Agency Nursing vs Staff Nursing

Brownms46 · Mar 26, 2002

Originally posted by Susy K
Very good posts I must say. Let me address a few points:

Brownie, yes I myself am guilty of the giving the most difficult pt to the agency nurse. Why? Well, I am tired, I have been in charge, and she is costing our unit $40/hour so yeah, she is gonna work! I can't cancel the agency person and put her on call, like my regular staff, so I either have to take her now, and pay her hefty price, or not take her, and potentially leave my staff up a creek or have to mandate someone overtime.

But Susy K

Was it the agency nurses fault that she was needed and responded to the request for addtional help? Your hospital did call her agency right...and your hospital did decide they were willing to pay of her services...correct?? You say..."yes she is gonna work"...but assigning her pts. that are the most difficult..are you not making things worse by not assigning pts appropriately....and giving weight to the fact that she may not be the best one to care for a more difficult pts??? I see this being a problem many times for a hospital and it's staff...as when an agency is treated in the above manner...then they decide not to return to a certain hospital because of these practices.

I once went to a hospital that also made this a practice...for one of the most miserable shifts I have had to endure. So when my agency asked one nite...after my repeatedly turning down this hospital for assignment....I finally told her..after she asked me..."how much would it take for you to go there tonite"" I told her they didn't have enough money for me to go back. Would you prefer...that no agency nurse would want to return to keep your staff from being short-handed??

I must say that some months later I did go back...and found a much better attitude from the staff at this hospital. Why?? Because I was not the only agency nurse who wouldn't respond to their calls for help.

I agree with Teshiee here also. I have and many, many agency nurses have had to deal with the attitudes of staff members who resented our making more money. I have always never understood the rational for why this was. One nurse even cussed out another agency nurse on an elevator one day....and told her SHE was the reason they hadn't received any raises. But she wasn't the reason...the fact that this was a rural hospital ...in a located not very desirable for young grads to stay around was the problem...there was nothing there to attract anyone...except maybe retirees. I have always felt...if you don't like the agency nurses coming to your hospital...then do the overtime...or do some recruiting for your hospital. Don't tell others how bad it is where you work...because that surely isn't going to induce them to come work there. Volunteer to go talk to grads...be nice to students...and work on recuritment while they're on your floor. Many times this is why a new grad will chose a hospital....because they feel they will treated well...and someone will help them learn...in their days fresh out of school...and NOT make them feel worse then already do about their skills....by not wanting to be bothered to answer the questions.

Yes...agency nurses are a short term solution...to a very big problem in this country. But don't forget ...there are MANY travel and agency nurses...that have been enticed to come on board with a hospital...just because of how well the staff treated them...when they came to give their help...:)

stepping down off soap box...now...whew..yeah I know long winded brownie...:chuckle

Q. · Mar 26, 2002

Well let me clarify about my assignments here.

Let's say I had a full post-partum unit, and a rule out labor patient, a pre-term labor patient and an overnight induction. I have regular staff who enjoy PP, so I would put them there as a break from a week of HELL in labor. I have a couple other regular staff members who I would put one for an open admission and she can do competencies or what-have you and the agency nurse could take the pre-termer. More running around, more acuity, but manageable. I let my regular staff do OTHER things that the agency can't do (like competencies, while waiting for an admit) and let the agency work.

Pretty much I let people pick their assignments anyway, I am not some dictator. I MAY force a person into a labor patient if I feel that they are hiding out too much in PP, to keep them competent, and usually the agency nurse doesn't speak up and takes what's left. Some regular staff ENJOY pre-termers, even though it's more work and higher acuity. Sometimes I want my 12 hour night person to take the overnight induction as that makes more sense, and that's what she wants to.

Bottom line, I let my regular staff pick first, agency gets what's left.

Brownms46 · Mar 26, 2002

Originally posted by Susy K
Well let me clarify about my assignments here.

Let's say I had a full post-partum unit, and a rule out labor patient, a pre-term labor patient and an overnight induction. I have regular staff who enjoy PP, so I would put them there as a break from a week of HELL in labor. I have a couple other regular staff members who I would put one for an open admission and she can do competencies or what-have you and the agency nurse could take the pre-termer. More running around, more acuity, but manageable. I let my regular staff do OTHER things that the agency can't do (like competencies, while waiting for an admit) and let the agency work.

Pretty much I let people pick their assignments anyway, I am not some dictator. I MAY force a person into a labor patient if I feel that they are hiding out too much in PP, to keep them competent, and usually the agency nurse doesn't speak up and takes what's left. Some regular staff ENJOY pre-termers, even though it's more work and higher acuity. Sometimes I want my 12 hour night person to take the overnight induction as that makes more sense, and that's what she wants to.

