Agency nurses refusing to work on a certain unit

Noryn · Aug 3, 2007

If it is more than 1 or 2 nurses then I would feel that you may need to start considering it could be a problem with your floor or facility. What do you mean busy but "doable?" Typically in these cases if you have one emergency, fall or something else then your entire shift is ruined.

What you have to consider is that it is the nurse's license on the line, so they should be able to refuse assignments they are not comfortable with.

There are so many variables here, yes the agency nurses could be "lazy" but seeing how it seems to only be one unit, I would get to the bottom of it. Maybe it is the staff? or the workload could be just too much. I would ask these agency nurses what the problems are if you are serious about trying to solve the issue.

vonxojn · Aug 3, 2007

I'm an Agency Nurse. I can see both sides of it because I've now been on both sides. As a floor nurse I can see how you would get upset about the extra help coming in but wants to pick what they can do. Which leaves you with the feeling of why have you here if you don't want to float.

to help out.

As an agency nurse...hospitals and staff nurse that I have dealt with have been known to give the WORST patient load or send you to areas that their own staff don't want to go. It's about safety AND keeping your license. Majority of places only give you a small amount of time to orient and expect you to hit the floor as if you've been there for years.

When I refuse to go to an area.. it's not because I'm lazy or just not feeling like working that unit.. it's Safety and keeping my license for me.

So I can see both sides of it. Don't just assume that the nurses don't want to work that area because of not simply wanting to work hard that day. It could be that the outside can see what the inside don't.

I'm always getting sent to the ER... well ER nursing is far different than floor nursing. This particular hospital thinks TWO days of orienting is sufficient and SAFE for me to learn what most new nurses don't get in 6-8 weeks. Come on...can u really say that's safe or enough of training.

When you injury or harm someone...you can best believe no one will stand in front of the judge at trial but YOU AND UR ATTORNEY. Not the hospital, the charge nurse, the NA's or MD's. JUST U AND UR ATTORNEY.

So yeah I don't have a problem refusing to go to a unit. What's the worse they can do...let me go. OK BUT I'll still have my Nursing License and another job in the mist.

JohnBearPA · Aug 3, 2007

I was an Agency Nurse for a few years, and am still listed as "inactive" at two agencies. I'm staff now, but let me tell you, if these nurses won't go to just one particular unit, there must be a problem with that unit.

When I go into a facility as agency, I usually get the worst assignment, most pt's, least CNA's, and least amount of support from other staff, because "he's making more money, let him figure it out" as to where things are, who pt's that don't have photos or wrist bands are, etc.

At that point, it's MY right to not accept an assignment. It's MY license, and I will protect it at all costs.

You (the OP), DO have the right to refuse an assignment, or ask for a transfer to another floor, or even another facility.

It sounds like you're bashing Agency nurses in your posting, like they're just slave labor to use at your whim, and that's NOT the case. Give the Agency Nurses respect, and they'll give it back to you.

Also, if your facility uses alot of Agency Nurses frequently, the powers-that-be might want to look into why their own staff is calling off so often. Might be a problem there. (gee, ya' think?)

I do my best to be the best nurse I can be, whether it's Agency or Staff, and have been requested by a number of facilities to come back. Most of the Agency Nurses I work with are the same. A few can't cut it in the real world, and believe me, they get weeded out fast, but the majority I've met or worked with were professional, caring nurses that just need or want the flexability that Agency nursing provides.

On another note, if there's a problem in just one unit, and you tell your agency nurses "If you don't want to go back to a facility then don't but if you agree to work at a facility then don't expect to work only on the floors you want to work on."---chances are, they'll walk and not look back. Kinda' cutting off your nose to spite your face if you ask me.

Best of luck with your problem, and sincerely hoping that your staff keeps coming into work so you don't have to work short or call the dreaded "agency".

Happy2CU · Aug 3, 2007

Ditto to what the other posters said. The agency nurses have every right to protect their license if they feel they are being placed into an unsafe situation. I'm a full time dialysis nurse who also works per diem at a LTC facility. I refuse to work the 11-7 shift at the LTC job because their staffing ratio for that shift is one nurse to sixty patients. I won't do it. I don't feel comfortable, don't feel I can provide the level of care that I need to and I refuse to be placed into a potentially unsafe situation. And the facility is okay with that, it's my license, my decision. You said the unit in question is "busy but doable" ~ but, what if something goes wrong?? There must be a reason so many agency nurses are refusing.

Medic/Nurse, BSN, RN · Aug 3, 2007

Oh Now - come on here. You don't REALLY believe that you should be ABLE to force agency nurses to work in a unit of your facility that you can't staff?

"Busy but doable...with alert patients that know...."

