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Careers: Nursing/temporary staff agency RN

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QUESTION: My daughter graduated with her RN last spring.  She got a job in an extended care facility a couple months later.  She has been working there but needs to leave as she feels it is an unsafe place.  She got a job offer from an agency that places RNs in temporary positions.  Because she doesn't have much experience she if finding it hard to get a job.  Do you think this will be a good thing?  They can't promise any amount of hours but said most placements last about 6-8 weeks at a time.  Thanks.

ANSWER: Victoria:

Thanks for being concerned about your daughters choices. Let me give you the short answer and then you can read the background on what has happened in nursing below if you want to. I would not recommend her leaving the extended care facility if its a full time job. The temporary positions are difficult because they expect the nurse to have a lot of experience to come in with a couple days of orientation to the unit and begin working right away. Not to mention that the temp nurses seems to get the worst and hardest pt. assignments in the beginning because some charge nurses feel they are making more money so they will dole out the worst patient assignments to the agency nurse. I have been on the receiving end of that myself :(

Once they get to know you and hopefully like you, they will give out more fairly even assignments. Its terrible, but there is always some resentment as they believe the temp agency nurse is getting more pay so they should work harder. I would stay at the extended facility with a goal to get into a hospital medical surgical unit full time. This will be a more permanent learning position that will be a good base for her to move on to other higher level areas of nursing, such as the operating room, recovery room, emergency room and the intensive care units. A good medical surgical base is needed to build on. The extended facility is not ideal and is dangerous because you have lots of patients to be responsible for. However, I believe she needs to hang in until she get the med surg hospital job.

Here is what has happened recently in nursing in my eyes looking from the inside out:

Nursing is about to turn the corner on entry level criteria for nursing. For years there has been a debate on what the entry level for nursing should be. We have not had a unified voice in nursing. We have a 1 year LPN program, a 2 year Associates RN program, a 3 year hospital based Diploma RN and finally a 4 year BSN program.

Unfortunately, because nursing leaders could not decide on pushing for a professional entry level nurse, the hospitals human resources departments have seemed to take over the reigns and solved the problem in one fell swoop. How ?.... Well they have just set policy to only hire the 4 year BSN prepared nurse. That pretty much left the 2 year associate nurse stuck with a degree that pushed them into the Nursing home arena with the LPN nurses. With the added pressure to outperform competitor hospitals, many are looking towards becoming MAGNET hospitals. These are hospitals that are magnets to pull in experienced nurses for better pay and BSN degrees or higher. Studies have linked MAGNET hospitals with better patient outcomes. So therefore, if a hospital can get the higher educated nurse and attain MAGNET status, they can bet more patients to come to their hospital.

http://www.nursecredentialing.org/Magnet.aspx

See....what most of the public does not know is that most nurses are paid by years of service and not education on the front lines as a staff nurse. Therefore, a 2 year RN with say 2 years experience would be paid more than a BSN or MSN prepared nurse with 1 year experience if they worked side by side as direct patient care givers in a hospital medical floor. So basically, the hospital is opting to hire the more educated nurse for the same pay out of school for the direct patient care positions and this had shut the door of opportunity on many new 2 year RN graduates. The 2 year RN with years of experience already have not been affected. It is really just the new grads.

I would venture to say this is what happened to your daughter as well as many..many other 2 year associate degree nurses. The reason this has happened is that the shortage of nurses really never manifested itself in the medical surgical areas of beginning nursing. The shortage is in the experienced areas of critical care transport,emergency room, intensive care, recovery room and operating room areas of nursing. This is difficult for the new nurse as they need to get into the medical surgical areas to get the experience as a base in order to progress to these other areas. Hospitals are finding that it is too expensive to train nurses in the higher level areas of nursing as many often up and leave to better hospitals once they get the experience. This translates into big turnover of nurses and thousands of dollars worth of losses. So what has happened is the lucky nurses with the experience, have on average 2 jobs and are doing quite well and are overworked. I personally have been working 60 hours a week in critical care transport and nursing administration which requires experience and higher degrees at the BSN level.

I am sorry for the long winded answer, but I wanted to give you insight as to why your daughter got pushed into the nursing home instead of like most of us who started with a 2 year degree in the hospital area of med surg.

Good luck and let me know how thing work out....

---------- FOLLOW-UP ----------

QUESTION: Are you saying she should stay even though she feels it is unsafe. A quick view of what happened.  She is on a unit where the patients are coming off ventilators.  She i certified in ventilator care.  The unit used to staff resp therapist on that unit but removed them.  She is the only nurse for 20+ patients.  Two patients coded with no Resp therapists available.  Her unit is the most difficult in the facility.  When she hired in she was told RT would be there, but as stated that has changed.  She was also told she would have help.  After the code incidence, which turned out good, she went up the chain of command asking for help.  She did this every day for 3 days with little or no help given. On the 4th day, she called in early to ask if the unit was staffed properly. She was told it was not.  She informed them she would only work that unit if staffed properly as they had not trained her sufficiently as they had promised. She said she would work any other unit.  She was suspended for refusing to work.  She is still on suspension while her case is in review. So, that is why she is looking to take the temp staffing job.  Should she stay if she is offered her job back?  Will she ever find a hospital job?  Should she attempt to get her BSN? Thanks.  Sorry so many questions.  Just trying to help her.  Single mom and out of work for now. Sad.  She's a good worker and all the patients' families say so also.

