Agency Nursing vs Staff Nursing

Brownms46 · Mar 25, 2002

My question would be Susy k...is in this climate of a nursing "shortage"....how you do propose to agrue about using agency nurses? I mean look at NYS...they 'say" they're in a crisis situation with unfilled positons on a sharp rise...and hospitals are advertising nationwide, and in some cases worldwide to fill those positions. I seen some hospitals with the same open positions for years. I also know that these same positions are being filled by travel nurses and agency for sometimes up to at least 2yrs.

The hospital I'm going to now...has had to have another sister hospital send volunteers from another town to help out during their servere shortages.....when they couldn't get enough agency nurses.

Now nurses have said they don't wish to be mandated or constantly hounded to do overtime...that they want to have a life with their families...so how can cutting out agency staffing hospital be accomplished at this time??

Thanks you for your response in advance... :cool:

Q. · Mar 25, 2002

Hi Brownie,

Thanks for the response. Let me give you some background info that might help to frame where the debate is coming from.

The cons of using agency nurses have been identified as the following:

1. Increase cost (some sources have cited that the use of an agency nurse with the same skill as a staff nurse, costs the hospital an additional 10-12% more) Staff nurses argue that if those monies were applied to retention or increased salaries, holes would not exist as much, agency would not be needed and would not cost the hospital and the actual employees could see that money.

2. Safety. It has been documented that agency nurses are not as familiar with procedures and skills, thus compromising patient safety. Some agency nurses get an "orientation" 1 hour before they actually start working. Some agency nurses (like on my floor) do not circulate for C-sections because they cannot keep up competency, therefore, the regular staff will have to assume her patient. Some agency nurses do not know proper procedures for codes or even where the fire extinguisher is located. Other arguments have been that at times, agency nurses may work other jobs or shifts, and the floor has no way of knowing where they came from, meanwhile, the agency nurse is going on her 16th hour.

3. Bandaid approach. Another argument is that the use of agency does not do anything to solve the problem of MOT and vacancies. In fact, some argue that agency feeds the problem. Staff nurses see their colleagues quitting, going agency, and then in alot of cases returning to that very same unit as a agency nurse, now making 3x what their colleagues make, doing less in some cases as an agency nurse is not in charge, is immune from certain patients/procedures, etc.

Now mind you, these are not my personal opinions. These are issues that have been documented, studied, and supported with hard data.

Brownms46 · Mar 25, 2002

Oh believe me...I agree with every point you have made...as each are very valid agruements, and very true in many instances!

In fact I know that agencies cost a much more then just the amount paid to an agency nurse as agencies charge sometimes 20% over and above what they pay out in salary to us.

But I would like to know...how do you feel ...it could be accomplished for a hospital to do away with agency nursing in the present of a increasing shortage of available nurses to fill the holes?

:cool:

Q. · Mar 25, 2002

I do believe that if the hospitals would apply that money to retention or staff salaries, allow more flexibility in scheduling, that agency could be eliminated.

It's my contention that there isn't a shortage of nurses. There's a shortage of nurses willing to work due to those reasons above.

For example, if I am going to work, I might as well work in a clinic setting rather than working next to a nurse at the hospital who is making 3X what I am, is inexperienced, and I am in charge and I just had to take over her abruption because she doesn't know our OR. So now the floor just lost ANOTHER full time staff member: me. And now there is another hole to fill with probably another agency person.

I do agree with the use of agency or travelers in certain situations: like when we had 3 full-timers out for maternity leave at the same time, etc etc. But I do not think I agree with using agency to regularly staff the floors to compensate for nurses leaving in droves because the pay stinks.

Teshiee · Mar 25, 2002

The reality of the situation is simple! NURSING SHORTAGE! I don't understand why nurses get pissed off at registry! I agree there are some nurses who are not really experienced in certain areas and cannot do what a regular staffer do. Yet, a regular staff nurse resents an agency nurse for making more money. For that I say, don't hate the player hate the game! I understand some hospitals are resorting to contract nursing in which they do a certain amount of weeks in that area. The good thing with that they can now be proficient in areas they werent before. You have to understand that registry concept was to be a fill in. Now because of the shortage they are used more than ever and unfortunately you don't get the same nurse everytime to be able let them become familiar with settings full time reguar staff nurse are use to. In house registry is getting popular as well to keep more of their staff inside. I can't be mad at anyone who wants to make good money! I don't know any nurse who doesn't work registry or have a second job!

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.

Brownms46 · Mar 25, 2002

I agree with you...as I have seen the disparity in agency nurses willingness to be accountable for the 8 or so hours they're on the units they staff. I seen agency nurses who have to be sent home...because they shouldn't have been there in the first place...ie no expereince on the unit they accepted to work on...and not even recent acute care experience. I have also received "report" from an agency nurse, who had worked for 16hrs with the same group of pts...and gave me a report that was 16hrs old! It took me most the nite to update everything...go over the orders...and find out what really was going on with the pt.

I have walked into CC units...where staff as soon I hit the door have asked me...."Now what experience do you have??" I don't blame them for asking...and I answer them...and try to alleviate their fears. But I also always request a 4hr orientation...and many times have received a 8 hr one. On travel assignements I have been given as much as two weeks of orientation.

But I have also walked on to units...where staff felt they should give agency nurses the worst of the pts..because of the following:

We make more money..therefore we should do more of the work,

They're tired of dealing with the more difficult pts...so let the agency deal with them...no matter that these are the pts...that are scattered around the floor...and the agency nurse is having to run from rm 1 to rm 5 to rm 11,..to rm15..etc. and that these are the very pts...that should have continuity of care from those who have cared for them before.

And Yes you're absolutely right...there isn't really a severe nursing shortage...but there is a shortage...never the less.

