[Mister Chris]

Originally Posted by DallasRN

I just returned to hospital and agency nursing after a long absence. I had worked agency for years off and on - dating back to 1986. As others have said, I've given up guaranteed income and benefits for the "benefits" of agency work.

It seems that one of the major things overlooked in some of these posts re: agency nurses being dumped on is simple patient care and patient safety. I'm not lazy, and in my years I've met few lazy agency nurses. However, the fact remains that an agency nurse, regardless of his/her credentials and abilities, is unable to provide the same quality care as a regular staff member and especially during the first few shifts at a facility. Personally, I would rather be assigned 10 "easy" patients than 5 sicker or more complicated patients. I can handle sick patients once I know a unit - where supplies are located, who to call for what and even where the phone numbers are listed. However, working with your hands tied behind your back compromises patient safety.

I worked a facility last week...first shift...and I was assigned 5 of the sickest patients on the floor. During the shift, I had a discharge and an admission. In this particular facility, the regulars would bite a cyanide capsule before they would offer any assistance. To make matters worse, about two hours before the end of my shift, a patient started going bad with a possible PE. B/P soared to over 200 systolic. Doc ordered stat scans, etc., and the charge nurse was kept well informed. Amazingly, when my relief showed up, she was an agency LVN and another person that had never worked in this particular hospital. I was astounded at the assignment!! To me, this reeked of total lack of regard for quality patient care and patient safety.

Is this fair to the patients? I think not. Quality and safe patient care is supposed to be our primary concern as nurses - agency or staff.

Unfortunately, I don't have a solution, but like someone else said, I do my best to just smile, smile, smile. As they say, never let them see you sweat. The most frustrating thing to me is that after all these years in nursing, nothing has changed. We will never progress as a profession as long as we attempt to destroy our own. That is so sad.

You are so right I have worked agency on and off for many years up to 1999 then went totally self employed - and am still working as an independent registered nurse. The freedom is great as you say, so is the money, and there is plenty of work about at the moment with the nursing shortage we have down-under, but I have moved away from the general hospital now and mainly do night shift at aged care facilities! Many years ago I did fight back when I was "put upon" with unfair work loads, and refused to go back to any of those places that treated me like a skivvy.

Love your answer - smile and dont let them see you sweat or suffer. Stay cool! I did find that very difficult but it was reward in itself.

Keep waving the flag for the agency or independent nurses.
Love loy all.
Mister Chris

[Crumbwannabe]

Originally Posted by Mister Chris

Love your answer - smile and dont let them see you sweat or suffer. Stay cool! I did find that very difficult but it was reward in itself.
:

You know, I finally found out you can't be up front. I believe in honesty, one of my flaws, and have told my agency contacts at some point that I was "not reinstated" due to having recieved a stint of Worker's comp. following a back injury sustained catching a 350 pounder. I still have severe back pain, neuropathy in one leg, and it's getting worse. I have to OD on salicilates on the job, and at home, use some opioid analgesic as directed to sleep and get some comfort. I have a feeling the liver will get me before anything else does. I have talked with too many chronic pain people who self-medicate with whiskey and Tylenol, and I'll be damned if I will compound my problem with alcoholism and go in to work with a hangover. I hate whiskey anyhow, but not on moral grounds.

Unless you have experienced chronic pain, you can't understand that it is always there with no escape, no real peace, and it can be a maddening fact of life. Not bemoaning my fate, just saying that I am inoperable and opioids are always going to show in my pee, so I'd rather be honest before a problem happens. Studies which can be referenced on the net show that a chronic pain patient who is comfortable and knows how to control their pain does a better day's work than a significant proportion of non-chronics. Also, the state BON has no problem with it given that you are not impaired due to abuse.

Mea culpa for bad strategy. No employer wants to hear any of this. Chronic back pain=disqualification from being human, participating in the fulfillment of being productive, making an honest living and staying off the dole. I'd have been better to let the fellow hit the floor with a colonoscope in to the hilt and perf his colon, costing the hospital a nice little sum. But I would do the same thing in the same circumstances if I had it to do over, even knowing what I know now.

Not to mention that no one can legally ask me the state of my health under employment law until a bonafide job offer is made and accepted. And then, ALL applicants have to be subject to the same pre-employment physical requirements. So by volunteering information, I'm shooting myself in the foot and have 3 "do not returns" simply for being up front, all with the justification-'...just not a good fit'. No bad performance or anything, just a judgement call.

