me..lol..but we do try our best to show the new nurse what all an admission entails so she will feel comfortable taking an admit eventually
We rotate pts so agency gets whichever is luck of the draw...we don't pick on them..h*ll, we are so glad to have HELP
Apr 2, '03
Thanks for replying everyone. You are all echoing the thoughts i was having. I work very
hard and I rarely complain, but I did feel like I was getting a little bit of a raw deal there. No one was mean, actually later in the night they were pretty helpful, but I just felt it was bad delegation of care on the charge nurse's part. She did know it was my first time there, and she put a few orders in the computer for me (b/c i couldn't), but didn't even get out of her chair when my patient arrived on the floor. My plan was to take the assignment, try to handle it, and talk to her if it was unreasonable; fortunately, it turned out to be ok. Like I said, I really don't like to complain, I know I'm the new kid on the block and I like to be viewed as a positive asset to the shift, not a burden. I've had some really good experiences elsewhere, and probably will be more selective in the future as to where I work. That particular night, I wanted the extra $$ and they were the only ones that needed help, so much like you, BadBird, I thought, "no matter how bad it can possibly be, I can do anything for 8 hours." It wasn't even an overall bad experience, just left a bad tast in my mouth. I personally as a charge nurse on my home unit would never give a float or agency nurse an admission or heavy assignment unless I absolutely couldn't avoid it.
It's interesting to me that patient care is essentially the same everywhere. It's often the staff you work with that make the shift a good or bad experience. You'd think in a place where they are willing to pay agency rates for staff, they'd just be happy to have the help; I don't consistently find that though.
Graysonret- I'm glad I haven't come across any situations as bad as the one you described!
Apr 2, '03
Depends on the place. Culture varies from one place to another. I've been dumped on before, but I'll try to avoid places that make that a common practice. If it happens once in a while, I'm ok with that. It's when it becomes an every shift thing that I say hold up and go elsewhere next shift.
Apr 3, '03
I also have my favorite places to go and ones I steer clear of. I always tell my agency I'll try anyplace one...if they dump on me too badly I won't return. And if staff makes comments that are hostile/anti agency it's a DNR for sure...life is too short.
Yes I have been to places that treat you like the hired help for one shift...and give the lion's share of the work to me so they can sit around. They don't see my face again. This is one of the downfalls of agency as it is easy for staff to dump on someone they don't know.