I've never done LTC, but when I hear "Busy, but doable...with alert...that know..." The one thing that I do know, for certain, is that my a$$ is gonna get handed to me all shift. And in an "agency" spot - sometimes, I can expect little in the way of help from the core staff (more than a few often have the attitude of well, she's making twice as much as me, so do double the work - ha!ha!)

Some facilities will "dump" on the agency nurses. They do really get the assignments that others DO NOT WANT. (I know that I did! More often than not!) After all, if your core staff are grousing about this unit and you stick your core staff in it - they become less than happy. Yet, you stick your agency nurses in it and they refuse to come back. Wow. 2 bad choices and no solution.

I know that you may not perceive it as FAIR that those nurses can dictate where, what, when - but, that is the big PERK of being agency. When I worked agency, I had a major amount of flexibility - treat me bad on a regular basis (with the worst of the worst - as is often the agency nurse patient assignment) and I would not go back!

==============================

Now, you can make the $$$ argument - and YES I was paid a higher wage. But with this MONEY came NO benefits and NO guaranteed hours. So, to expect that any agency can:

* "tell me what is expected and to stop whining" and

* "that after I agree to work in the facility that I cannot decline to work in any specific unit"

is very unrealistic. I'd just stop working for that agency. That is the best thing about agency is that I am in CONTROL of my practice environment.

==============================

A couple of other things come to mind:

* If a facility does not "like" me for any reason they can just not use me again. Why should I not have the same "right" of refusal as an agency nurse?

* Ask yourself, WHY? As in, if the staffing of this unit is ALWAYS an issue with core staff and agency (to the point that the agency nurses are alerting each other) then is there a valid reason? I suspect that the workload is unrealistic, that you have a core staff attitude issue and/or quite possibly it may just make for a situation that is UNSAFE.

Inquisitive One - here are the bottom-line berries. I realize that you are in a situation that has a difficult staffing situation and it can be challenging, stressful and frustrating. I do understand - I have been there too. And yes, the nursing market is really tight in some locations - so that can add to the problems. I also understand the issues that come with the amount of money (though you never detailed this - I'm guessing) that agency nurses get, and for that you should be able to have some control of them. But, in the interest of helping you solve your problem here is an idea.

Staffing with agency is a BAD long term solution. If it is a short term staffing issue, okay. (Someone on unexpected leave, a new grad orientation class finishing up, etc.) Organizations that have to depend on agency for even minimal staffing needs to do some serious evaluation of their workplaces. I'd start there.

Look at:

* workload

* core staff attitudes toward the agency nurses (I had a couple of support staff make my life miserable at a facility or two, after all WHO was I to ask THEM for ANYTHING. They had attitudes about the fact that I had no standing, that I made so much $$$ that I should earn it in their eyes, etc. I refused to return on THIS issue alone)

* safety

* orientation

Maybe you can find a solution that will make it possible to staff this very unit with your own staff. That would be the best answer.

As to your position on control of the agency nurses. Yep, you are off base on this one. Everyone can decide to work staff or agency. When I work agency, I get to have more control. Is it fair? I guess it really does depend on where you are.

GOOD LUCK!

fergus51 · Aug 3, 2007

It's the benefit of being an agency nurse. It annoys me at times too (especially when I get floated out of my unit when my unit is using an agency nurse), but if it seems like such a great deal to you perhaps you should consider becoming an agency nurse yourself. If you really feel it is a problem, speak to your managers.

JohnBearPA · Aug 3, 2007

It's the benefit of being an agency nurse. It annoys me at times too (especially when I get floated out of my unit when my unit is using an agency nurse), but if it seems like such a great deal to you perhaps you should consider becoming an agency nurse yourself. If you really feel it is a problem, speak to your managers.

On reading some other posts by the OP, I've come to the conclusion that she IS the manager. Hopefully, it's NOT the unit she's responsible for. Sometimes it takes an outsider to see the real issues here, so here's an idea,,,,, ask the AGENCY nurses why they don't want to work there. Also, you can ask the agency manager what reports he's gotten from the nurses assigned there, and believe me, HE knows what they're bit*hing about.

On a side note tho, if you (OP) were the manager assigned to me, and I was an agency nurse, and you treated me with the disrespect you seem to show in your post while I was there, don't doubt for a minute I'd not only never come back there, but I'd let every other agency nurse I know (and we usually know each other pretty well, both from our agency and also other agencies that nurses we've worked with have worked for) EXACTLY what issues I've had with that department, and recomend that they didn't accept an assignment there either.

Good luck, I sincerely hope you get to the bottom of this issue before blasting agency nurses in the future.

Liberty Bellpn · Aug 3, 2007

I've done agency and I think I can see both sides.

But...I think you have to expect this and be prepared to encounter the unknown when you sign up for contract work...isn't the nature of the job to go wherever you're needed and be able to handle the job?