You can't be ethical in an amoral world. I sort of know in a much smaller, and much less valiant way how the forgotten soldiers of many of our wars feel. Those who were maimed in protection of others, and lost their humanity as a result. Not to say that I put myself on a par with persons of such courage by any means, but I feel their frustration much more than I did before my accident, and I think I need to learn how to lie well to live with my fellow man.

[Crumbwannabe]

Well, I did it.

After 25 years of specialty, critical care, et.c. I find myself obsolete in the role of a med-surg R.N., which is just about all that is available at the various agencies around here. I have become persona non gratis at a couple of places for failing to know the place inside out on my first day, or find out my back is injured. Compound that with the fact that there's no consistency. It's a completely different pace, philosophy, the whole shot.

Yesterday I had a one on one GI bleed in ICU, kept him alive standing standing on his head in spite of huge volume loss and hypotension. The docs diddled around for 8 hr. on a critical patient preferring to get office done first. The "wallet biopsy" was not favorable, and he was pretty much, as a poor person, an inconvenience in their eyes, apparently, or so their conversations would lead one to believe. Felt good to be in the battlefield again, though.

So anyhow, to hone my skills and organization, I took a job as charge at a long term care. I don't think I am too good to work there, but my talents lie elsewhere, and they didn't inquire as to the state of my back injury. At least one place was honest enough to tell me before I started working.

If you work only critical, you starve in agency. So, I can at least help build up the new hospice, get that going, and maybe that will be a good challenge.

[kadokin]

Originally Posted by coolatta19

Topics like this make me want to quit Nursing school....

I was born with a positive disposition and would like to keep it that way...I annoy my friends and family for seeing the brighter side of things all the time...(I hate stress) and would like to keep it that way...I'm afraid of becoming a bitter, mean, vengeful person...I want to make a difference...I belive in teamwork...that's the only way you'll make the job easier for you and everyone else...Why do some people spend so much generating negativity when they can be constructive and in charge of their own well being? What ever happens, I hope the day I start Nursing, I'm with a wonderul crew such as everyone that has posted on this topic!

I hope you find a wonderful crew just like I did. This is hard work. There will be stress, and lots of it. Just keep repeating your wonderful mantra-I want to make a difference. I believe in team work. Don't beat yourself up if you sometimes feel mean, bitter and vengeful. Nursing needs more people like you! YES!!! teamwork is the key!!
"Whatever you do, work at it with all your heart, as working for the Lord, not for men" Colossians 3:23
Unfortunately, many of the people you work with are tired and quite a bit used up. It is the nature of the beast, as you will soon find out. Give them their due, understand that they have paid theirs(dues) a thousand times over and lead by your example. It really is " the toughest job you'll ever love" and requires immense patience w/your co-workers as well as your clients. As the dean of my nursing school said, "nursing is a privilege", we get closer to our customers and provide them w/a service that no profession in the world can ever equal or imagine. So saying, we still need to fight for our rights and equal compensation, as the general public has no idea what this job entails. Fight the good fight and give the best care.

[kadokin]

Originally Posted by justdeda

it seems i forget the lessons ive learned from the years of working agency: staffing, visiting nurse, private duty, school nurse, office nurse, flu clinic shooter, etc... after a while, i find myself double checking, double thinking, wondering if im doing the right thing, wondering if i shouldnt have become a lawyer, a teacher, an architect...

thats the time that i usually change agencies, or types of nursing im available for, or, if its been a really bad burn, sit at home and not work, until the bills knock at the door, and i go out there again, to smile and be exactly what the job needs, the poster-nurse for whatever agency im with-- until the next burn.

something new for me, i dont know if anyone else has had this experience, but here it is. at a ltc facility ive been doing night supervision for for the past 9 months or so, the staff has suddenly become aggressively uncooperative, actively defiant, and a chilly, chilly atmosphere prevails. no clue as to why this started. after two nights of this, with one date still committed, ive decided to come down with the flu, and let someone else handle the burden. for some reason, leaving before my time is up is as much of a downer as deciding not to return after the commitment is completed, or being asked not to come back after being accused of something i havent done, even tho theres no comfortable way i can face the current staff for even one more horrible night.

the hostile atmosphere mattsmom describes is so prevalent in some units, and so totally absent in others, it makes me wonder what the heck the hospital or facility is doing to their staff to make them the way they are, good or bad. i sure understand your decision not to return, mom, and i sure hope you find something that gives you satisfaction and brings in a paycheck, that doesnt involve the kind of vulnerability that our job seems to require!

