Wednesday, May 31, 2006

In the Defense of Agency/Travelers/Temps...6/10

Had a lot of email about temps. There are good and bad, some are temps because of the situation like ours, some are because they like to be, and some are because they can't get hired any other way. This one seems like the first kind.

I read your comments about agency nurses and I would like to add some of my own, as well as steer you straight about we agency folk.

While it's true that agency personnel are temporary by nature, it isn't quite true that we have no vested interest in the patients in a certain facility. I am a former PRMC employee/refugee, currently working as an agency medical technologist. While I do not stay at any one place for longer than, say, 26 weeks, I do care about the quality of my work and how it affects the patients of the client facility I may be at. The same is true for most of the agency nurses. Granted, I have not yet found a place I care to stay permanently, and granted I have no desire to stay at my current post past my contract time, but one thing I pride myself on is turning out good work. I felt the same way when I was a former McCuistion employee, and even under the Christus and Essent regimes.

OK, so much for defending my career, now for some numbers:

I'm not sure how much agency RNs bring in on an hourly basis, but I can tell you that it costs the facility a pretty penny not only hiring an agency person, but add in the salary, insurance, per diem, car allowance, housing (paid for by the client in the fee paid to the agency) and whatnot, and it ain't cheap. Multiply that by all the agency folks contracted out by PRMC, and that's an awful lot of coin going out the door. As a contract medical technologist, I spent 20 weeks at the VA center in Augusta, Maine. I was told that the VA was paying my agency on average of 75 dollars per hour to have me there. I paid no bills or rent, my utilities were paid, and all I had to buy was food (and the occasional adult beverage if I desired), gas, and stuff for personal maintenance. RNs historically get paid more than medical technologists (could be all the P&Ming their group has done over the years), so I'll bet 75 bucks an hour is darn cheap- probably higher for the nurses.

Again, we are temporary- once our contracts are up, unless we get extensions we're gone. Training time (which takes up considerable amount of contract time), & money out the window, which has got to be invested for each new temp.

Here's an idea, radical tho it may be- spend the coin to improve the wage & bennie package, change the facility culture, and make the place more attractive to we allied health personnel to want to stay. I was happy during my time at McCuistion, and even tho we sniped with the St. Joe lab, we helped each other out when we ran short of certain reagents, let each other run specimens on our analyzers in a pinch, and had a friendly rivalry with little hostility. THR screwed that one up, resulting in the merger of facilities and eventual purchase by Essent.

It could be the only way to change culture is to change ownership.

I know- well, duh.......

PS- I know how to post to blogs and all, but the computer I use at work to answer email prohibits access to weblogs. My wife was kind enough to copy & paste some of the jucier parts & send 'em to me in an email. It's good to know that there are some other employees there in Paris that aren't bending over when Essent tells 'em to. Perhaps someday I'll tell you how I came to be an ex-PRMC employee, but for now keep up the good fight, and chinga Essent!
By the way, did I mention that I worked agency many, many, moons ago? When I was, I worked where I wanted to, because they wanted me. The ones that E$$ent wants...don't want them...Frank.


Anonymous said...

Great post! And I have been told it cost 95 dollars an hour per RN, by an ex administrator--and that was 6 years ago.

I too have been an agency nurse. I tried it after I left the cath lab.

Nursing skills isn't really the issue with agency. Its more of an efficiency thing. When you know the people you work with, and where everything is -- you can just get things done faster.

And lets face it. All hospitals don't do things the same way. Some hospitals will write you up if you don't use Nitro tubing on a pt with a drip---some hospitals don't even have nitro tubing.

There are so many little issues like that. You are asking for nitro tubing, and someone goes what's nitro tubing? You think--ok, they don't know--I'll ask somebody else. You've asked 10 people before you figure out--they really don't use nitro tubing.

It takes up time. Every hosptial has their own little peeves--and every hospital has issues that they may be lax on.

You set up for a chest tube with the regular set up---and no--this doctor wants the old pump and bottle.

Knowing your doctors, nurses and what they expect in each situation, takes time, and its aggrivating to everybody involved.

There are at least 10 issues that come up like that everyday. It takes your entire 13 week assignment to figure all of this out, and then it is time to move on.

You've probably wasted 16 hours of your assignment on these little issues.

Anybody working agency know what I mean? It doesn't matter how smart you are--or how much experience you have, you always feel like a Dumb A$$, because that's not the way we do it here. Or that's not the way Dr. so and so wants it done.

Anonymous said...

Not to mention the money issue here.

If you set up a hemovac-- and then the doctor wants an Emerson pump--you have wasted a hemovac.