Bottom line, I let my regular staff pick first, agency gets what's left.

Ok...with that clarification...I concur! I also feel that staff should be able to have first pick...as long as the pts...are not hand picked by the staff as the worse ones on the unit. This I don't feel is condusve to being in the best interest of the pts. What I mean by that is...selecting all the turns..heavy drgs pts...with all the IVPBs...and spliting the rooms to acheive this point.

I have had to deal with being in an CC unit....and being given pts. with so many lines...that I had to tag them...and being given pts who required hemodynamic monitoring.. with q 4 COs..and incont to boot. But in this case I said nothing...because I was able to do it safely and in time...I stopped being given those pts...as I soon became treated just like staff. I allowed this to happen because it kept me competent also. But I saw this done to another nurse who had signed on for one of the bonuses this hospital was offering...and guess what...she resigned and gave them their bonus back!

But what you have described...I could live with that...with no problem...as I like to keep busy...:)

:cool:

Stargazer · Mar 26, 2002

So logic tells me...if these things existed in the hospital for staff nurses, agency would soon be obsolete, or, used more appropriately.

Susy: Bingo.

My unit was NEVER short-staffed back in the days when the hospital had its own "in-house agency." Regular staff nurses could sign up to be on call for 4-hour blocks (at time-and-a-half for up to 12 hours/shift or 40 hours/week, and double time after that).

Shifts were adequately staffed, everyone who wanted to make extra money was doing so, the "agency" nurses didn't need one single second of orientation--in fact, it often resulted in better continuity of care for their primary patients--and morale was great.

Then the hospital decided that the in-house agency was too expensive, and eliminated it. And tried to solve the subsequent (VERY!) short-staffing with mandatory OT. I cut back to from 1.0 FTE to per diem shortly thereafter. As much as 2 years later, when I came back to do some shifts, they were spending a fortune on outside agency nurses and travellers, and were STILL chronically short-staffed. As far as I know, now 7 years after THAT, they're still having staffing problems.

Apparently none of the geniuses with MBAs in hospital administration can add 2 + 2. Can you say, "Penny smart, dollar stupid"? :rolleyes:

SharonH, RN · Mar 26, 2002

Suzy, I assume you mean "for or against" from the hospital's POV?(as opposed to the nurses' POV).

#1: First, let me address the cost issue. In addition to their regular salaries, staff nurses cost quite a good deal of money:recruitment(sign-on bonuses, advertising), orientation(up to 8 weeks depending on the institution, benefits(holidays, sick leave, vacation), insurance(this is very expensive for the employers), and employment taxes. When you add that all up, not only are the employers' costs NOT significantly higher, they are probably about equal, maybe even less in some cases.

#2: Hours. Although it is rare that you have more than enough staff, occasionally the moons do line up and the census drops. You have to pay full-time employees their hours whether you need them or not. Agency personnel, not so.

#3: Paperwork. Agency personnel are responsible for meeting their own educational, professional and orientation requirements leading to less paperwork and record-keeping for the hospital.

That is all I can think of for now.

myst · Mar 26, 2002

Dear Susy K,

You ask alot of very good questions but you over looked the obvious.

First and most importantly of all, agency nurses are a write off, financially speaking, for the facility. So, they can deduct the cost of an agency nurse where as a full time employee really costs them more.

Think about it.

Also, it should be up to the agency who "owns" the nurse to make sure her skills match the needs of the client. If not, then the facility using her better do it or they're assuming a pretty big liability,

besides the obvious fact that she'll get an assignment that won't challenge her/his talents.

Lastly, I must confess that I worked agency when I was an LPN going back to college for my RN. I worked agency because of the MUCH better pay($21.00/Hr.) vs. working in facility for $12.00, and the scheduling flexibility really worked well for me. Here in Florida we do not nessessarily get time and a half for overtime, and unions are forbidden (essentially), so you have to make decent money where you can, how ever you can.

I'm sure these are many of the reasons many nurses have left facilities and chosen to work agency. If I was younger and didn't have my souvenier herniated disc's, I'd be back in agency myself!

Myst:roll

Brownms46 · Mar 26, 2002

Originally posted by myst
Dear Susy K,

Also, it should be up to the agency who "owns" the nurse to make sure her skills match the needs of the client. If not, then the facility using her better do it or they're assuming a pretty big liability,
besides the obvious fact that she'll get an assignment that won't challenge her/his talents.

Myst:roll

You absolutely correct myst! It is the agencies responsibility to make sure the nurses skills match the needs of the client...but sadly I must say that doesn't always happen. Most of the agencies I have worked for give tests...for each area the agency nurses wishes to work in. And I have seen some nurses shy away from these agencies...not because they can't pass the test...but because many have test anxiety.

