[loricatus]

After reading that whole article, I realized that they have no concept of emergency nursing and really believe that the fall is being pinned on the agency nurse without any real prove that it was the agency nurses fault. If that nurse had an ICU patient, they also may have been dumped on with other ICU patients and up to 8 or 9 total patients. How can you watch all those patients adequately? ICU patients do not get intensive care nursing in most Emergency Rooms; and, this is not the fault of the nurse, it is the fault of management. MDs are notorious for leaving bed rails down, as is ancillary staff. I cannot count the number of times I have seen this.

When an adverse incident occurs, management will try to hang the nurse, whether it is agency or staff. If agency is present, of course, they will hang before a staff member-but, without a doubt, a nurse (and not management) will be the fall guy/gal [no pun intended]. For cases like this is why I have my own malpractice insurance!

[BrokenRNheart]

All very well put by everyone.

Reality. Another nurse goes down for what we all know isn't right. We all know what is needed and we say it. The problem is that the people who say it get fired and if you want your job you keep your mouth shut about the truth and pray that patient injury doesn't happen on your shift and find you alone in litigation. Co-workers can't afford to go down with anyone.

This is about unsafe conditions and being under-staffed. Not about an agency nurse. ER's are widely staffed with agency. The reason why is the problem. It is the same reason for the tone of so many here and all over in nursing.

And, we can vent all we want but we also know there is nothing we can do to change it which is why there is a shortage and nurses with inactive licenses.

I would sell my soul to un-do this and go back and pick another career. I would do anything to have it to do all over again.

I personally can't even begin to pass judgment on the agency nurse when I sat and watched at least 5 nurses hang out at the nurses station for 12 hours straight just socializing. These were regular staff and the manager hung out with them too and call lights were going off non-stop. Half the staff on the floor was float and agency and they were the only ones at the patients' charts and bedsides. I know this isn't always the case, but it is definitely one that anyone out there can relate to.

My guess....this floor needs agency because good nurses didn't want to stay and work their tails off while the people that ran the floor sat around socializing with the manager and doctors.

The floor I left after 3 years? We had hard working nurses. At one time we had hard working techs. The techs got tired of the work and they all left. They were replaced with lazy techs that have no clue what it is like to work in the medical field. They are seen with their feet kicked up relaxing and the nurses are working harder because of it. Some of them are nursing students who are tired from class and don't want to work when they come in. Management was aware but wanted us all to shut up - not complain - and work. Well, I left good nurses behind that are complaining every day. I couldn't take another day of hearing the complaints and knowing nothing was going to be done. I spent nearly 2 years busting my tail working 10 times harder just to see these techs sitting on the computer or hanging out socializing for hours. They left early, I got out late. There are a bunch of great nurses back there but they are unhappy.

[Nurse4years]

Old agency nurse here- gotta give an opinion.
Bad agency nurses usually don't get work. Once you have proved yourself incompetent, facilities may dnr you (do not return), will not book you, or will cancel you before others. And the name of the game is to keep your shift.
You really have to be on top of your game to walk into an unfamiliar place, hit the floor running, perform all duties, and still be able to give a competent report at the end of the shift-
That being said, there has been many changes, including utilizing bad nurses ("warm bodies") and greatly lowered standards of care.
Obviously, lawyers are now attempting to use an agency hook in their lawsuits.

[BrokenRNheart]

Originally Posted by Mschrisco

Old agency nurse here- gotta give an opinion.
Bad agency nurses usually don't get work. Once you have proved yourself incompetent, facilities may dnr you (do not return), will not book you, or will cancel you before others. And the name of the game is to keep your shift.
You really have to be on top of your game to walk into an unfamiliar place, hit the floor running, perform all duties, and still be able to give a competent report at the end of the shift-
That being said, there has been many changes, including utilizing bad nurses ("warm bodies") and greatly lowered standards of care.
Obviously, lawyers are now attempting to use an agency hook in their lawsuits.

Amen. I have worked as both staff and agency and you are absolutely right. It takes a certain kind of nurse that can handle being in a new environment and get the work done. And yes, there are bad agency nurses. But there are definitely BAD staff nurses too.

[psychnurse1998]

Originally Posted by kinghill

Just horrible. What is the solution to prevent this kind of stuff from happening?

http://www.sun-sentinel.com/news/loc...85,print.story

South Florida Sun-Sentinel.com
Lawsuit over man's death puts use of agency nurses in spotlight
Part-timer blamed in death

BY BOB LaMENDOLA
South Florida Sun-Sentinel
March 10, 2008

A patient's death after falling from his bed in a Plantation emergency room has raised questions about a common practice of hospitals hiring outside, fill-in nurses on a regular basis.