I don't know how much they cost a piece--but I'll bet money they are not cheap.

Anonymous said...

Not to mention, if your a traveling nurse, and you try to stay ahead on current therapies, practices, etc... and you have been to advanced facilities, and then you go back to a smaller hospital with fewer resources, and you suggest something, they look at you like "your an idiot."

You might say something about evidence based practice--and be mocked for knowing something that they do not.

fac_p said...

The average employee costs about $5-10000 to replace. A portion of that is orientation. Add that to the cost for a temp, since they still have to be able to find their way to the coffee pot and other necessary locations. Each new temp is chipping away at E$$ent's profit and level of patient satisfaction.

Anonymous said...

You are so right fac_p. I still don't understand the rational for driving away worthwhile effecient employees. Many who could find their way around the entire hospital, for temps who cost so much more.

I don't understand why their aren't incentives for nurses to stay, instead of cutting pay. I don't see why they aren't begging them to stay instead of giving the BS that if you survive this merger you will be rewarded.

What the hell were they thinking?

For some reason I keep thinking with all of the "mistakes" that they have made, it fits some greater purpose. What's the greater purpose if the place goes bankrupt and the doors shut? I can't figure it out.

Workin4Change said...

Just heard yesterday from a PRMC nurse that HR isn't renewing the contracts of 40 contract RN's...though the truth is probably the RN's declined to renew on their own.

According to some of the "travelers" the only way they sign on for PRMC is to specify to only work in specialty areas, such as ICU or ER, where the matrix (patient load) is much lighter than on the regular floors.
They all agree working on the patient floors (3-7th floors) are hell! Everyone one of them had heard of this site and was quite excited to get the address so they could read and participate on their own.

Just makes me wonder how many new RN grads there were this year?

Here's another funny thing...Admin has offered the area in the hospital that finds the most "outdated supplies to return to materials" gets a pizza party!!

Whoo-hoo, throw that dog a bone!

Does this suggest that maybe whoever is supposed to keep up with this sort of thing isn't, so PRMC gets people who have their own jobs to do, to do it for them??

Give me a break, PRMC, clean that nasty hospital up and hire some people to regularly inventory what's out there being used on patients!!

Meanwhile, our patients keep getting referred to other facilites......

Anonymous said...

That sounds right, E$$ENT rewards the lazy employees for NOT doing their job of keeping a current inventory.

Anonymous said...

What's it going to be like when those 40 RNs are gone?

Anonymous said...

I don't know why anyone would think that the pt. load is lighter in the ER. You may have anywhere from 6-12 admits, and discharges per shift--plus drawing your own blood, doing your own EKG's, catheters, IV's, NG tubes plus all of the little specialty things like holding on to the pt while the doc pulls out a dislocation.

The floors get their patients with IV's, NG tubes, cathters most of the time.

Don't get me wrong. I like ER--but the work load is not lighter. I've done both.

Anonymous said...

Sounds right, E$$ENT will reward those employees who don't do their job, rotating stock and keeping on top of all supplies, reward the lazy ones.
Maybe next time, NEW CONCEPT HERE, party for the department that has no outdated supplies.
Encourage the positive
MGMT 101.

Anonymous said...

Pizza party, my gosh I guess we have went back to junior high.

That stock should be checked for outdates every month, in IV's, betadyne swabs, sterile equiptment etc...

When you don't have enough people to take care of patients. Who is going to have time to check for expireds?

Anonymous said...


If they did it that way--they would actually have to check for expired stuff themself. OMG

The lazy find a way to suit themself. They don't care if its negative reinforcement. It keeps them from getting of their butt.

Anonymous said...


If they did it that way--they would actually have to check for expired stuff themself. OMG

The lazy find a way to suit themself. They don't care if its negative reinforcement. It keeps them from getting off their butts.

Anonymous said...

I probably should've commented this on the "suggestions" post, but gee, we have all these stickers with you think anyone would get a clue and tag the supplies that they receive with the extra date stickers? That way using the oldest first is easier???? Who'da thought...

Anonymous said...

"The floors get their patients with IV's, NG tubes, cathters most of the time."

Yea we get them with IV's in their Left AC...with perfectly good distal the poor pt has to AND wants to be stuck again so that the damn pump will quit beeping and the IV will stay good with the pt actually getting the prescribed fluids.

We drop 99% of our own NG tubes because those orders are on the admit orders, not the ER orders. So even tho the pt needs some decompression to relieve the nausea with a bowel obstruction they dont get that until they come to the floor.

