How is agency set up?

CraftyLPN · Nov 3, 2002

I am not sure if this any help... The one agency I was considering joining had at least a RN and aLPN supervisor..Then depending on what cases you have, and what kind of medical coverage,(medicaid,medicare,passport,waiver,ect)..they staff accordingly.They had a seperate person to do the scheduling.

The RN/LPN supers usually do home visits to determine how well the family approves of nsg care they are getting and how the client is progressing and documents as such.. to determine eligibility for health care.

I hope this helps a little... all this is refernce to home care

nightingale, RN · Nov 3, 2002

The agency I primarily work for, NurseFinders, has no nurse on staff. There are rotating callers or schedulers; my guess is there are approximately 6 who rotate between days and night call and scheduling. I do not know the number of nurses but they are one of the leaders in staffing in Denver.

Now, AllAboutStaffing, the big Daddy Agency, has hundreds of nurses. Or that is what "they tell us". It seems like they have dozens of schedulers on hand. This is all undocumented but it gives you some idea.

Are you thinking of starting an agency?

lee1 · Nov 4, 2002

Originally posted by nightngale1998
The agency I primarily work for, NurseFinders, has no nurse on staff. There are rotating callers or schedulers; my guess is there are approximately 6 who rotate between days and night call and scheduling. I do not know the number of nurses but they are one of the leaders in staffing in Denver.

Now, AllAboutStaffing, the big Daddy Agency, has hundreds of nurses. Or that is what "they tell us". It seems like they have dozens of schedulers on hand. This is all undocumented but it gives you some idea.

Are you thinking of starting an agency?

No, just trying to understand why it takes so FEW RNs to run an agency and so MANY to run a hospital------most hospitals still too managerial heavy with not enough bedside staff. Can someone please explain????

nightingale, RN · Nov 5, 2002

Originally posted by lee1
No, just trying to understand why it takes so FEW RNs to run an agency and so MANY to run a hospital------most hospitals still too managerial heavy with not enough bedside staff. Can someone please explain????

I wish there were some rationale that I might understand. It is irritating to see how "top heavy" some insituions are. I have a hard time emphathizing with the "budget argument" when they talk of why we have so many patients to an overworked population of nurses. The patients we care for are oftne so very sick and need more time then we afford them.

I was going to answer this with a NO.. but I did not want to insult you with a seemingly curt answer.

If anyone here can explain and justify it.. let us know...

B.

Brownms46 · Nov 5, 2002

ALL ABOUT STAFFING or AAS is a division of Columbia or HCA, and was set up to help HCA and others now control rates for travel, and agency nurses at HCA facilities, which keep growing by the day!

There are many agencies that may have a token Director of Nurses who is an RN, but there are a lot of them who don't have a clue about nursing!

Most agencies out there are backed by doctors or companies looking to make a buck off the backs of nurses, and are in it for profit only! They'er not out there for the nurse! Their business pure and simple and are run as such to make a profit for their share holders...which many aren't doing so good at!

I have ran into nurses who have started agencies, but many of them have gone by the way side within a short amount of time. They don't take the time to learn the business end of things before just jumping out into the mix. How many people run an agency?? That depends on the size of the agency, and if the agency is a franchise connected to a large corporation, or a local agency.

Most of the companies out there, that I know of personally, have no RN in control of anything! There are there to assist with problems that may come up with hospitals or staff relating to nursing. Or they assist in the educational part of the company. Making sure the agency is in complaince with those things that apply to nursing.

Many small agenies may have a small core of people who switch off call, and many companies hire evening and weekend staff who handle call for during the after hours. Some companies don't even bother to do this, or can't afford to do it.

I hope this helps a little... :cool:

nightingale, RN · Nov 5, 2002

Originally posted by nightngale1998
Now, AllAboutStaffing, the big Daddy Agency, has hundreds of nurses. Or that is what "they tell us". It seems like they have dozens of schedulers on hand. This is all undocumented but it gives you some idea.

Thanks Brownie for responding.

Let me clarify my statement above. AllAboutStaffing (AAS) has hundreds of nurses to staff. The actual office has dozens (it seems to be a dozen or two) of clerks who do the calling and scheduling.