hugs

justdeda

although I am not an agency nurse, this situation sounds vaguely familiar from back in the days when I would float from an adult psych unit to an adolescent psych unit. I wonder, are some of the supervisorly personnel not nurses as was the case in my situation? I found this to be a very adversarial situation. And one of the problems was that the non-nursing personnel spent a great deal of time(on the clock , mind you)critiquing performance of nursing personnel. While these very same nurses were runn ing around like the proverbial headless chickens trying to get their work done so as to prevent overtime, the caseworkers and administrators were often found (when not attending to personal matters on company time) SERIOUSLY! gossiping about and critiquing the nurse's performance. Hey! I am just trying to get my meds passed and my assessments done while people w/equal credentials to mine were relaxing and figuring how much better I could do my job. I AM NOT KIDDING! THIS HAPPENED TO ME! Beware of people w/too many degrees and not enough reality. And I am a BSN!

[mattsmom81]

Originally Posted by Crumbwannabe

Well, I did it.

After 25 years of specialty, critical care, et.c. I find myself obsolete in the role of a med-surg R.N., which is just about all that is available at the various agencies around here. I have become persona non gratis at a couple of places for failing to know the place inside out on my first day, or find out my back is injured. Compound that with the fact that there's no consistency. It's a completely different pace, philosophy, the whole shot.

Yesterday I had a one on one GI bleed in ICU, kept him alive standing standing on his head in spite of huge volume loss and hypotension. The docs diddled around for 8 hr. on a critical patient preferring to get office done first. The "wallet biopsy" was not favorable, and he was pretty much, as a poor person, an inconvenience in their eyes, apparently, or so their conversations would lead one to believe. Felt good to be in the battlefield again, though.

So anyhow, to hone my skills and organization, I took a job as charge at a long term care. I don't think I am too good to work there, but my talents lie elsewhere, and they didn't inquire as to the state of my back injury. At least one place was honest enough to tell me before I started working.

If you work only critical, you starve in agency. So, I can at least help build up the new hospice, get that going, and maybe that will be a good challenge.

Good luck to you ...sounds like we've gone through some similar trials in the areas of our own health and our careers. I'm hoping this will be a good change for you and you will find reward in your new position.

[Crumbwannabe]

Originally Posted by Crumbwannabe

Well, I did it.

After 25 years of specialty, critical care, et.c. I find myself obsolete in the role of a med-surg R.N., which is just about all that is available at the various agencies around here. I have become persona non gratis at a couple of places for failing to know the place inside out on my first day, or find out my back is injured. Compound that with the fact that there's no consistency. It's a completely different pace, philosophy, the whole shot.

.

This I love...After 3 weeks I get a call from the ADON (Background, a nursing home closed, so we got like 36 new patients in 3 days) and said something vague about not writing something in the right place, and of course, they needed to be concerned about the state, and it's right to work here and all...blah, blah...however, if I wanted to switch to nights, she could keep me on. I smell caca del Toro. I was the token caucasian.

Back to qagency, hopefully a new position in rehab.

[nurse educate]

Well, I've decided (after numerous phone calls and offers) to scratch the agency thing altogether (before even trying it). As a per-diem, I feel like lately I've been treated pretty crappy, and these are people I know, and have worked with for almost 4 yrs (I used to be staff). I feel like I get the crappiest assignment, because everyone takes the patients they had yesterday (and leaves me with the leftovers- regardless of the acuity). And yes, I said something after this happened. I understand the whole continuity of care thing, but fair is fair. And this I always love- I write down the names of my patients, wait for the nurse to give report. I say to her "do you have pt. xyz?" And she gives me this chuckle (as if to say, ha ha ha!! You're in for a great night). And of course all the other nurses know this, which is why I was assigned to her in the first place!! I know they have this attitude that I am not there all the time, so I should share in their misery. But I'm there enough. I'm not a fly-by-night per-diem (but I'm hoping to be soon!!)

I can only imagne how I'd be treated as an agency nurse, where nobody knows me at all!!!

[mattsmom81]

Isn't it sad how nurses treat each other...the fulltimers take it out on perdiem and agency, the weekday crew dumps on the weekend crew, day shift dumps on night shift...what a gigantic pecking order in healthcare!

And of course docs, administrators, patients and visitors, other departments... all take things out and dump responsibility on nurses. I wonder sometimes if its this bad in other fields.

Nurses are the cat in a 'kick the cat' system.