Critics of the practice, including nurses' groups and some industry officials, say medical care for patients may suffer when hospitals rely too heavily on short-term, temporary nurses who may not know a facility's system, patients, personnel or building as well as staff nurses.

I have worked agency, and usually you get little orientation. I posted this concern in other thread, most replies seem to indicate this is the norm. I managed to get through 2 assignments without errors, but the structure seemed to be a very high risk for me to make an error. I was lucky to have one govt facilility that offer about 4 days orientation. Even though we were agency nurses, I think we did as well or better than some regular staffers. I do agree the continuity of care, if its good care, from regular staffers, helps reduce the chance for errors. Based on my experience a bill to require a minimum 4 days orientation, would help reduce errors.

[Nurse4years]

Originally Posted by psychnurse1998

I have worked agency, and usually you get little orientation. I posted this concern in other thread, most replies seem to indicate this is the norm. I managed to get through 2 assignments without errors, but the structure seemed to be a very high risk for me to make an error. I was lucky to have one govt facilility that offer about 4 days orientation. Even though we were agency nurses, I think we did as well or better than some regular staffers. I do agree the continuity of care, if its good care, from regular staffers, helps reduce the chance for errors. Based on my experience a bill to require a minimum 4 days orientation, would help reduce errors.

Orientation for what?
How to give meds? Where the dirty utility room is?
No, an true agency nurse can walk in the door, get his/her pyxis/accudose access, get report, and hit the floor running. This is what we do.
I don't need 4 days orientation. I don't need 15 minutes. What for?
Policy and Procedure books are always on the unit, there is almost always a regular staff present, and if not...refer to P&P.
I have worked at facilities will all agency staff. Patients taken care of, all paperwork completed, everyone happy, including Physicians and Administration.
Practice the 5 rules, all the time. That reduces errors. Couldn't tell you how many armbands I have found incorrect, days and weeks after admittance, or how many times I have found meds given incorrectly.
(this is how I got into a habit of writing the dosage I gave beside my initials)
Orientation would drive me up a wall---patients, charts, kardex (computer or pencilled), supply room, pharmacy phone/extentsion number, paging system...all a little different, but basically the same.

[psychnurse1998]

Originally Posted by Mschrisco

Orientation for what?
How to give meds? Where the dirty utility room is?
No, an true agency nurse can walk in the door, get his/her pyxis/accudose access, get report, and hit the floor running. This is what we do.
I don't need 4 days orientation. I don't need 15 minutes. What for?
Policy and Procedure books are always on the unit, there is almost always a regular staff present, and if not...refer to P&P.
I have worked at facilities will all agency staff. Patients taken care of, all paperwork completed, everyone happy, including Physicians and Administration.
Practice the 5 rules, all the time. That reduces errors. Couldn't tell you how many armbands I have found incorrect, days and weeks after admittance, or how many times I have found meds given incorrectly.
(this is how I got into a habit of writing the dosage I gave beside my initials)
Orientation would drive me up a wall---patients, charts, kardex (computer or pencilled), supply room, pharmacy phone/extentsion number, paging system...all a little different, but basically the same.

I dont think agency work is for everybody good thing it works for you, and others. I still dont know what you thought of the article.

[psychnurse1998]

Originally Posted by Mschrisco

Old agency nurse here- gotta give an opinion.
Bad agency nurses usually don't get work. Once you have proved yourself incompetent, facilities may dnr you (do not return), will not book you, or will cancel you before others. And the name of the game is to keep your shift.
You really have to be on top of your game to walk into an unfamiliar place, hit the floor running, perform all duties, and still be able to give a competent report at the end of the shift-
That being said, there has been many changes, including utilizing bad nurses ("warm bodies") and greatly lowered standards of care.
Obviously, lawyers are now attempting to use an agency hook in their lawsuits.

Thanks I hadnt read this post, I see you did post your views on the article. I was unable to correct my other post.

[dzd&cnfsd]

Well said BrokenRNHeart.

[caliotter3]

I worked in a situation where agency nurses were being utilized. Regular staff were quitting due to the poor standards. I was not surprised to observe the lack of cooperation and even outright hostility shown the agency nurses and CNAs. I went out of my way to help these people. The others did not. As far as I was concerned, most of the staff were just cutting their noses off to spite their faces. I really don't know what they think they were accomplishing by running off agency nurses. But it just goes to show one how bad the place was becoming. The agency nurses who refused to come back after one or two shifts were wise to protect their licenses.