They do have RN's "on staff" but they are part of the top heavy management "team".

As for me, I am attempting to have independent contracts directly with facilities. It is only a matter of time before this becomes more and more popular. Yes, I have to arrange for my own taxes etc.. but I increase my profit margin substantially and.. quite frankly.. I like the feeling of being independent.

What Brownie states about profits, particularly for the big agencies like those who really are in a position that "controls the market" is SO true. Sure AAS starts off by paying big money for agency staff. They slowly pick away at those numbers in their nursing pool of PRN to take lesser paying "contracts" or to "come on board" at a facilty for less money to avoid the call offs that is enevitable in the PRN pooling off nurses.

Yes indeed... it should be called "All About Profits"... remembering that this too is at the expense of nurses making less money, having less control, and ultimately (IMHO) less dignity...

Remember... AAS big bust in, what was it CA? They were indited due to medicare fraud? Yikes.. and fact.

What are the answers... let's discuss some solutions and empowerment of WE the NURSES... Another thread?

I welcome and encourage your ideas, posts, and discussions.

The Moderator

B.

Brownms46 · Nov 5, 2002

You're welcome nightngale1998, and EVERY word you wrote is sooo true!! AAS will start out paying rates equal to, and in some cases (rarely) they will pay higher. But when the nurse going to re-sign a contract, they find their rates have been lowered...ONLY when they have already agree to do the contract with AAS!! More than one nurse has had this happen to them, AND also had their HOURS of the contract changed. IE supposed they were doing 12hr nites. Well when they got the contract they find out their NOW doing days! And YES HCA was indicted for fraud...and it hasn't slowed them down one bit! The threw a scrapgoat to the wolves, and kept on pushing! They have now taken over sooo many hospitals, that nurse who refuse to work for them are having less and less choices, depending on the city or hospital they want to go to. Because of them...now states are getting into the mix to control the rates nurses are paid! The rates have dropped sooo low, that they have now become LESS then they were over 10yrs ago!

Yes I believe the only way nurses are going to be taken seriously and paid anywhere close to what they're worth, is for them to go independent, and take their careers into their own hands!

Too long have agencies made huge profits off the backs of nurses! Too long have companies placed nurses in situations that cause them to fear the lost of their licenses just to make a decent wage! Too long have they been jerked around by those who have no clue as to what they do, or they trials they endure because they refuse to deal with the business of being a nurse!

And YES it IS a business...where others are getting rich off of us!

Nurses must bite the bullet and put out a greater efforts in controling those things that effect them daily. If nurses continue to allow others to pick them dry, and toss them back on the trash pile when they're finish with them, these carpet baggers will continue to do so, without regard for those who are breaking their backs to be of service to mankind. While these products of mankind utilize them for profit, showing no concern at all for how they rob us blind.

It is time for nurses to wake up and smell the poop! Cause we being smothered in it daily, by those who tell us they know what we do, and realize that what we do is important. Piling the poop on higher and higher! Because it's all a snow job...and a good snow job at that. Because too many nurses are still listening!

Ooook ..done now... :cool: !

IMNewhere · Sep 25, 2003

"As for me, I am attempting to have independent contracts directly with facilities. It is only a matter of time before this becomes more and more popular. Yes, I have to arrange for my own taxes etc.. but I increase my profit margin substantially and.. quite frankly.. I like the feeling of being independent. "

Hello! I wanted to make a comment on the quote above. I think it's great to be independent and to be an entrepreneur, I am as well! But I don't think that it's for everyone. We are very lucky to have options! If you want to be independent you have that option and if you want a permanent position you can do that, if you want to work for an agency who will handle all of the scheduling and taxes and in many cases pay you completion bonuses and provide you with a housing allowance, etc... then you can do that. Each scenario has it's advantages and disadvantages. Such is life!

Nursing is truly a noble profession, and not just anyone can be a nurse. Nurses have not always been treated very well, or given the respect that they deserve.

