Volume 2: Agency Nursing; Life in the fast lane

            Cathy, my best friend in nursing school approached me after silently closing the door to the classroom. We were always the first two done with exams, rather good test takers, I guess. The fact that we had the two highest GPA’s in the class supported our methods. Neither of us dithered over questions; we had learned early on that to read too much into a question was academic suicide. So, after every exam it seemed like the two of us wound up talking in the lounge while we waited for most of the rest of the students

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“That was tough.” I said as she neared the table. “Yeah. Way worse than nursing three” was her only response as she sat down with a heavy sigh.  For the first time in two years, we were not excitedly talking over the questions, evaluating our answers and generally riding the joy that comes from blowing away a difficult exam. Life had changed drastically for us as students, as nurses and as people. I had not slept since the night two days previous, as I had been on the midnight shift at an Alzheimer’s unit. The emotional drain was beginning to show. I knew something would have to change.

That afternoon, as I was walking along the hall between classes, I overheard some students talking about a nursing agency that was hiring. Every one of us was aware that the real money in nursing is with an agency. Whispered stories of fabulous income which when overheard by staff were quickly dispelled as fanciful and beyond our ken. “You need five years of med-surg experience before you even think about agency” was what one of our instructors would always say. “ No one will even talk to you until then”. What I found out, later that evening, was; that was not only not true, but the nursing shortage coupled with the greed of those who run nursing agencies meant that they were more than willing to talk to anyone, even green L.P.N.s

            Interestingly, none of the agencies I spoke with would divulge their rate of pay. All of them stated that they would only discuss that in an interview. So, I asked around and decided to go to the one that was rumored to pay the most. The “interview” consisted of filling out the paperwork, receiving the papers to get my drug test and fingerprint check, and giving them my availability. I did not even know it at the time, but I was already hired. The moment I turned in my drug screen and background check, they gave me a schedule and told me what I would be making. Less than a week later, I was walking in to my first assignment cold, without training and largely unprepared for what lay ahead.

            Bent river manor (named changed for the purpose of this article) was a 90-bed long-term care facility with one ward dedicated to rehabilitation. Like most LTC’s, it was shabbily run, mechanically old and terribly understaffed, hence the need to pay four times the normal rate for an L.P.N. I reported to my station, was shown the storage closet and med room and given the keys to a med cart, told to count the narcotics with the nurse standing there waiting to be relieved and left on my own. Luckily, the nurse going off shift was kind enough to give me more than a cursory report on her patients and let me know something about them as people. Little did I know that this would be one of the better reports I would ever receive as an agency nurse.

            One thing should be said right from the start. First, staff nurses hate agency nurses, generally because staff nurses are underpaid and overworked, thus they resent the fact that agency nurses are making so much more than them. The second thing you should understand about agency is that agency nurses almost always get the worst assignments and the least competent aides for exactly the reasons stated above. They say that “nurses eat their young” and nowhere is this more apparent than the treatment of agency nurses in the long-term care setting. I have been denied needed help, guidance and have never had a proper orientation to a floor or unit mostly because I was resented for making so much money.

             So, what could possibly be the upside of agency nursing? Well, for one thing, if you are brave enough it will drastically sharpen and speedup your assessment skills. When you have no prior knowledge of what normal is for a group of people, you must learn to combine the focused and general assessments, apply basic knowledge of human responses to stimuli and hone your skills at applying the knowledge you gain f4rom those assessments. It will also force you to learn quite a lot about the medications you give, their interactions and the responses people have to them. Then there is the money. I was able to spend less than 20 hrs a week at work and brought home more money than I had as a staff nurse full time in a facility.

            Life itself is a balancing act. Give and take. If you can give as much as it demands, can take the abuse it gives and have the courage to walk into a med pass blind, then you can reap the benefits of more pay, less hours and an experience that will sharpen all your skills and make you a better nurse. But it is not without it’s dangers. Med error rates are much higher for agency nurses. Not all get reported, but from experience I can promise you I have seen far more errors by agency than staff. Med errors can kill a career, let alone a patient and if you have assets, can take everything you have. Remember always that nurses are to blame for mistakes made by ALL the health care team. We are the last check on errors and omissions and the laws are rather unforgiving in this area. The decision to go to agency is a tough one and should be well researched and thought out before making the leap.

Robert L. White is currently a school nurse for inner city underprivileged children, owns two companies and writes copiously on many subject from religion to science