ANSWER: Victoria:

Well...I did not know it was that bad. The economy and the lack of hiring 2 year RN's with little experience is why I said to hang in there.  

I would tell management that she will be filing a complaint with The Joint Commission(TJC) if they decide to unfairly punish her or fire her for advocating for a safe environment. The TJC is the accrediting agency that allows them to receive medicare and medicaid from the federal government.

http://www.jointcommission.org/report_a_complaint.aspx

She need not do that, however, the implication that she could and she knows where to file will raise their eyebrows and realize that she means business. The investigation alone will cause misery and $$$ to the extended care facility. Losing funding for Medicare and Medicaid would probably close them down.

The problem if she leaves is the possibility that the agency job does not pan out or has no benefits and she will have difficulty supporting herself. If she can live with you until things get better then that is an option you can discuss.

I am sorry times are tough and your daughter should be proud that she is an outspoken advocate for her and her patients safety. Hospital jobs are hard to come by. I would look hard and try any hospital within a 50 mile radius to apply to. I drive 55 miles one way to work and I know many nurses who have to do the same.

Good Luck!

---------- FOLLOW-UP ----------

QUESTION: She may have an opportunity to hire in at another nursing home.  My question is this:  About the temp agency job, she was told that many times the companies hire full time, is that true?  Will it get her face and work ethics noticed in case they hire full time down the road or will she be in a bad place because she was a temp and paid higher wages?  Basically will it work for or against her?  And thanks for the link.  Is it completely online?

Answer
Victoria:

Yes..the BSN and MSN are totally online. Mostly all paper writing and power point presentations along with questions on the discussion board to answer with her classmates. It is nice since its 24/7. I do most of my homework while at work during downtimes at 2-6 am in the morning.  

Going to another nursing home is probably a good idea now anyway since she probably will be scrutinized by management for bringing up the safety issue of her and her patients.

Sometimes, when the hospital uses agency and they like the nurse....yes....they can work deals with the agency to let her go to full time. The agency wants money as a buyout/finders fee from the hospital, however, most of the time the hospital pays as they get the nurse on as fulltime at a cheaper salary in the short run. However, the benefits are costly so many hospitals would rather just pay the higher hourly rate and not the entire benefits as a fulltimer.

So its possible to get a fulltime job out of an agency job. They dont hold the higher wages against the nurse as its common practice to have higher wages as an agency nurse. I actually did that fulltime for a few years. The agency drawback is the constant search for new shifts each week. You never know what your work hours are or what hospital they want you at on the particular day. Its sometimes covering a last minute sick call out from the hospital fulltime nurses.However, it builds character and diversity and the feeling that you can work anywhere at anytime and be successful at your job.

Ken

Careers: Nursing

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Ken , BSN, RN, CCRN, MICN

Expertise

I can answer questions regarding all aspects of Nursing as a career in general. If you need help deciding if nursing is a career for you, then let me help you with your decision. As an added bonus, I can answer your questions from the perspective of being a man in nursing who has a wife that is also a nurse. Men is nursing is more accepted today than it was when I began in 1993. Regardless of your gender, Nursing has so much to offer and is among the most respected professions of our time. I have been a registered nurse since 1993 and have been certified in Critical Care nursing since 1996. I am currently a full-time Critical Care Ground Transport Nurse/Mobile Intensive Care Nurse(MICN). I am working per diem as a night Shift Administrator/Nursing Supervisor.

Experience

My experience over the years since 1993 have been spent between the Emergency Room and the Critical Care Units. More recently since 2007 I have been working in Emergency Medical Services (EMS) as a Critical Care Transport Nurse/Mobile Intensive Care Nurse(MICN)/Emergency Medical Technician(EMT). This unit is known as the Specialty Care Transport Unit(SCTU). I transport all age populations with critical medical problems from Hospital A to Hospital B in the back of an ambulance. My job is to make sure this patient remains in the same or better condition and to handle any emergency that may arise during the over the road transport. BLS/ACLS/PALS/NRP/ITLS Certified Provider.

Organizations
American Association of Critical Care Nurses Honor Society of Nursing, Upsilon Rho Chapter, Sigma Theta Tau International

Education/Credentials
BSN,Nursing/Pursuing MSN in Nursing Administration Critical Care Registered Nurse(CCRN)/ Mobile Intensive Care Nurse (MICN)/ Emergency Medical Technician (EMT)/ AAS Business Management

Awards and Honors
American Ambulance Association-2009 Star of Life Recipient

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