I will say that I do put in few foleys, those do get done in ER. But then again with them being so busy they dont have time to help someone to a BSC.

Anonymous said...

If admin would let the materials mgmt people stay for more than 4 hours on the weekends they would probably have enough time to check the inventory for expired items. BUT Linda, Stacy, Betty, Larry etc are working their tails off just to keep the floors stocked in necessities, which I for one appreciate. Dont tell admin but some people cont working off the clock when teh 4 hours is over just to make sure that their floors are stocked. And God forbid you have to ask house to go get something for you, they usually just tell you to go to another floor and ask if they have it. But then again we really cant expect Suzy to slam all the floors with simultanious admits, while needlessly swapping, LCing, floating staff AND go to materials for us...

Anonymous said...

Ahhhh but aren't the nursing schools graduating now? So.....40 new-fresh-outta-school nurses!!

Anonymous said...

Ahhhh but aren't the nursing schools graduating now? So.....40 new-fresh-outta-school nurses!!

4:39 PM

Yes 4:39 PM the nursing schools are graduating now. Just one problem; most do clinicals at PRMC. Do you really think they are going to work there after that experience? If they do how long will they stay and how many will just be there for a little experience before moving on? Oh yeah and with all of the high and mighty super nurses that can't remember that they were once new grads, well it seems like they don't want any new grad help. Just look at all of the posts putting down new nurses. Why would any "fresh-outta-school" nurse want to work in a place where; not only does the facility cut their throat for money; the staff stabs them in the back because they are new?

Anonymous said...


I hope your saying this is a fairly recent development, within the last year and a half. I don't really know how they do it on days, but I do know at night, we did have IV's, foleys and Ng tubes started on the ones that needed them, and the first antibiotic, and whatever drips they needed. The ABG's, EKG's, and lab work was done by us as well.

The reason the distal veins were probably good, was probably because they were rehydrated in the ER. AC usually mean they didn't have anything else when they arrived, which could have been hours before because it usually took us that long to get a room.

Anonymous said...

I can't believe that 40 new nurses would do that to themselves. Ah the naievety of it all.

Anonymous said...


Another reason you may have AC veins, is if the EMS started the line in route to the hospital.

It's one of the biggest veins, and it is better to push large amounts of fluids through, and if you have to give caustic injections such as lasix, phenergan etc. its less likely to have problems than a smaller vein.

Have you tried an armboard?

EMS and ER start IV's on many patients. Some pts are admitted, some just get IVs for fluid or medicine. It's not like on the floor when you start them, you already know that you are going to have to give blood, and you are going to need an 18 guage.

Most of the time-the EMS and ER don't know what they are dealing with until the lab comes back.

Anonymous said...

"New Grads"

PJC had 46 RN students and 68 LVN students graduate. Some did go to work up at PRMC, but lots of us did not, and WILL not.

Students get to see it all. We see how the Admins treat the staff Nurses, and how the staff nurses treat the travelers, and us students when we were there.

That was the main reason I chose not to work there. I learned nurses really do eat their young. They could blame it on being over worked, and underpaid, not having time to share their knowledge. (even though there were times when we students had every pt on the floor, and nurses only had to go and handle IV's and IV meds.. but I understand they didn't have the time)

I seen how they treated a traveler on her first day there. No one would even say good morning, or introduce themselves to her, and dumped on her all day. I can understand you resent them paying so much money for a traveler instead of putting that money into raises, bonuses, and elsewhere where needed. Take that up with administration, not OUT on the travel nurses. That's just rude, and does nothing but make everything administration is doing to the staff nurses just desserts in my book.

Bitching and moaning never solved a problem. Neither has being rude and mean to those who have done nothing to you other than breath the same air as you. So I say to the staff nurses who are doing a good job, giving it 110% with a smile on their face, and being polite, and using a team spirit to provide pt care. Keep up the good work, and I hope it gets noticed, and you get a proper reward. To those who don't give it 100% and try to infect those around them with their own misery, I too hope you get noticed, and get your proper reward, for you have no business in nursing, for you have lost the first tenent of nursing. Nursing is caring! Caring includes not only for the pt, but for those with whom you work with to care for the pts.

A recent PJC LVN student!

Anonymous said...

I read with interest/disgust your account of how travlers are treated by the "homeguard"folks. As a healthcare professional, as well as a traveler in my chosen field (lab), I find that belittling. All that money E$$ent pays out to their agency does NOT go to the temp= we/they only get wages, per diem, etc. More than half goes to the agency. Look it up.
As for professionalism- don't go there. We'll match professional attitudes any day, any place, any time with the most dedicated Homeguards and size up even, thank you.