But there are agenices out there that are not so....well responsible. And the hospitals at times will be unforutante enough to get nurses who accept assignments they shouldn't...because they want to work...and feel they shy by for 8hrs.

Yeah...I know I'm not making this look good for agency...seeing as I'm agency also...and have been since getting one year experience But ..this does happen. On the other hand...without the agency I don't feel I could have worked as a single mom with a daughter which a disability....that requred trained sitters who could take care of a very young child with a trach. A child who went back and forth for bronchs q 4-6 weeks...and ended up in ICU...many times over a two year period. Or with children period...who get sick on a regular basis...or because I wanted to send my children to private schools. I mean we all do what we must to survive.. :cool:

Q. · Mar 26, 2002

Originally posted by myst
Dear Susy K,

You ask alot of very good questions but you over looked the obvious.
First and most importantly of all, agency nurses are a write off, financially speaking, for the facility. So, they can deduct the cost of an agency nurse where as a full time employee really costs them more.
Think about it.

I guess I must ask you to elaborate on this concept. Not to mention, this seems to prove that the use of agency is certainly not in the best interest of the nurses themselves!

I realize a regular nurse may cost more in the long run, however, bottom line is, as a per diem nurse myself, without benefits, I STILL am not paid what an agency nurse is at the same hospital, same unit.

Sharon, I was speaking from a nurse's POV, not the hospital's. Alot of nurses feel that agency use is a widespread problem. Some hospitals in my area have even advertised that they will NOT use agency as much as they have in order to attract more regular staff.

luvrn · Mar 26, 2002

To me giving an agency nurse the worse patients on the floor, tells me the needs and concerns of the patients aren't taken into consideration. We are all here to do a job and do it as safely as we can. Giving one nurse all the hard/confused/ect patients just doesn't give the patients the best care THEY deserve. Also just another way to have less help is you treat the agency nurse bad.

mattsmom81 · Mar 26, 2002

Originally posted by Teshiee

I work registry and have a parttime job! I love the lack of political mess that goes with being full time. My parttime job allows me to keep up with my skills and have a more flexible schedule to work more days if I wish. Everyone has different reasons why they do agency nursing! And everyone has the same opportunity to do it ! For those who oppose registry I say get over it. Until the powers that be make nursing staff ratios a priority with decent working conditions agencies are here to stay.

Agree wholeheartedly Teshiee!

I have done staff and also supplement agency for some extra $$$, variety and independence!

I've had to threaten to quit unless my home facility called in agency numerous times...they prefer to save a buck and work me 'unsafe'.....thank God there are agency nurses or we would NOT have anybody at all in a pinch!! Staff is burned out, exhausted on OT and have to say no sometimes......

Teshiee · Mar 26, 2002

Susy K

Like I said before don't hate the nurse hate the system that allows it to occur. See I get the feeling you resent agencies and you have made some valid points but to take it out on registry nurses is not going to make the it all go away. I never said registry was a solution it is not the nurses fault that these hospitals uses them inappropriately. I am human when someone sends me to the hospital to make 38$ an hour plus overtime I don't expect to get over but I do expect to be treated fairly because like you I am a nurse first who want decent working conditions but because they arent I have to do what is best for me!

Brownie I sware you feel what I am saying I have worked in one NICU as registry for one year because their staffing was so bad. They would float out their regular to keep us there. Now I agree that is not fair but it is not my fight. I come to do my job and be the best at it. I was working with one NICU that slammed me to death they made sure I got the worse of the worse which is okay sometimes because we have our days when we have a good assignment and a nutty one so I roll with it. But when you notice a pattern I simply don't go back. I get sick of hearing them bicker, complain and moan. When the manager has a meeting not one of them speak and make valid points. I just take care of my patients go to my resource nurse when a problem arises and go home. I work registry at different facilities in my area I am flexible like that but that is just me.

Q. · Mar 26, 2002

Originally posted by Teshiee
Susy K

Like I said before don't hate the nurse hate the system that allows it to occur. See I get the feeling you resent agencies and you have made some valid points but to take it out on registry nurses is not going to make the it all go away.

Let's try to keep this in perspective. This is a debate for my class, and I chose the con side because it was my knee-jerk opinion on the subject. I really had no opinion but was leaning towards NOT approving of agency use, so, that was the argument my team and I chose. Heck, one of my teammates is an agency nurse herself! She thinks this will be a good learning experience for her.

I have seen both sides; I have been able to go home because of an agency nurse, and have been left out to dry because of an agency nurse (ie: she couldn't do a crash C-section) and I see that the hospitals are trying to cut costs, yet, insist on paying these nurses rather than their regular staff of >5 years! To hell with retention! Well NO, that is not the answer. We need to improve things to make those 2.2 million nurses return to work, not put a bandaid on the problem with agency nurses.