Agency Nurses

[Davey Do]

Generally, I have found agency nurses to be more of a liability than an asset.

In the past year, I have written up two agency nurses for hostility, refusing to accept assignments, insubordination, and even patient neglect/abuse. When one agency nurse attempted to apply for a regular full time position, with the encouragement of my colleagues, I wrote a "Letter of Condemnation" to my supervisor and the department head.

When stressed, I often use humor in order to deal with that stress. Here are a few cartoons I made based on actual situations.

However, this past weekend, I worked with and agency nurse who really showed her mettle. I was so impressed in fact, that I dropped an email to the department head with a cc to my supervisor.

Part of the email read like this:

Amy:

I wanted to let you know what a pleasure it is to work with agency nurse Tammy Kay RN.

Tammy is pleasant, outgoing, and ready to learn about and/or lend a hand in patient care responsibilities. Although she had no orientation on the Gero Psych Unit, she gave me a shift report which rivaled a regularly scheduled RN. I look forward to working with her in the weeks to come.

...

Sincerely,

Davey Do RN

"Although she had no orientation on the Gero Psych Unit" was also really a dig at administration for allowing a non-oriented agency nurse to be the evening charge for four hours.

It would be interesting to read others' perspectives on agency nurses.

[Been there,done that, ASN, RN]

If you have found agency nurses to be more of a liability, then your facility needs to use other agencies. Agency nurses are like any other nurse, some are good and some are not.

Agency nurses have to hit the ground running, on a new unit and in a new facility.. with little or no orientation. It's a tough gig.. I did it for years.

Funny coincidence... my first agency job was on a geri-psych unit. I had no specific psych experience. I made it work and they wanted to hire me.

Staff nurses must evaluate each and every agency nurse's performance. Keep up the good work, but cut the good ones a little slack.

[Rose_Queen, BSN, MSN, RN]

I've found that agency staff tend to fit one of two types:

1. Only travel because they probably can't hold down a full time job

2. Are really good at what they do and like to travel

We've had several agency surgical techs in our cardiac ORs over the years. One wowed the team and was asked to stay on permanently (he chose not to- liked to travel too much), some were lackluster, and then there was the one whose contract we had to terminate- she had a habit of throwing out counted items which meant the circulator and any help that could be recruited were digging through 5-6 bags full of bloody trash hunting down whatever it was that was missing. The attitude with this one was also something to behold- it was never her fault she threw away counted items.

We've also seen some agency RNs in the OR and in PACU. Several of the agency nurses in PACU were asked to stay, and two of them did. One is still here.

[quiltynurse56, LPN, LVN]

Yes, we agency nurses have to hit the floor running. There are going to be poor nurses working via an agency. Your facility can ask the agency to not allow them back. Also, it has been noted that the orientation time is often lacking. I am suppose to arrive 2 hours early the first time at a facility. Since I usually work night shift, this is often very minimal though I have worked at some where the orientation was fantastic.

[Rod, Male Nurse]

I have worked with some incredible agency nurses in the acute care setting...but in my opinion those nurses were only about 30% of the agency nurses I have encountered. Several factors play into this. Agencies get paid when their employees work so if they don't have a nurse with the experience to work in a hospital they have to decide to either not get paid or to send a nurse with lack of experience. The agency isn't responsible for your nursing license, the nurses are. So if the nurses are willing to work in a situation like that and risk their license then the agency is ok with it. Many of the agency nurses I worked with only had acute care experience in nursing school or maybe a couple months just out of school. When I worked the floor I dreaded getting report from an agency nurse if I wasn't familiar with them. On the other hand, one of the hospitals I teach at has several agency nurses that pretty much exclusively work at that hospital and get more than full time hours doing so because they are so excellent and the hospital wants to keep them there. I was a travel nurse for a couple years and at times we were referred to as agency nurses because technically we did work for an agency. The difference was that as a travel nurse you interview with the hospital prior to a contract being signed and your experience is under great scrutiny before they hire you. Local staffing agencies don't function that way, many times they are just supplying Nurse, LPN or Nurse, RN to fill a spot.

[Rod, Male Nurse]

I am not a fan of agency nurses only getting an hour or two of subpar orientation. A good nurse can hit the ground running but I feel that even most good nurses need more time to become oriented to the facility. You can be a fantastic nurse but if you have no clue where to find things or what the policies are, you will likely look lost the entire shift.