And in reading about how travelers are treated, and knowing firsthand how PRMC/E$$ent treats its "homeguard" employees, it's no wonder the temp RNs are moving on. Yes, it may be cheaper to hire new RNs' but why ruin their careers by starting out at such a place? And I'm not picking on the employees, but on PRMC and E$$ent brass.

You're right- no two hospitals do things exactly the same way, regardless of department. The basic skills are pretty much the same, but the Way Things Are Done Around Here do vary.

Don't be hatin' on the travelers, regardless of who we are- we;re just as skilled as you homeguards.

That 95-dollar-per-hour fee for temp RNs sounds about right-multiply that by the 40 RNs (after inflation adjustment)< and E$$ent is paying massive amounts of coin.

But as I said earlier, it's a culture thing. and E$$ent doesn't understand.......

Anonymous said...


I hear your irratation. Dr.'s do it too.

It's like See how smart I am, and how dumb you are. I think some of it comes from them being treated that way when they were students and new nurses. They think its how you are supposed to treat newbies.

So new grads be ware. Don't let this happen to you. 2 wrongs don't make a right. It just makes more wrongs. Find a nurse advocate and a good nurse to follow so you can learn the right way to do it.

If they are treating new nurses this way, you can bet they are doing other things the wrong way too, because that is the way they learned them. They may have learned from a burn-out who's give a s--- is a quart low, or they may be a burn out themselves.

Don't do this to yourself or your patients. If you can't find a pt/nurse advocate that is a good nurse, don't work there. Its career suicide. You will be infected from the get go.

P.S. I have even seen this attitude in RN students because they were taught by these infected nurses.

Good Luck and God Bless------

Anonymous said...

If you have read this blog site--you know that the issues here go deep. There have always been some petty gripes between departments, and hospitals (there were 2-now we are joined) but nothing like the finger pointing and the burn out that we have now.

Yes, mergers are always stressful, but I've been through them before, but this one has been devious.

No one communicates because no one trusts anyone else. Every department seems to hate every department.

No one understands the other's job, and don't care. The other departments just bring them work.

Agency is the enemy instead of the God Send that they should be reguarded as--because their friend--or friends were fired or let go, or quit, and now they have a new person to take their place, getting paid more than their friend was etc... and they know if they are making more than minimum salary their job as at risk as well.

New students are reguarded as dogs because they filled their friends spot, making less money than their friend, and not knowing as much as their friend did.

It's like this big hostile picket line that everyone is crossing, without being on strike. Everyone is the enemy instead of the team mate that they need to be.

This is what has happened here. No one even can stick together enough to get a union started, because no department trusts another, hardly any nurse trusts another.

Patients don't trust nurses etc...

It has basically ruined our hospital and community. It started with the"lets get the salaries under state and national level" and has ended in distrust, and distaste for Paris.

Anonymous said...

What makes you think a union is an answer? Even back in the Bible, Jesus said that one man cannoy serve two masters- he'll wind up hating one or the other.

Last thing Paris needs is an outside bunch getting the employees to strike, making patient care suffer. Haven't the good folks of the area suffered enough?

Just my opinion......

Anonymous said...


We can't strike here. It can't happen in Texas, but with the union, you have someone keeping administration honest and doing what they say they are going to do. And you have someone to take grievances to, instead of suffering in silence, because if you speak you lose your job.

The Bible does say you can't serve two masters. God is the only one. You can't serve money and God--that's 2 masters. I also believe that to be true.

Have you not found it hard to take care of the patients the right way under Essent. It's almost like serving 2 masters. Trying to keep administration and Pts. happy is an impossible task.

However your not serving a union. A union is serving you. Your not under their power--they are working for you, helping you to take care of patients.

Anonymous said...

I agree with all of your post with the exception of the following statement:

"However your not serving a union. A union is serving you. Your not under their power--they are working for you, helping you to take care of patients."

The union doesn't work for the employees. The employees ARE the union. It would be us as employees helping the patients and providing a level of security for ourselves. There is power with numbers so lets work together and do it for ourselves and our community. I, for one, think that a union is the only way to make a positive change for patients and the employees alike

Anonymous said...


I wish everyone could understand that the union is creating a better team. A team that will back you up when you need it.

Anonymous said...

To "I agree..."

You are right and wrong. The LOCAL is the employees. But the union does work for you. You draw on its vast network of knowledge and resources. Your union will supply you with legal advice, and if necessary, legal representation (probably at a fee your local would pick up). Your officers will go to seminars, conventions, caucuses where they would meet other local officers that have been through this before and you will learn from that. Eventually, after you have made it through this, you will be the ones giving advice and helping others through trying times.

