Agency Nursing vs Staff Nursing

Q. · Mar 28, 2002

Well Moe-

What led to our debate topic WAS a discussion of the nursing "shortage," which, is predicted to get worse. Hospital conditions aren't improving all that much (some pay has increased and some benefits - like full tuition reimbursement for new grads) but says nothing of retention. Adding fuel to the fire is agency. And that's what spawned our debate topic.

Agency allows increased pay, flexible scheduling, no call and no MOT. So....it's not the hospital environment per se that is so horrible, it's the pay, the INflexible scheduling or rotating shifts, the call and MOT. When agency is used inappropriately, it can be argued that that contributes to staff nurses leaving, either for agency themselves or a different setting altogether, contributing to the shortage, which in turn contributes to the use of agency.

It's a vicious cycle. That's why we need to show that using agency, on top of being unsafe at times due to poor skills, is also not HELPING the nursing profession at all.

Though I was really convinced with someone's argument (I think Teshiee) who said "let the hospital be the fool and pay exorbant amounts for agency" This is convincing, but wouldn't it be better to pay the regular staff that salary?

Or perhaps nurses ALL need to be independent contractors, and be allowed to bill out based on education, experience, etc.

Brownms46 · Mar 28, 2002

Originally posted by Susy K
all.

This is convincing, but wouldn't it be better to pay the regular staff that salary? - Susy K

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...:).

Agencies came about because someone in the higher ups saw a way to make money. Are you aware that there are agencies out there fronted by nurses...with money put up by doctors??? I mean they're are making money hand over fist. And now the there are hospitals who have sought to even control what they agencies may charge for a nurse.....further keeping down nurses ability to get a decent wage......

Or perhaps nurses ALL need to be independent contractors, and be allowed to bill out based on education, experience, etc.

- Susy K

Brownie...- BUT...aaaaaaahhh...NOW you have hit the nail squarely on the head. This is the only way ...that a nurse will be able to really have autonomy....is by controlling her own purse strings...Bravo...Susy K...Well done...:)!

grouchy · Mar 28, 2002

SusyK,

I liked your last comment, about independent practitioners. Great minds think alike!;} Do nurses really need to be direct hospital employees? I know this sounds really pie-in-the-sky, but,hey, it works for the docs!

Maybe the hospital is an outdated institution that needs to be reinvented for the new millenium.

Personally, I think the #1 reason to be a hospital employee is to gain training as a new grad, or when switching to a new area of practice. Once you're experienced, you might as well go agency, if you can swing the insurance. Maybe we need to do things more like doctors do.Since many of us ( especially us BSN nurses ) come out of school in need of alot of practical training, maybe we need an arrangement similar to internship and residency. We'd go to school for the theory, then do a residency after graduation for the hands-on. We'd get training, they'd get staff for a certain guaranteed period of time. After we completed our residencies we could be independent businesspeople OR employees, like the doctors are.

Just something to think about!

**SKM-NURSIEPOOH, BSN, RN** · Mar 28, 2002

Originally posted by grouchy
SusyK,
I liked your last comment, about independent practitioners. Great minds think alike!;} Do nurses really need to be direct hospital employees? I know this sounds really pie-in-the-sky, but,hey, it works for the docs!

Maybe the hospital is an outdated institution that needs to be reinvented for the new millenium.

Personally, I think the #1 reason to be a hospital employee is to gain training as a new grad, or when switching to a new area of practice. Once you're experienced, you might as well go agency, if you can swing the insurance. Maybe we need to do things more like doctors do.Since many of us ( especially us BSN nurses ) come out of school in need of alot of practical training, maybe we need an arrangement similar to internship and residency. We'd go to school for the theory, then do a residency after graduation for the hands-on. We'd get training, they'd get staff for a certain guaranteed period of time. After we completed our residencies we could be independent businesspeople OR employees, like the doctors are.

Just something to think about!

...that's a good idea. Many CRNAs are independently contracted-out to either hospitals or with MDs.

And I like the idea of hands on residency for BSNs after graduating from the university for there is a lot who don't get enough exposure doing the clinical rotations. Love the idea -:kiss

montroyal · Mar 28, 2002

Originally posted by Susy K
Very good posts I must say. Let me address a few points:

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.

Susy K,

nurses are willing to work, just not with bitter, unhappy people like you. Agencies will continue to grow while nurses continue to work in situations which make them so unhappy. The hospitals will continue to abuse and mistreat nurses as long as the nurses permit it. Unhappy nurses mean high turn over and low shift coverage, thus agencies. If you are really this unhappy, its time for a change. Take control of your nursing career and set limits for what you are willing to accept, or find another career. Its not worth being this unhappy. Continue with the same attitude and you are only helping to foster the need for agency nurses.

mattsmom81 · Mar 28, 2002

Brownie, I totally agree with your point (and other posters' points ) about agency work 's attractiveness ---we crave control over something in our nursing lives...something we give up when a facility employs (and uses and abuses) us! The meat at the core of the nursing shortage lies within this abuse.

Susy, I have worked with a few nurses who are indeed independent contractors...they negotiate their own wage and have legally written contracts for a period of time with facilities. Not many; and most have been men who did not have families to consider. I considered incorporating and independent practice at one time, but there are pros and cons.

The positive to agency contracting is the freedom to pick and choose assignments, have a life and time to enjoy it, and not have to do the legwork of finding your own work. It is worth it for me to give 25% or so of the charged agency rate to my agency. We make our own choices based on our needs and wants.

So true about hospitals writing off agency and not taking any real loss....when I was a nursing supervisor I saw the dishonesty here...unit managers used the line"we have to eliminate agency" to force OT and manipulate their staff. MY DON told me to book agency 'just in case', push the staff to work as tight and as short as possible, then use agency when necessary because 'their fees come out of a different fund so not to worry' ....