Being on the other side of the fence now, (house staff) the things that make me crazy are nurses who tell you they can't perform certain duties, like IV's. Can't start 'em, won't even attempt it, and can't hang them.Often I've heard "I'm not IV certified"....so my thoughts are then---why would you take a job with those limitations, when IV therapy is routine in most facilities?

I've always tried to be helpful to agency nurses, because I've worked it too. (and there's still the stigma that they're only "in it for the money"), which is unfair... I've worked with many great concientious nurses that I WISH were regular employees!

You know what I find scarey though? I see alot of new grads picking up agency work in LTC/skilled facilities, often working the nightshift where's there's very few resources. I think you need to have experience, great assessment skills and good judgement to handle the work. These positions rely on just YOU--no docs, no "team", limited equipment etc.And we get some unstable, sick patients. So wouldn't it make sense to require x number of yrs experience in the field before signing anybody up?

I know it won't happen since nurses are desperately needed, but it would be much safer practice, wouldn't it?

Inquisitive one · Aug 3, 2007

A little more about this unit. It is the largest unit in the facility with 33 residents but they are mostly the walkie talkie type of resident. There are no gtubes, no vents, no trachs, once in awhile there may be a Level 1 patient, no mechanical lifts, no wounds, 4 CNA's during the day and 3 on evenings, a nurse that helps with treatments and orders along with a nurse manager who is always available. Treatments may involve an ointment and occ. respiratory assessment. Agency nurses are not responsible for any of the extra paperwork like MDS's, monthly summaries, editing etc. We do not abuse agency nurses, they are booked where there is a need because of days off, vacation time or calls offs. We try to maintain consistent staffing with our own staff. Many of the agency nurses that come to the facility have done so for quite some time so there is even some consistency with them. I think the problem arises because the other units are smaller with an average of about 22-25 residents and many of the agency nurses have worked on these units as well so they are aware of the difference in time the med pass takes etc. The residents on this particular unit are more aware of what they should be getting and when they should get it so they may be perceived as being 'demanding'. Our units are organized and staff is friendly and appreciative of the agency nurses that come to the facility. This facility has an excellent reputation. Don't misunderstand me, I'm not bashing agency nurses, most do a wonderful job and are there for the resident. On the other hand, if I worked agency I wouldn't expect to be able to pick the unit I work on or call off because I'm booked on a unit that I don't like or I feel is more work because of the number of residents on the unit but the acuity is basic LTC and the biggest part of the job is the med pass. I do understand canceling if I felt that I was unsafe because of resident acuity or specialization. If I felt I was being taken advantage of then I wouldn't work the facility at all. But I guess that's the flexibility with agency nursing. I've really enjoyed 99% of the agency nurses that I've worked with and I've learned from them because they see how things are done in other facilities and can make suggestions on ways to improve something. We've already weeded out those nurses who aren't at work to work, both staff and agency. On the other hand there are a few nurses form this agency who enjoy this unit but they are not always available. Thanks for your comments and I will continue to assist both staff and agency nurses who work this unit and take suggestions on how to make things better.

heron, ASN, RN · Aug 3, 2007

To the OP ... I want to repeat the suggestion by other posters to ask the nurses or the agency why they are refusing this unit. I have been known to get cynical on the subject of management/corporate "happy talk" ... to hear some managers, their unit/facility/company is heaven on earth! There is another side to that coin ... there is a strong tendency on the part of bedside staff to tell mgt what they want to hear. I do not believe that anyone would willingly cop to dumping on an agency nurse. You need to get both sides of the story ... the truth is probably somewhere in the middle. If no agency nurses are willing to talk to you about what is wrong ... perhaps an unannounced visit to the unit in question on a weekend or night shift can give you an idea about what really goes on.

It may not even be a staff attitude problem ... there may be an issue with a pt or family that agency nurses are just unwilling to deal with. Some of my most difficult or threatening situations have been with "walkie-talkies" with major psycho-social issues.

In either case, many agency nurses may choose to walk away rather than open a can of worms by challenging permanent staff or a paying customer.

You sound like you love your facility and are working very hard to make it a reasonable place to work as well as deliver great care. I hope you can get to the bottom of the problem real soon and move on.

nurse15dc · Aug 3, 2007

What you have to consider is that it is the nurse's license on the line, so they should be able to refuse assignments they are not comfortable with.

The way I see it this is one of the FEW perks of being agency. You can choose to refuse an assignment.

I was staff in on LTC that had 1 unit with 5 extra rooms and 2 to 3 times the number of medicare residents. They could have made the work load more equal but they refused to do it. I worked this heavy unit for 1 yr then quit. Too much liability, and impossible to finish all the charting on time on a regular day...let alone on a day when someone has to be transfered, a res falls etc.