Agencies... How do they staff?

caliotter3 · Mar 4, 2012

In almost two decades of working in home health, I have never worked for an agency who staffed the way you describe. Every agency that I have been associated with, placed 'permanent' nurses according to the needs of the client and the nurse's need for work. Hit and miss, daily sporadic staffing, seems to me to be too much work to create a lot of chaos and discontent. I would have a serious talk with your DPCS or business manager concerning this. Point out to them how much complaining you have been hearing from the clients. I can't understand how they don't already know this.

Merlyn · Mar 4, 2012

Ive worked for agencies for about 30 years. Some keep the same nurses at one place. Some just have a list that they go down.

If a nurse can make it to a job, fine if they can't they go to the next name on the list. I have also worked with agencies that "Ghost Scheduled" They would call you up around Six in the morning tell you such and such has a need. They bet that such and such has a need. If they do fine. If they don'[t you don't work that day

ventmommy · Mar 4, 2012

The agency we used (we only used one agency over the years) never did it like that. We had 8 nurses oriented but really only used about 6 to cover 14 shifts per week. We had very consistent M-Th day and night nurses. The weekends were mostly nurses that only worked every other weekend. I could not have handled a revolving door like that. It's not fair to the nurse, the patient or the family.

allnurses Guide · Mar 4, 2012

My experience has been pretty much like the above. I do believe the overall quality of the nursing care is better when the client and nurse get to know the routine. The thing about private duty patients I've noticed is their very specific needs and ways to go about the common issues like feedings and respiratory care specific to that patient/family. It takes a long time in some cases to get that down well.

I'm recalling a particular adult with MD who could eat po but there was a real art to it. There were many times this person cried tears of frustration over "having food shoved in my mouth" - sometimes there is difficulty in understanding speech that is compromised by trach/vent etc - you can get attuned to that in time. I wonder what the reasoning is behind your agency's MO with this.

realnursealso/LPN, LPN · Mar 5, 2012

I've been doing peds homecare for alot of years. Any agency I've worked for wanted consistant staff for cases. The families we deal with would never stand for your agencies idea of staffing. I work days and go to the same case x amount of days a week. Maybe you should look for another agency who staffs cases the usual way.

SDALPN · Mar 5, 2012

I've seen similar with crappy agencies. They do it for a few reasons. The way around it is if you find a case you like, just let the families know how important consistancy is. Some of the reasons they do it are:

1. Agencies hire nurses even when they don't have work for the nurse. So if they get a shift open or don't have consistent nurses on a case they can lead the new nurse on by telling them they have work that could increase to full time hours (but never does). It benefits the agency because they think they will always have nurses if a new case comes or a shift needs coverage. Plus they won't have to pay OT if they have more nurses than work. I had one even cancel a nurse if a new nurse coming on complained and wanted hours. They would cancel a reg shift on a nurse and let the new nurse work a shift or 2 to make them think work was coming.

2. I worked a case where the mother was extremely manipulative with her nurses. So the agency realized that if the nurses only worked a shift or 2 a week that the nurses would last longer. The agency didn't always tell the nurses this. Usually the nurses found out on their own. I was lucky and a scheduler told me what she was doing and why....made it easier to understand what was going on and handle it better.

3. Some agencies want a nurse that can float to multiple cases as needed. Usually cases that have a high number of call outs and usually because they are undesireable cases. I love floating because it keeps my skills up and gives me variety. But I will admit its not best for peds because consistency is better. Even worse when I'm the only nurse the child trusts and there is no way I can work the case F/T. I've had that happen twice.

4. Another reason is overtime. If you and a few others can work multiple cases they can use you like a pawn in a chess game to move nurses around so another nurse doesn't get overtime.

5. Speaking of pawns in a chess game....Lets say nurse A can't work at case 1 but can work case 2 and 3. Nurse B can work all the cases. Nurse C can work case 1 and 2. One of the nurses calls out and the agency has to move nurses around based on the cases they can work. So all the cases will get covered but they will have to move nurses around to make it happen. Its easier to move the nurses around if they are oriented to the case. Nurses get kicked off cases all the time and that adds a challenge to the scheduler. I hope that one makes sense...its kind of confusing but it is done all the time. I've been called many times because a nurse calls out and another nurse who can cover the call out has been kicked off the case but can work the case I'm scheduled on. So they move me to the call out case and put another nurse on my scheduled case.

I'm sure I can think of other reasons and experiences later. If the family expresses they are unhappy. Tell them to talk to the agency about it. The agency would expect you to do this. If its not resolved after that you can hint around that if they threaten to go to another agency that the agency will panic and do whatever the parent wants for scheduling not to lose the case. If the family is still not happy, its time to find another agency. Agency culture is odd and difficult to learn. I can't say I've worked for one yet that has been 100% honest and/or cared about their nurses. But without us, the agency wouldn't make it. The agencies forget that so easily!!