So how do hospitals that have tried to woo nurses back...with internships for the ones who have been away from nursing for a long period...who have tried offering enomerous bonus's as much as $10,000 here in this area...flexibility in scheduling...and a host of other things...and still can't get anyone to fill the position...what do they do in the meantime??

I will give you an example of a postion held right at this moment by a travel nurse...who has been here for two yrs now at an area hospital.

This hospital has offered everything but the kitchen sink...or I think....relocations money...housing...assistance with daycare..sign on bonus..etc...etc. This positon is a days position 10 hrs...M-Thr...No weekends...except one weekend a month on call. I have seen their advertisement in over 6 different sites...and after two years they still have no takers! But they're paying a travelers...who is in 7th heaven with this position. She has tried to leave the position and travel else where several times...but as they have had no takers for the position...they keep asking her to stay.

This situation is not only here...but in many different places...so what is the answer??

And yes the attraction of the salary we make can be a deterent to keeping staff members. But agency work isn't really for a lot of people...and most only try it...and soon find out..it's not for them..for a number of reasons.

:cool:

JMP · Mar 25, 2002

Susy

I would be interested to know how States that have unions vary in their use of agency nurses? Or does it affect the situation?

In Ontario, as with all Canadian proviences we are in strong union positions which offer the RN's good wages, job security, benefits etc. We have a shortage here, but no agency nurses.....at least not where I work. We are also deemed essential workers and DO NOT have the right to strike.

RNPD · Mar 25, 2002

I think that agency nursing definitely has a place-but the facilities misuse it. When regular staff is on LOA or agency is used as Brownie is with long term contracts-well that's what agency should be for. But to fill in staffing holes in the day to day schedule makes no sense. Hire the people you need, instead of paying exorbitant agency fees.

I worked day to day agency and it isn't easy. That's why I only would accept a single facility-too confusing to go from place to place. It served my needs at the time.

Brownms46 · Mar 25, 2002

Originally posted by RNPD
I think that agency nursing definitely has a place-but the facilities misuse it. When regular staff is on LOA or agency is used as Brownie is with long term contracts-well that's what agency should be for. But to fill in staffing holes in the day to day schedule makes no sense. Hire the people you need, instead of paying exorbitant agency fees.

I worked day to day agency and it isn't easy. That's why I only would accept a single facility-too confusing to go from place to place. It served my needs at the time.

I agree...that there are hospitals out there that see agency is a short term solutions rather than pulling out all the stops to recruit additonal staff. I don't deny that one bit. But ...there are many hospitals out there...one in particular here...who has bent over backward to recruit help. They have had TWO job fairs in less than 6months...have offered bonues to employees to help bring in help...and other incentives. But you have people who have no regard sometimes for being a part of a team...and think nothing of using their sick time...and calling in at the last min.

And you have staff who are tiring of feeling in the gaps many times for those who feel no desire to be at work when they are supposed to. And then you have people who find out the job isn't for them...so they leave many times before they can even get off orientation.

And you're right about going place to place....it can be very confusing. That is why I prefer travel....because I can feel I can be more effective working in familiar setting for weeks at a time...rather than trying to remember each time..." now what does this hospital do about this or that". I just feel it is a better solution than daily staffing... :cool:

lever5 · Mar 25, 2002

Suzy K,

I am a traveler, I work 8-13 wk contracts for different hospitals. I really enjoy doing this, but I do not believe it is good for staff moral or retention. I hear, "Well, you make the big bucks", "How come you don't have to go to staff meetings", "agency gets away with murder, (do not have to comply with paperwork)". There is a lot of ill will towards agency nurses. At this point in my life traveling is meeting my needs, as my mother is 85 years old and in NY. I can spend extended periods of time with her and then come home to North Carolina. But I believe you could make a point against angency nurses by outlining the retention and moral of staff nurses and what it does to them.

Q. · Mar 25, 2002

Very good posts I must say. Let me address a few points:

Teshiee:

I don't think nurses are "pissed off" at agency, as you put it. I myself couldn't care less who walked on to relieve me after my shift, as long as I could go home when my shift was over. To hell with the unit, the patients, the skill-level of the agency nurse - to HELL! The hospital didn't give a rip about me, therefore, why should I give a rip about them and cared WHO staffed the unit? But after a while, my apathy wore off and I realized that agency is being used inappropriately. As I have said, there is a place for agency and travelers; extended LOA's, maternity leaves, etc, but when I became Charge Nurse , and had to staff my unit with nothing but agency nurses and maybe one regular staff member who was a newbie to Labor and Delivery, I started to realize that there are some serious safety issues here - no more or no less an issue than using your regular staff on MOT.

JMP - very good point. I don't know if there is a difference with agency use in areas that use unions. I DO know that hospitals here aren't THAT bad as nurses are willing to work there, obviously, but as an agency nurse. Why? More pay, flexible scheduling (self scheduling), lack of responsibility (such as NEVER being in charge) immunity from certain things (not having to go into the OR, as with my unit, not having to stay MOT, not having to be on call) and not having to be involved with the hospital "politics." So logic tells me...if these things existed in the hospital for staff nurses, agency would soon be obsolete, or, used more appropriately.

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.

Sometimes agency nurses appear so scandalous, so used-car salesman like, with opportunity costs, etc. (not the nurses themselves, but the whole agency concept) And this I feel is where dissatisfaction occurs, and the "shortage" of nurses grows. Like I stressed, there are 2.2 Million nurses out there. There is NOT a shortage. Those 2.2 just don't wanna work. And why? That is what needs to be addressed. No offense, Teshiee, but playing the game will not solve the problem in the least! Frankly, I am scared sh**less to become old and get sick. :eek: