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Agency Nursing… the Good, the Bad, the Beautiful

The Good, the Bad, and the Beautiful of Agency Nursing
HONGQI ZHANG/123RF.com

Agency nursing is a relatively unknown and misunderstood field that is growing in need every day. With staffing shortages abounding in medical facilities of all kinds, more and more nurses are needed to fill the void and in response more and more medical staffing agencies are popping up every day. According to the American Staffing Association, there are approximately 39,000 offices in the US. Imagine, all those agencies and all those nurses and yet the field remains mysterious.

I had the privilege of working as a local agency nurse for a little over 2 years. I worked in medical rehab centers, long term care, drug & alcohol rehabs, inpatient psych units, and even did some work for insurance companies. While I chose to decline the invitation, I also could have chosen to work in acute care, schools, personal homes, pediatric facilities, and even group homes. I absolutely loved (and sometimes hated) being an agency nurse. It was mostly good, sometimes bad, but always beautiful…

THE GOOD…

SCHEDULE

Agency nursing is the only position I’ve ever found where you truly choose your schedule. The agency gives you a list of open shifts and you decide which ones you’d like to work. Don’t want to work weekends? Don’t pick up weekend shifts. Don’t like night shift? Don’t choose those openings. Want to take 3 weeks off? Go for it! Your schedule is truly yours and nobody asks questions about why you’ll take one shift over another or when you’re planning to “do your part to help out on XYZ shift.” During my time at agency I was very specific and stuck to my own schedule. I took openings only at facilities that I enjoyed (or mostly enjoyed) and worked only 1 shift on certain days of the week. The coordinator at my branch knew well what I liked and would call me as soon as she received the available openings to let me put in my usual. It was fantastic!

PAY

Have I mentioned the pay? Second only to having a schedule with the flexibility of a contortionist, the pay is fantastic in agency! I expected to take a pay cut since I was under the impression that we were paid well at the hospital. I was amazed when I was offered $15/hour above what I was making for regular pay! In addition, anytime a shift was high priority, on a holiday or weekend, or offered on short notice, we were offered bonuses! For a little extra cash, I often picked up insurance assessments through the agency that would pay $100-$150 for about an hour and a half worth of work! In addition to those options, it wasn’t hard to recruit additional nurses to our local agency and once they were hired I was given a $750 bonus! Later in my career, I picked up a second agency that paid an additional $10/hour over my original agency! I can tell you that working 2 or 3 shifts (8 hours, not 12) per week and taking frequent vacation time, I still made the same amount of money that I would have made working 40-50 hours weekly at the hospital!

FACILITY CHOICE

I often hear nurses say that they don’t want to enter into agency work because they don’t want to work in awful facilities that are short staffed. While there are some sketchy places with almost no staff who attempt to use agency, their use is short lived as nurses refuse to pick up their shifts. I’ll admit. The worst place I’ve ever been was through agency. I worked a single shift and put it on my “never again” list. I actually had nightmares the night after I had worked there. But, otherwise I’ve worked in tons of places that are wonderful! Sometimes I was there because the regular nurse was on maternity leave, receiving medical treatments for a period of time, or had just retired. It wasn’t always because the facility was awful. What really matters here is that I had choice. I could say “No” to crummy facilities and push for filling openings in places I enjoyed. TIP: LEAVE A HANDWRITTEN THANK YOU NOTE FOR THE SCHEDULER OF FACILITIES THAT YOU ENJOY WORKING AT. IF YOU GET THE CHANCE TO STOP IN AND SAY, “HI” DO SO. BUILDING THAT RAPPORT OFTEN LEADS TO THE FACILITY REQUESTING YOU BY NAME! In fact, I’ve had instances where more than one facility was requesting me for the same shift. I ended up in a bidding war and made twice my going rate that night!

NEVER BORING

You literally cannot get bored when working agency! And if you do, it’s because you need to step out of your comfort zone and try something new! For the longest time, I worked all my shifts at the same facility and always as House Supervisor. After a while, people actually thought I was an employee, and I was beginning to get bored. I told my scheduler at the branch office and within just a few days I had an all new assignment working in psych and drug & alcohol rehabs! I was meeting new people, learning new things, and back to feeling the excitement of trying something new!

THE BAD….

THE DUMP

While I absolutely loved working agency, one of the downfalls was definitely the dump. When you’re from agency, you’re often given the less desirable assignment. As an RN, I tried to avoid this by scheduling myself for House Supervisor when in LTC, but things change fast! One particular night I had a nurse walk out without counting her cart. I notified the DON who had me call the emergency on-call list. The nurse who arrived began yelling at me to get on the cart because she was taking over House Supervisor. While I agreed, I refused to sign for the cart once I realized the narc count was off. After a lot of back and forth between the facility administrator, my agency, and me the count was fixed and I agreed to sign. Here I’d like to refer you back to my earlier section on “facility choice.” I never returned to that place again and I told all my agency pals about my experience. The important thing to remember is to always advocate for yourself, protect your license, and call your agency if issues arise. My agency always backed me up when I called them and while I was in the field alone, I always had support behind me! (Side note: While it wasn’t something I ever thought about, our agency had a great legal team as well. I was once called to a legal disposition concerning a nurse that I had sent home when I witnessed her abusing a patient. Through the whole process, the legal team at the agency represented me and was wonderful to work with!)

