Why the beef with agency?

GM2RN · Jun 11, 2011

I have never understood why most facilities won't reward their own staff for picking up extra when needed. I worked at a facility that ran a program called "in-house registry," where it was VERY financially attractive for staff to work extra. This program worked so well that most of the time, staff nurses would be clamoring for those extra shifts and there would be no need for agency to begin with. Hospital saves money, nurses are happy, unit is staffed = everybody wins. The hospital would still use agency nurses as needed, but there was little to no bitterness toward them from regular staff.

Yup. Another novel idea would be to pay their staff nurses a decent hourly wage for ALL hours worked, and maybe they wouldn't have so many holes in the schedule.

diva rn, BSN, RN · Jun 11, 2011

The only time I worked with agency nurses or I should say nurse, was in PICU. This was a rather specialzed unit and they sent us a nurse who had NO pediatric critical care--or any sort of critical care experience at all.

It was a disaster...all of the other nurses had to not only help her but make sure she didn't hurt of kill anyone in the process...and take care of our own assignment as well.

(And yes she was being paid a lot more than we were but that was not the issue) the real issue was that it was so much harder when she was there that we truely would have rather taken a larger assignment. But we could not do that-against rules-incase of admissions.

We finally had to make our manager realize that we weren't being mean...this person, while nice was not competent...and they kept sending her anyway.

and thankfully we got a new full time hire:)

So I guess agency would be ok, if they would send someone who was fully qualified for the job!

heron, ASN, RN · Jun 11, 2011

The only time I worked with agency nurses or I should say nurse, was in PICU. This was a rather specialzed unit and they sent us a nurse who had NO pediatric critical care--or any sort of critical care experience at all.
It was a disaster...all of the other nurses had to not only help her but make sure she didn't hurt of kill anyone in the process...and take care of our own assignment as well.
(And yes she was being paid a lot more than we were but that was not the issue) the real issue was that it was so much harder when she was there that we truely would have rather taken a larger assignment. But we could not do that-against rules-incase of admissions.
We finally had to make our manager realize that we weren't being mean...this person, while nice was not competent...and they kept sending her anyway.
and thankfully we got a new full time hire:)
So I guess agency would be ok, if they would send someone who was fully qualified for the job!

The question of "what can she do" is a big one and I'm sorry your admins didn't listen. I'm also sorry the nurse they kept sending didn't have the integrity to decline the assignment.

This came up for me once while working hospice inpatient. It was my third night on, so I knew the unit pretty well. We had 11 patients, me, an agency nurse who hadn't ever worked there and a staff CNA. Our usual assignments were one nurse as primary to 5 or 6 patients, no charge, with the tech covering the floor. This was not going to work when the agency knew nothing about our med system, treatment policies, etc. So ... I took charge, did meds, chart checks and handled calling the doc, etc. Had the agency nurse doing assessments, treatments, qshift charting and working along with the tech. It worked out especially well, since there were five deaths that shift and I would have had to handle the pronouncements, calls and paperwork, anyway. Only stayed an hour late!

There may or may not be room for that kind of flexibility on your unit, but if you can pull it off the untrained agency nurse can still pick up some part of the load.

diva rn, BSN, RN · Jun 11, 2011

That's ok if you have 5 deaths on a hospice unit with a agency nurse...not so much if you are in a PICU.... :eek:

I am being facitious, of course. It just didn't work, and you are right, the nurse should have declined the assignment--we certainly made it clear that she was incompetent..and we made it clear to her! But she kept showing up! ack!

They stopped using agency, thank goodness.

Amparo Pagan Titmus, MSN, RN · Jun 11, 2011

Having been an agency nurse as well as a staff nurse and supervisor, I will make comment here. It's a double edged sword. It is a common assumption that the "hired help" make more money. From my experience the facility that hires pays a nice chunk of change to the middle person, the agency. I have worked at places where the staff make far more than I do, even as a traveler, and they have benefits. "I" cost more because of the added fee paid to the company.Also from my own observations, it is assumed that agency nurses are only in it for the money and in some places they may even be viewed as lazy or uncaring. Though this may be true for some it is not true for all. Most travelers/agency nurses that I have met are highly skilled and very current in their knowledge and skills because they have to be and because of the tremendous amount of experience they acquire having worked at many different places and settings. The facility/staff need the help yet their is often times a resentment. I see welcome the help. If you are concerned or resentful that someone might be making more money than you, well then try it yourself. We all choose what we do and therefore control our own situations.

It would be so wonderful if each of us, embraced what each of us brings to the table. By welcoming those that come to help, we build camaraderie and respect in our profession and in our units. We must realize that this is a form of lateral violence. How we treat each other is also viewed and sensed by our patients, visitors and other healthcare personnel. Just something to keep in mind:heartbeat.

heron, ASN, RN · Jun 12, 2011

That's ok if you have 5 deaths on a hospice unit with a agency nurse...not so much if you are in a PICU....
I am being facitious, of course. It just didn't work, and you are right, the nurse should have declined the assignment--we certainly made it clear that she was incompetent..and we made it clear to her! But she kept showing up! ack!
They stopped using agency, thank goodness.

Just an fyi ... the deaths were more or less expected, not due to agency nurse ... but the intensity of care, given grieving families, etc was roughly equivalent.

As for the situation you describe, the first responsibility is on the agency nurse to decline the assignment ... but the agency and the admins who kept sending her back need to step up, too.