How hard will it be?

nightingale, RN · Apr 18, 2006

I know this might sound a little vague, but I will try to convey my thoughts, and hopefully some of you guys will do your best to give me your opinion..
OK... I basically have no adult med surg type experience since nsg school 4 years ago, I have done ER. I want to start to do agency per diem work, like say in a rehab or nsg home, maybe a few shifts a month, since I have a full time day job in the OR. My question is,
1- will I be able to handle it?
2-Is it literally just going to work and just functioning like the employees that have been there?
3-How is that even possible?
I am a fast learner, but somehow, I dont know about this.
4-just because they will hire me doesnt mean I should accept it, right? I need opinions...
5-will I be thrown to the wolves?
6-Do facilities give any type of orientation whatsoever? Help!!! Input!!!:uhoh21:

I am glad you are asking; to me it shows you really care and are being cautious (that shows a lot about your character).

1-My guess is you will probably NOT be able to handle it. Variables are; how similar is the organization of your ER routine to a rehab or Nsg Facility floor and in my HO that are very different. I have worked both with a primary background in med surg.

2- No...

3- Facilities vary, a small country hospital has a different set up of organization to a facility floor then a larger fast paced facility. I started out in a very large hospital (from Nursing school 8 years ago) and it took, for me, a full year to grasp the organization skills of getting out meds, assessments, orders and reorders, and the flurry of taking care of my pts. I am not trying to make it sound hard but I think the organization part, once you have that under your belt, will be what you need to master. Like the rhythm of the ER, it just takes times to get comfortable. Since you already have the Nursing Expertise, in my opinion you will "get it" quicker.

4- Yes you are right. The "Agency" is in it "for the money" most often. Even the better agencies will assume that if you say you can do it you can. You will probably fill out a skills list that should itemize you strengths (numerically) and weaknesses.

5- You sure might. I have been. Fortunately, I had two years of working two very different types of facilities before I started Agency Nursing. I was very grateful and confident to have that under my belt as I have been asked to handle pts. that were beyond my capabilities or those that were out of my area of expertise.

6- So little orientation it makes me shiver... Some are decent but promises melted when I would hit the floor and the orienteer Nurse was handling too much and pushed their pts on my load. Nursing is too fast paced in my opinion (I call it organized chaos).

As an Agency Nurse, you are there to add to the environment of assistance and care. Sometimes, staff will be rather mean (I do not return to those facilities) and love to report the new Agency Nurse... People can be cruel at times and when you are not proficient in Nursing, it can involve threats and documentations against your license. I am sure my Nursing Board has verbiage to a Nurse working within their scope of practice.

I hope this helps you in getting started. I would recommend working PRN Float Pool for a facility and perhaps working nights until you feel comfortable walking onto almost any floor you plan to work as an Agency Nurse. In my opinion, Agency Nursing has been the icing on the cake, the cream filling in the middle, and the most rewarding and invigorating type of Nursing I could have imagined for myself.

Please let us know how ou make out.

RNOTODAY, BSN, RN · Apr 19, 2006

Nightingale, thank you!!!

I have been talking it over with a few people, who have actually worked some shifts, like in a nursing home.and they said it was "easy".easy , meaning, no IV's,no vents, etc. Po meds and TX , stuff like that. But to me, I dont chalk that up to "easy" very quickly, because I have never done it before, and handling something like 20-40 pts or more doesnt sound easy, no matter what you need to do for them!!!

I think I might try a facility directly, and try to work per diem there, like you suggested.... but another question I have, is, would a facility train and orient a per diem person????? I always thought you need experience to work per diem, that they wouldnt train you. Obviously it differs everywhere, but have you heard of that being the norm?

nightingale, RN · Apr 19, 2006

Usually, a facility will orient you. Again, there are times when this is promised and you get to "own" the shift or someone calls off.

I have a confession, when I first answered (and then edited) I was referring to a med surg floor in my sleepy state. The revision I made to edit does hold true for a nsg home and a rehab center; to me, those two alone can be very different. Some of the regulations of resident treatment and policies vary very much from what you are used to. HIPPA is HIPPA etc but getting a sense for resident rights alone is a handful.

The pt. is a resident in a nsg home and is treated as such. There is much family involvement in the care and planning of the resident. An example would be a change in med or a change in care, of course the Dr. is involved but you need to take care in involving the family in the decision process.

Perhaps it might help you to do some "homework" by reviewing some of the posts and issues on our Geriatric and LTC Forum. Here is a link:

https://allnurses.com/forums/f22/

Here is a link to our Rehab. Forum:

https://allnurses.com/forums/f47/

I will tell you a secret, be careful, Elder Care is addicting; hard work yes, but if you have a good team of CNA's etc... you will find it VERY rewarding.

Let us know how you are doing.

night

Brita01 · Apr 19, 2006

Nightingale, thank you!!!
I have been talking it over with a few people, who have actually worked some shifts, like in a nursing home.and they said it was "easy".easy , meaning, no IV's,no vents, etc. Po meds and TX , stuff like that. But to me, I dont chalk that up to "easy" very quickly, because I have never done it before, and handling something like 20-40 pts or more doesnt sound easy, no matter what you need to do for them!!!
I think I might try a facility directly, and try to work per diem there, like you suggested.... but another question I have, is, would a facility train and orient a per diem person????? I always thought you need experience to work per diem, that they wouldnt train you. Obviously it differs everywhere, but have you heard of that being the norm?

I pretty much agree with Nightingale's post. And if you're going to a nursing home for the first time, it is not easy because you don't know any of the residents and their pictures on the MAR never look like them, if they HAVE pictures. So med pass can be a horrible experience if they're all up out of bed and in the dining room. Now if you take a night shift, the med pass will be much easier for you as the residents are all in their rooms and beds. Just keep in mind that the aides start getting them up early and when it's time to do blood sugars, some may be up in their wheelchairs already. I also recommend rehab on night shift, once again because the patients are up and out of their rooms during the day. You get some experience with IVs, orthopedic equipment, and some hands on ADL care come morning, plus in my experience, it's not as crazy as med/surg.

In all the different facilities I have gone to as an agency nurse, I only had one orientation. And it was only because they did everything by computer and wanted agency staff to know proper procedures. As far as getting oriented to the floors, if you're lucky someone will point out to you the med room, the bathroom, and the supply room. Usually I would just wander around the floor and note where things were. If you do decide to work one or two facilities exclusively, this will probably be the easiest for you. You will get to know where everything is and make friends with the staff which will be extremely helpful to you.

The agency does not care if you really know what you're doing or not when they send you to a particular area. If you tell them you can do it, that's pretty much what they want to hear because cha-ching for them. It's up to you to work where you know you're going to be more comfortable.

NrsJena · Apr 29, 2006

Just to throw my two-cents in here, I think the question of easy or not depends on the shift you take. I worked in a nursing home right out of school. Day shift is rough- 8 AM meds for 30+ resident's, Dr's and families who expect you to know everything or absolutley nothing. Try to do that in two hours! I've had many days that I barely get done just to turn around and start with another med pass. As for trachs- I have encountered them. Most nursing homes don't use RTs anymore. Midnights is better- but can still be crazy in the AM. Depends on the normal routine- which is set up for the facility nurses who know everyone.Easier-but not easy. Orientation? Haven't had one yet.

The key is to walk in knowing you will have no clue-accepting it and doing the best you can anyway.

To be honest- my heart still skips a beat every time I walk in somewhere new.:)