I started my own agency a short time ago. I'm still learning about what it means to be a nurse. Sure, I know the specialties and enough of the medical jargon to place nurses, but I learn something new everyday. I have been a recruiter for almost 10 years, but started out in technology. A few years ago when the market took a dive many recruiters were left jobless, with high unemployment rates and a suffering economy, there were not too many options for recruiters. I had a friend who started a healthcare recruitment agency in 2000. He was bringing nurses over from the Philippines. He told me that the Healthcare field was booming. I didn't jump on the bandwagon right away. I did some research and tried to learn as much as I could. I wanted to see how I could help, how I could offer a service to hospitals and Medical Centers in the form of quality healthcare and to nurses in the form of career management, guidance and opportunity. It isn't all about profits for me. I am trying to earn a living, don't get me wrong, but I am doing that by offering a service not taking profits away from nurses.

I realize that there are agencies out there who make a bad name for all of us. That is a shame. I find nobility in helping people to find a better job, which may be closer to their home so that they can spend more time with their families, maybe it's a position with more upward mobility or an opportunity to learn something new, maybe it's an opportunity to make more money. Whatever the case, I have helped many people over the years and most of the people that I have placed still keep in touch with me and some of them I consider to be very close friends.

I thank you for reading my reply! I respect each and every one of you and know that you are all very special people who could never do what you do just for the money! I do believe that this shortage of Nursing Professionals will ultimately result in a newfound respect and advocacy for the Nursing Profession.

Sincerely,

IMNewhere

adeoyin · Jun 7, 2005

I AM THINKING OF SETTING UP A NURSING AGENCY AS AN ENTERPRENEUR. CAN SOMEONE PUT ME THROUGH THE WHOLE PROCESS PLEASE. JUST THE HIGHLIGHTS ON HOW TO START. ANYONE WITH IDEA OF BOOKS OR WEBSITE THAT I CAN CONSULT?

SINCERELY

ADEOYIN

suzanne4, RN · Jun 7, 2005

Welcome to Allnurses.com.............please do not post in all CAPS. It actually means that you are shouting. There are already many, many threads on this topic in the entrepreneur forum. Check it out.

eddy · Jun 9, 2005

I've owned my own business (a small/midsize accounting firm) and I've been an employee (accountant, financial analyst, controller... and yes a nurse).

I can say from experience that there are some very STRONG pro's and con's to both. The most important these days is health insurance. As a very small company or a company of ONE (independent contractor) you will find it very difficult and almost impossible to find health insurance that is within financial grasp. Obviously, if you have a spouse that works somewhere and can put you on their insurance this isn't a huge issue. However, if you must provide your own, seriously think about the costs. Also, you do not get any other "benefits" associated with being an "employee" of a larger company such as paid vacation, group retirement plans, liability umbrella insurance, work comp insurance, disability, scholarship reimbursements, and all the other stuff.

Of course, you will also pay BOTH portions of your taxes. Your employer covers half, but as your own "employer" you pay the whole thing.

Alas, it is generally the norm that IC's get lower bill rates than agencies do.

These factors can, and often do, eliminate the percieved

"better pay" of being an IC.

I'm not saying it is a bad thing to do. Not at all. I applaud the entrepreneurial spirit (I'm still a part time independent accountant)! All I am saying is that the perception some people have that agencies are ripping nurses off or causing you to make less as a nurse is simply not true.

The idea that hospitals are increasingly seeking IC's for staff shortages is also NOT true. Hospitals are ACTUALLY increasingly seeking "master vendor" contracts with large nationwide agencies that manage all of their agency staffing (as well as many other processes, systems and supplies in hospitals). As stated prior, All About Staffing (AAS), a subsidiary of HCA is one of the big ones. Like it or not, they aren't going away and will only grow bigger and grab more market share as time goes on. Hospitals are simply not interested in managing hundreds or even thousands of single IC contracts every year. It's a paperwork nightmare, a legal department fiasco, a staffing department impossibility and an accounts payable disaster!

With all of this said, should you choose to go the IC route, I bid you best of luck. There are some out there doing well at it, but fewer than you think.... the rest that say it's great merely want to sell you something. :)