I didn't make it as a supervisor in this facility obviously...LOL...my conscience couldn't handle the manipulation I saw, and how nurses who spoke up were punished.....

Some nurses need the safety net of 'being on staff' somewhere. Some hate being on staff and revel in their independence. We're all different..ain't it great? :)

Good luck with your project, Susy! You're getting lots of input. :)

Q. · Mar 28, 2002

Originally posted by montroyal

Susy K,
nurses are willing to work, just not with bitter, unhappy people like you. Agencies will continue to grow while nurses continue to work in situations which make them so unhappy. The hospitals will continue to abuse and mistreat nurses as long as the nurses permit it. Unhappy nurses mean high turn over and low shift coverage, thus agencies. If you are really this unhappy, its time for a change. Take control of your nursing career and set limits for what you are willing to accept, or find another career. Its not worth being this unhappy. Continue with the same attitude and you are only helping to foster the need for agency nurses.

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. :rolleyes:

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.

Q. · Mar 28, 2002

Mattsmom-

Yes, definitely alot of feedback! It's an interesting topic to say the least. The thing is, I am still neither hard core against or hard-core for agency. I like the idea of nurses contracting out and not being employees of the hospital, definitely.

:)

Brownms46 · Mar 28, 2002

Originally posted by mattsmom81
Brownie, I totally agree with your point (and other posters' points ) about agency work 's attractiveness ---we crave control over something in our nursing lives...something we give up when a facility employs (and uses and abuses) us! The meat at the core of the nursing shortage lies within this abuse.

Susy, I have worked with a few nurses who are indeed independent contractors...they negotiate their own wage and have legally written contracts for a period of time with facilities. Not many; and most have been men who did not have families to consider. I considered incorporating and independent practice at one time, but there are pros and cons.

The positive to agency contracting is the freedom to pick and choose assignments, have a life and time to enjoy it, and not have to do the legwork of finding your own work. It is worth it for me to give 25% or so of the charged agency rate to my agency. We make our own choices based on our needs and wants.

So true about hospitals writing off agency and not taking any real loss....when I was a nursing supervisor I saw the dishonesty here...unit managers used the line"we have to eliminate agency" to force OT and manipulate their staff. MY DON told me to book agency 'just in case', push the staff to work as tight and as short as possible, then use agency when necessary because 'their fees come out of a different fund so not to worry' ....

I didn't make it as a supervisor in this facility obviously...LOL...my conscience couldn't handle the manipulation I saw, and how nurses who spoke up were punished.....

Some nurses need the safety net of 'being on staff' somewhere. Some hate being on staff and revel in their independence. We're all different..ain't it great? :)

Good luck with your project, Susy! You're getting lots of input. :)

Good Insight mattsmom! Excellent points! Glad to see someone from the other side...ie management input here! I have seen that practice of scheduling agency....just in case...especailly here. My last week of working here I was cancelled for all except for one day...and placed on call at a nominal hrly rate for two nites. Hence even more reason for doing contracts... :cool:

shay · Mar 28, 2002

Well, I'm sure I'll make no friends with this post, but let me weigh in on the subject....

I think agency nurses have the right idea...I'm all about exploiting the nursing shortage. Pay me through the nose, damn it. I don't work agency, but believe me, I have toyed with the idea a million times for the exact reasons people state...name your price, write your own ticket, work when you want where you want, no bickering b.s. about holidays, vacation, etc..

No, they're not the best solution for the unit or for the nursing shortage, but hey....as long as employers continue to turn a blind eye to the problems that plague their hospitals that LEAD to the need for agency nurses, I say more power to 'em. Go ahead, get paid ladies (and gentlemen).

Brownms46 · Mar 28, 2002

A M E N

**SKM-NURSIEPOOH, BSN, RN** · Mar 28, 2002

I've once tried to do agency work & I didn't feel comfortable with it.

My one & only assignment was at a LTC facility. I had roughly 15-20 mins of orientation there & I was supposed to give all meds & do the treatments, write my notes, & supervise the aides.

First of all, when I arrived there, I got the sense that I wasn't wanted by the perment staff nurses. The supervisor told me that they tried to cancel but was unable to reach my agency in time. Then they wanted me to fill in as an aide as they have mandated one of their own nurses to take my slot. I told them no thanks because this was an extra part-time job & that I do plenty of patient care at my regular job. I informed them that I had the right to leave & that because they didn't cancel in time, they would have to pay the agency for four hours...whether I stayed or not. That mandated nurse decided that she would opt to do the patient care...she stated that she would get to go home on time that way.

I didn't have a problem with familiarizing myself with the stock-room, patients' charts, med & treatment cart. I did however, feel uncomfortable regarding identifying a lot of the residents. Many weren't wearing name badges nor did the MARs have their pictures in them. I found it hard to identify those residents who required their meds crushed or those who were violent. The staff there didn't assist me as to the particulars of their residents & seem to delight in my having to have to take extra, unnecessary steps in order to finish the shift. I managed to get done in enough time & I saw that the other regular nurses sat down most of the shift (3-11pm), shooting the breeze with their staff.

I left that place & thought that it wasn't worth me jeopardizing my license just to make some extra bucks. Needless to say, I never returned.

This is, of course, my personal experience with working agency. I think that I might've jumped the gun before giving up on it. I may even go to another one....but the point is that they're out there for those nurses who do feel comfortable & can perform without any reservations. I commend those strong individuals who can deal with the staff nurses who they know are deliberately trying to make their day miserable by giving them the most difficult assignments. I take my cap off to them!!!:-):roll :kiss :blushkiss