ASSIGNMENT CHANGES

Creating your own schedule only guarantees that you won’t work when you don’t want to. There’s no guarantee that what you signed up for will still be open when you arrive or that the position you chose will be available. However, in instances when you arrive at the facility to find that they have filled the opening with their own staff, you receive 4 hours pay and can call the branch to be re-assigned elsewhere if you choose. In my opinion, 4 hours of pay for a short drive isn’t half bad. If however, you arrive for a shift as House Supervisor and find out that you’re assigned to a cart, you’re kind of out of luck. Changes happen and you need to be willing to roll with them. While some agencies will allow you to decline working the change, many will stop offering you shifts if you pull something like that. Unless the switch is outside of your scope of practice, it’s important to be open to whatever is thrown your way.

FLY BY THE SEAT OF YOUR PANTS

Imagine walking into a building you’ve never been in, finding someone you’ve never met, being given keys and a clipboard and told, “You’re in charge.” Welcome to agency nursing! I can’t tell you how many times I’ve started a shift with next to no orientation or training. It’s not technically supposed to be that way. You’re supposed to arrive 30min-1hr prior to your first shift in a facility for orientation. Some even require a full day of training before you can work there (paid of course). But, anyone who works in healthcare knows that things don’t always happen the way they should. Agency nurses need to be familiar with the state laws, standard policies, and their scope of practice while being willing to dig around or ask questions to figure out the rest. It sounds really crazy, but after a few times it does get easier!

AVAILABILITY CHANGES

I loved working agency, until November and December. Each year the facility nurses who were saving for the holidays would pick up all the extra shifts and leave the agency guys/gals high and dry! Sure, there were always shifts somewhere, but they were the less desirable openings. When working in agency, you have to prepare yourself for dry spells. Take the extra shifts when the branch is flooded with requests and relax with things are a little slow.

THE BEAUTIFUL…

GREAT NETWORK

Nothing boosts your networking skills like working agency! As a relatively new nurse who was new to the area in which I was living, I knew very few people. That changed in an instant when I started popping from place to place for work. I met tons of nurses, administrators, schedulers, DON’s, and agency staff who have become friends, references, and now colleagues. When I saw an opening for my dream job, I found that I already knew one of the nurses who worked for the group, and one of my references (a DON I met through agency) was a close friend of my interviewer. It’s a small world and those connections really helped me along the way!

EXPERIENCE

While the standard 1-2 years of medical-surgical nursing and a specialty look great on a nursing resume, agency nursing is one thing that will set you apart like no other! It shows that you’re a self-starter, willing to take on challenges, have a wide-range of experience, and know what you want. There are few other positions where you’ll ever see/learn as much as you will in agency!

TRAVEL OPPORTUNITIES

Travel nurses and agency nurses are essentially the same thing. How you handle travel is totally up to you. Local assignments and contracts are readily available and usually within an hour or less of your home (depending on where you live). They’re great for people who want to stay in one area, but still want the freedom of independent work. Travel contracts that take you out of state are typically higher paying and more structured (picture 18 weeks of 12 hour shifts 3-4 times weekly at the same place). The possibilities are limitless!

THE BUY OUT

Buy out is a term used by agency staff to describe an instance where a facility wants to hire them on permanently. In that case, the facility pays the agency for the privilege of hiring the nurse on. While the nurse can continue to work for the agency, it does mean that he/she can no longer pick up shifts through agency for that company. I’ve seen this happen frequently as agency nurses fall in love with one assignment and offer to come on as staff. Working agency is a beautiful way to “try out” different places before applying!

THE DREAM JOB

Without agency, I never would have landed my dream job. The experience of working in so many places and organizations gave me a perspective that I didn’t previously have. After a couple of years, I had nailed down EXACTLY what I wanted in a job and had met some nurses working in the field. I waited patiently for the perfect position to open up, and jumped on it. I’ve been there for about a year now and absolutely love it! I miss agency at times, but since I still travel to many local facilities to see patients, I often get to stop and say, “hi” to friends and patient’s that I miss! The real beauty is that I know my agency is always there. If our company closes its doors, or I find myself bored of the work, I can be working for agency the very next day! It’s a form of job security that you’ll find no place else!


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About Tammy McKinney, RN

Tammy McKinney is a Registered Nurse from Pennsylvania. After earning her Business Administration degree, she went on to earn her degree in nursing from Pennsylvania College of Health Sciences. With a background in Infectious Disease Nursing, Agency Nursing, and Hospice Care she enjoys sharing her experiences through her writing.

With years of experience in article creation, copy writing and editing, and marketing, Tammy’s freelance career began long before she became a nurse. She continues her work in these areas with a focus on medical writing in an effort to positively inform and impact the nursing community.

Connect with Tammy: https://www.linkedin.com/in/tammy-mckinney-097982191/.