Agency Nursing vs Staff Nursing

prn nurse · Mar 29, 2002

I can't believe I have read this entire thread and no one has mentioned infrastructure. Do you know what it is? Do you know who pays for it? In any debate re: agency vs. staff, ...the infrastructure has to be considered and accounted for. Infrastructure expenses are the reason administration desires agency nurses. The agency nurses do not cost the hospital a dime in infrastructure expenses. These costs run for DECADES for every staff nurse. From the day she signs on until the day she dies and beyond. The CEO KNOWS the agency nurses' sole expense in his budget . There are thousands of infrastructure expenses; what are they? Staff nurse: When you sign on and check the 401K box, WHO do you think is accounting for your withdrawals over the next 20 years? Where_in what building? on which new computer? which clerk is being paid to post it? who is paying the clerk to answer the phone when you call? Who is administering your 401K when you retire? There are thousands of infrastructure expenses. The agency nurse walks in , works, walks out. No bennies to account and affect the bottom line for the next forty years....If you were the CEO, which employee would you want? Think of all the infrastructure expenses you cost your company.....hospitalization insurance..who's tracking that? Do you know how corporations calculate the agency nurses' salary? Agency nurses are paid what staff nurses are paid. All nurses make the same salary. The staff nurse who says, "the agency nurses are making all the money", are not recognizing their own expense to the company. Staff pays for the infrastructure...and should...it benefits them.

Brownms46 · Mar 29, 2002

Originally posted by prn nurse
I can't believe I have read this entire thread and no one has mentioned infrastructure. Do you know what it is? Do you know who pays for it? In any debate re: agency vs. staff, ...the infrastructure has to be considered and accounted for. .

Ummm...a prn nurse...:) I think you miss this post..:) Post #38

Brownie- Yes it would...but I believe they will never do it...as it would kick into profits too much. I mean when you pay a staff nurse...you pay more than just her/his salary for the hrs they do...the hospitals pays more in benefits also...and overtime...as you know there are still not going to be enough nurses who want to go full time!

The other thing is that no matter what...the agencies are there because those in power don't want to pay all those bennies out...they don't have to carry agencies nurses on their payroll...they don't have make sure they who needs to renew their licenses...who needs to renew their cpr...who needs to do the annual recert...or whatever. They are relieved of having to worry about that agency nurse once they leave at the end of the shift....because she/his is the agencies problem. They don't have to worry about work comp either...and dealing that nurses medical bennies...retirement....lord I could go on....but I won't.... :)

:cool:

LaurieCRNP2002, MSN, RN, APRN · Mar 29, 2002

My $.02 worth :chuckle

Like Suzy K, I am working on my master's degree; I will be done in December (yeah!). Last July, I signed on with an agency and am happy to report that for the most part, I have been treated very well--well enough, in fact, that at one facility in particular, I actually look forward to going to work there! I also maintain per diem status at a hospital I have been affiliated with for several years. Although the agency I work for serves this hospital, I watched a friend/coworker resign, return as agency for a few shifts then be told she wasn't going to be allowed to return to that facility, thanks to a couple of mean-spirited managers! So that is why I haven't resigned my per diem position there.

Anyway, I totally agree with Cindy CCRN--hospital administration is not going to truly value us until they are forced to do without us. Imagine if all nurses went agency or became independent contractors! Or better yet, just left! As someone else said, the bigwigs don't care about us,so why should we care if we leave them high and dry? However, most of us won't screw over the bigwigs b/c who would REALLY end up suffering? The PATIENTS! I don't think any of us want to see the patients suffer any more than they already are.

So while the insurance companies, drug companies and high-level hospital execs line their pockets, they are burning out the nursing staff and putting patients in jeopardy. Our health care system is teetering on the brink of disaster; it's become all about the almighty buck. Very sad state of affairs for the greatest democracy on earth.

Laurie

Q. · Mar 30, 2002

Laurie-

I thoroughly enjoyed your post. Thanks so much for the information - it definitely helps.