While the employees may be the local, your union definitely works for you. If it didn't, there would be no reason to organize.

Stay on track. You're headed in the right direction. Don't just talk about it. Do it.

Good luck.

Anonymous said...

When travelers are used as a hammer against the staff, or as an alternative to regular staffing, rather than as filling in the normal gaps, the general feeling is not of welcome....

Anonymous said...

OK 1005

We basically agree. The real question is is it worth my time to contact an organizer? In other words are there enough supporters that would sign cards so that we could have an organanizing effort now, and would there be enough votes in the end to get the required 50%+1 needed to win a union election?

Maybe FAC_P should post this as its own topic and let the readers decide. If the majority wants it I will step up and contact a union organizer.

Anonymous said...


That was an excellent explanation! One thing good about talking about it is to get the word out, and dismiss people's fears about unions. You have to have the majority of the vote of hospital employees.

It's my understanding that Tyler was voting on union recently and lost the vote by a very small percentage.

It's because some people have the wrong idea about unions, and they get the wrong idea by administration mostly---they don't want it. They can sure get by with more if no one is there getting in their business, and keeping them honest.

Let's say the Employee handbook says that they will pay for education related to your job. Your working 3rd floor and you want to take ACLS. The hospital says no we aren't paying for it, and we can't let you off to take the class.

You file a grievance with the union. They look at the handbook. They see it is what is best for the patient- you, and the hospital in general. They get you the class and the days off to take it, and even pay for your time in the class.

You don't have to fight. You don't have to worry about getting fired for it. It's best for your pt, you and the hospital.

What about the uniform colors? Administration says if we work in one area, we must wear a certain color. This is a big issue if you are new to the hospital--because you have to go out and buy these uniforms. The hospital doesn't pay for it. The colors doesn't help patient care in any way. In my opinion its just a control issue. But the union would look at that and could settle a deal to where the hospital is either paying for the uniforms, or the dress code is changed to more fit the needs of the hospital and its employees.

These are trivial issues actually compared to some of the ways that a union could help out.

What if census is low, and administration is wanting you to get off of the clock, and carry a beeper, and respond back to the hospital on a 20 min. notice if census picks up, and they are going to pay you very little, if any at all for this. The hospital needs to realize that they are paying you for knowledge as well as service in some areas such as the Cath lab and ER, and you must get your 40 hours a week to meet your family obligations.

Now the union could negotiate a deal where you can get your hours, maybe by working in another area, or doing QA for someone, or some other way to get your hours other than coming in to the hospital an hour at a time, covering their busy times--and having to work or be on alert to work all of the time just to get 40 hours a week.

Its really just keeping it fair. If they hired your on a full time basis, and you are not getting full time hours--something has to give.

Nobody wants to work in Paris because they are sick of not being treated fairly. The union is just keeping it fair. And the people in the union does not want the hospital to shut its doors, so they aren't going to negotiate deals that will put the hospital in jeopardy financially.

If Essent isn't smart enough to find ways to cover the cost of treating employees fairly-- then they don't need to be in business anyway. I'm not working to keep a CEO in a Mercedes or a Jag. I'm working to feed my family, and take care of pts.

Anonymous said...

OK, that's a fairly convincing argument. Main reason I'm not a big proponent of unions could be some of the bad rap some union bigwigs have recieved- that is a problem with me.

But since I'm no longer a PRMC employee (can you say "railroaded" by the CFO and the ER nurse, bypassing all the discipline procedures?), I obviously cannot vote either way. If I could, I'd vote yes- reluctantly, but yes.

Uniforms- geez, I mothballed five scub suits and had to go buy 5 more in the navy blue (lab's chosen color), which at the time was not a big cash problem, but then again I wasn't making a phlebotomist's salary. The handbook speaks of diversity- why not expand it to include scrubs, and discard the silly one-color-per-department rule?

And while I'm here, may I remind you that there are NOT two hospitals any more- it is ALL ONE FACILITY. The Civil War is over, and thanks to E$$ent both sides lost. We aren't the enemy, no specific department is the enemy- the enemy has representatives in the front offices on the first floor, and at corp. HQ in Nashville. You guys need to stop P&Ming and stop swinging the oars at each other, and put 'em in the water and all row TOGETHER.

And for God's sake, stop being hostile to the travelers- they're just as professional, and they're there because nobody else want to work permanent at PRMC except you folks who are tied so deeply into the area you're stuck there. The hostility doesn't help at all.