The Good, the Bad, & the Ugly of Being an Agency Nurse

Before you cash your check for or against agency nursing, ask yourself – what do you really know about it?

Perhaps you are a nurse (or other allied health professional) who works or worked for a temporary staffing agency.

Perhaps you are natural staff at a facility who has worked with, hired, or scheduled agency nurses.

Staffing agencies (really, staffing firms, since employees are paid after working not paying to be placed to work) can really be an excellent way to supplement your staff but there is great risk in choosing a firm that also produces quality temporary healthcare staff.

If you are a nurse or allied health professional (because not only nurses can work with agencies, heads up!) looking for work, take deeply into consideration the benefits and possible challenges. Find an agency that truly aligns with your professional needs and goals, that you can either commit to full time or use to supplement your income as needed.

Let’s talk about it:

The Good

A nurse who chooses to work for a staffing agency has, usually, a few drivers behind that decision. Primarily, staffing firms offer:

• Schedule Control: Opportunity to work when you want and are able to, offering a work:life balance traditional employment models cannot accommodate (i.e. forced number of weekend rotations, inability to plan around school events and kid’s schedules, difficulty managing continuing education).
• Location Preferencing: Worked somewhere that was unsafe, inhospitable, or just overwhelming? Don’t have to pick up there again.
• Budget Flexibility with Weekly Pay – very common for staffing agencies to pay weekly, which helps ensure a balanced budget and also allows for periods of increased demand i.e., leading up to holidays or summer vacations, paying off debts or preparing for an extended period of working less than usual.
• Constant Challenge: you can choose to work in a variety of settings within your scope and in a variety of settings, including geographical changes. Many nurses choose agency lifestyle simply to avoid the feeling of stagnating.

That’s a lot of good! So why doesn’t every nurse choose this?

The Bad

• Lack of Scheduling Control: There may not always be opportunities for shifts at facilities or locations the nurse prefers, which may make creating a full time schedule challenging some weeks and the nurse may not have the opportunity to “make up for it” by working more hours the subsequent week.
• Location Preferencing: Some nurses are very adamant about a drivable distance to their place of employment – if there are no shifts available or the rates at preferred locations aren’t as favorable, the nurse does have the option to change/expand her workable area to find what he/she is looking for, but this is not always agreeable.
• You’ve committed to a shift sometimes before knowing what’s in store. Once a nurse has clocked in and assumed responsibility for her shift, there are a very limited number of acceptable rationales for backing out and to do so requires an in-person facility supervisor to willingly take over. For instance, when trying out a new facility, if you begin to take report and realize the ratio of patients you will be responsible for or the needs of certain patients on your roster exceed what you can realistically or safely do, this can become A Situation. There are laws in place to protect nurses from proceeding under these conditions without repercussions, however, very specific circumstances have to occur. Most commonly, the nurse is stuck working that shift to the best of his/her safe ability and chooses to not return to that facility. *
• Constant challenge: If you are working and living in an area where there is not a consistent demand in certain areas, you may find yourself constantly challenged in ways that do not appeal to you. If you feel driven to work agency life for scheduling and budgeting control but really only enjoy a certain type of work, it might be better for you to seek contracts with places you work and enjoy so that you are guaranteed hours/week and still protect your independence from full time routine employment.
• Inhospitable natural staff. When natural staff at a facility becomes so disengaged or inhospitable to outside staff, these dramas can affect the patient bottom line and must be avoided at all costs. One of the disparagements of agency nursing is, however unfortunate, occasionally you must contend with this sort of reception. Having thick skin and a great work ethic will help pass your shift but no one – NO ONE – enjoys work in a toxic environment or can perform their best under such conditions.

Oh, that does sound like it can be rough. So what’s ….

The Ugly?

The Ugly can’t be bulleted, it’s just this: not all agencies are designed with intention. An agency run with intention operates with integrity. Its team members are team members, not employee numbers. Its clients are partners, and there are expectations that work both ways. The combined primary clients are the patients we are all serving as professionals in healthcare: the patients. (If your brain went, ‘the insurance companies,’ you’re not alone but that’s for another day!) Happy staff make happy patients and happy patients make facility’s profits and the wheel keeps turning. Some agencies truly are fly-by-night – facilities hire them out of desperation to keep warm bodies on the unit, and it shows.

Top complaints about “agency nurses” :

1. They’re almost always late, sometimes extremely, and often habitually when they find a few facilities to frequent often that don’t complain
2. They often take their time on breaks, extending well beyond the reasonable or allotted time and often don’t bother to coordinate with natural staff to cover them
3. They often show up in a state of reduced professionalism – dress, energy, hygiene – there seems an unfortunate trend in nurses behaving like they have no need to present themselves professionally if they’ve ‘no skin in the game’ or the person immediately responsible for paying them isn’t on the unit (a little ‘while Mom’s away’…)
4. Facility’s administrative staff tend to let them get away with these concerning behaviors because they are desperate, or possibly unaware
5. They need lots of help*

*Now, when I hear “agency needs lots of help,” what I immediately think is: of course. Any nurse new to your facility will need help. There are things that any new staff member is going to need to know, but agency staff are not given orientation time. They become adept at finding information and speaking up when they need something as it comes up, and most professional nurses natural to a facility can easily answer these questions without much upset to their workflow.

These complaints often stem from agencies that do not operate with intention.

When you are looking for an agency to hire or an agency to work with, hold their staff to the standard that, minimally, natural staff is held to. No cell phone policy? Also applies to agency staff. 30-minute lunch break? Means 30 minutes. Shift starts at 3p.m.? 3:30 p.m. is late. No Call No Show = No Work No More. An agency that retains employees who do not measure up to basic professional standards expected of a licensed nurse do not deserve a seat at the table.

A good agency to work for will offer the following:

• Adequate pay for your scope, experience, and expected work demands
• Reasonable options for locations 
• Exceptional communication between team and management
• Support and Uplift their staff
• Treat their staff like team members
• High hiring standards – professionalism is expected and extended in return
• Adequate onboarding – including background checks, drug screens, licensure verification, etc.
• Work with you to find placements that are mutually beneficial to the client and you, the employee
• Respond to your needs and concerns
• Expect you to represent them and follow through if there are concerns voiced – a good agency is not going to overlook staff who misrepresents them in the community

*When searching for a nursing firm to work for, ask them: do you vet your facilities? do I have the choice to give instant feedback or communicate with my team from the facility if I get into a situation? What are your policies to protect me in a situation where I walk into unsafe working conditions? How an agency handles these situations speaks to the integrity of both their business and their commitment to improving healthcare & their team, versus the almighty dollar.

Good luck and, as always: CYA!