Good luck with school!

prn nurse · Mar 30, 2002

The infrastructure I was referring to is not someone sitting in your hospital's offices checking to see if your CPR, etc. is current. The infrastructure is in other buildings and cities. Staff nurses and agency nurses make the same salaries. Any staff nurse can add 40% of her hourly salary and that should be what the agency nurse is costing the staff nurses' corporation. The value of the staff nurses' benefits is 40 % of her salary. It has been calculated this way for twenty years , who knows? Maybe longer. That 40 % pays for your benefits and the cost of administering them. We do all make the same salaries in our respective cities. So, IMHO, it is kinda chicken---- to shaft temps with the worst patients.....on the basis they "are making the big bucks". I am always appreciative of them and welcome them and treat them with hospitality and as professional equals. I love my benefits. It is my choice to work on staff. And I am GRATEFUL for a temp, not resentful or envious.

Q. · Mar 31, 2002

Prn Nurse-

As far as infrastructure, do agencies not also provide these types of benefits to their employees? Something is not adding up.

You have a staff nurse, who is making $20 an hour, with all the "infrastructure" expenses you mentioned as well.

You have an agency nurse, who is making $50 an hour, with all the agency's infrastructure expenses. How is it that the agency is able to administer these expenses AND pay the nurse more, but the hospital is not?

Something is not adding up for me here.

imakidnurse · Mar 31, 2002

I believe there is a viewpoint that may not be addressed here in this forum so far, and that is the viewpoint of the nurse manager and or director of the units. I believe that if some of you were put in a position of actually having to staff a unit, you may sing a different song. I am not a manager myself, but I have seen some of what they go through.

The point was mentioned that the agency nurses can pose a safely issue due to the fact that they are not familiar with policies and procedures. That is the falt of the institution. I can't begin to tell you how many times I have walked onto a unit and gotten absolutely no orientation. They only care about a warm body. You are left on you own, often with a very heavy assignment.

Teshiee · Apr 2, 2002

I DON'T KNOW WHY I KEEP GETTING MISQUOTED.

THE TERM "DON'T HATE THE PLAYER HATE THE GAME" MEANS FOR THOSE WHO DON'T UNDERSTAND. DONT GET ILL WILL WITH THE AGENCY NURSE WHO IS THE PLAYER. BUT BE AGITATED TO THE SYSTEM THAT ALLOWS REGISTRY WHICH IS THE GAME!!!!! THAT IS WHY WE HAVE SO MANY PROBLEMS NO ONE IS PAYING ATTENTION TO WHAT PEOPLE ARE WRITING YOU SEE WHAT YOU WANT AND THEN MAKE COMMENTS THAT ARE TOTALLY OFF BASE!

I AGREE WITH SOME THINGS WITH SUSY K AND RESPECT HER OPINION. LIKE ALL OF US WE HAVE DIFFERENT REASONS WHY WE CHOSE REGISTRY OR PREFER TO WORK FULL TIME STAFF WHATEVER THE CHOICE IT IS OUR PROROGATIVE!!!!!!!!!

montroyal · Apr 2, 2002

Originally posted by Susy K

Perhaps you need to read the entire thread before commenting. This was a thread started to give me insight about a debate I am doing.

I DID take control of my nursing career; thank you. I work in a clinic setting now and am in school for my MSN - hence, the project this thread is about. I left the hospital because as a nurse with a mere 4 years experience, I was in charge of a bunch of agency nurses who couldn't do C-sections, couldn't start amnioinfusions and docs were unhappy. I was stressed and so I left. Now another agency nurse is there in my place.

Please don't make assumptions about my state of mind or my degree of happiness. And please read an entire discussion, not just the bits and pieces that you care to, if you are going to comment.
Thanks for your post.

