- I've worked for three agencies at one time (long-term care facilities). I know of one individual who works for five separate agencies (again, long-term care).
- My first rule to the agencies, do not book any shifts without calling me first.
- Second rule: I let the agencies know my availability for the next week or two. Note that I do LTC agency (RN) full time.
- Third rule: I keep a calendar on my clipboard, where I write my shifts and personal appointments (school, md appts, social events, etc.). This calendar goes everywhere with me.
- Fourth rule: Every week, I check my timesheets against paystubs. You will catch payroll errors ... especially for those shifts where you stay late. I book in 15 minute increments ... and yes, I expect to get paid if I am working/have to stay late.
At the end of the year, I use these timesheets to calculate mileage for tax purposes.
- If I get called to a shift, then I let the other agencies (courtesy call) know that I am unavailable for that shift. Sometimes I do forget ... as it can get ultra crazy (busy) out here. Hence, the reason the agencies need to call me prior to booking a shift.
- I carry a binder with each facilities information, policies, names of people, etc. This helps to cut down on the confusion ... especially if you haven't been to a facility in two or three months. Nothing worse than calling the MD, and not having the facility's return phone number, or not knowing how to transfer calls, etc.
Every facility is different with respect to RN responsibilities. Some places, I do the med pass (this can even vary by shift or floor within the same facility). Some places, I do Medicare charting, and the 2am chart checks. Other places don't want agency nurses doing Medicare charting or 2am chart checks (as it's the LPNs responsibility).
- Been doing this as an LPN for 4 years and as an RN for 8 months. Some places are hell-holes (so you don't book them -- or try not to book them) ... other places are total dreams.
Some places book you a month in advance and never cancel. Other places book you 5 minutes before the schedule starts. Yes, we do get cancelled ... it happens.
- I'd say the biggest drawback/hangup is walking into a facility and being expected to do a fresh admission. Unfortunately, there are no standards in LTC ... and each facility has its own policies/forms. Basically, I will do a skin assessment, MD orders (MAR/TAR), vitals, get the diet order and let the kitchen know, med list, call family (POA), call MD, fax orders to pharmacy, write a nurse's note, possibly order/complete lab sheets, and put on 24 hour report. Major time killer ... especially if person is sick or has stage 3 or stage 4 pressure ulcers. Even worse, if you are in the middle of a heavy med pass.
- Bottom line ... it's a decent way to make a living. Just expect crazy hours and last minute phone calls.
- Essentially, your job as an LTC agency nurse is, "keep 'em alive until the next shift."
- Sorry for the long rant ... but hope this helps.