Were the nurses not doing performing these duties because of hospital policies or because they had no knowledge of how to do them. If it was hospital policy, then the hospital is to blame for your situation, not the nurses. If the nurses could not perform these duties because of lack of knowledge, they and the hospital should be held accountable to the board of nursing. I can't believe any state board of nursing would allow nurses to work in a position that they are not able to perform their duties. If a nurse is counted as staff, then they must be able to perform all the duties required by a staff nurse in that postion. If they cannot perform all the duties, they cannot be counted. That why , at all the hospitals I have worked, orienties were not counted on the staff sheet as filling a staff position for the shift.

Kathy8716 · Apr 2, 2002

I've just finished a 3 year!! 'temporary' assignment with a local hospital. I've seen both sides of the agency nursing issue. I believe that agency nursing fills a real need. But more often (at least in the hospital I just left) the agency nursing is needed because of mismanagement of current staff. "Rent a nurses" are very costly to hospitals. If the hospital were to pay their own staff more $/hr, they could have better staff at a lower price to them. They could also increase their own staff @ a higher $/hr. Both of these steps would ease the budget crunch, increase staffing & do a lot to help morale of current staff. I believe that there will always be a place for temp. nurses because of illnesses, leaves & vacations, but from what I've seen, this hospital would rather pay out more $ than actually address the issues & concerns of staff who've already committed to them.

Kathy

bestblondRN · Apr 3, 2002

Our hospital took a good, long look at what was contributing to the enormous vacancy rates on our units. Our agency bill for RN staff for 2001 was almost $4 million (all unbudgeted dollars), and our CNA billing was an additional $1.5 million (again, unbudgeted dollars)--a huge hit for our 330 bed hospital.

The administration realized that this couldn't go on any longer, so they invested $3.5 million dollars and did an across-the-board pay raise for all RNs. First, they brought us up to scale by region (comparing us to all other "city" hospitals, including the unionized ones, in Chicago). Second, they adjusted the pay scale based on years of RN experience in the U.S. For a number of nurses, the increases were upwards of $10,000 a year. Since the first of the year, we have reduced our vacancies significantly, retained nurses who had been looking at moving to agencies as their primary job, and recruited a lot of new nurses. I really half-expected our staffing ratios to be cut in all of this, but the administration is holding true to their word to keep staffing levels as they were (which are very good, comparably speaking). Benefits were also left intact. Yes, we are still using agency nurses, however in far fewer numbers, and really as a bridge until positions are filled and new people are oriented.

I think hospital administrators, being primarily business people, look toward the bottom line way too often. In this case, they realized that they would have to invest money in their staff in order to save or make money, retain nurses, and provide quality care--and their strategy is working, so far.

fadingyouth · Apr 3, 2002

i have been an agency nurse and traveler for some 15 years.

While it is true that we only seem to stop gap the problem and not fix it(hospital staffing shortage), it is the hospitals that need to awaken. In this city staff shortages are often created by the dollar amount. I was recently offerred a full time position for 1/2 of what I earn working agency. As a LVN of 35 years experience that would have given me an increase of $6.50 since I first stepped foot in any hospital. The certifications that I strove to obtain mean little today.

In some areas we are contracted for 8 to 13 week periods and those often continue for a long course--several years for some. Over a period of time we become as knowledgeable as a staff nurse and with most contracts here it is mandated that we accept 5 on-calls a month. We are scheduled by the nurse manager and abide by the protocols and rules set by the hospital.

A few "old-timers" recently discussed this problem and concluded that: 1) hospitals need to learn how to take care of their staff; 2) enticing benefits and bonuses need to be offerred;

3) Pay is an issue in that sometimes a nurse needs the pay right then; and 4) they would like to have some measure of control over their schedule--their life.

As for having "bad, inexperienced nurses" it is not always the trademark of an agency nurse. I have met staff nurses who did assessments w/o the use of a stethoscope, attempted 5 times to start an IV then asked for help, and became mesmerized by the activity on the monitor. Please remember that there is good and bad in all areas--the title or degree means nothing! :rolleyes: