10 Things To Be Aware Of If You're Thinking Of Working As An Agency Nurse

"While working as an agency nurse, you represent the nursing profession, the agency you work for as well as all agency nurses." - Josephine Amoah, RGN Band 7

Working agency shifts is fun and creates opportunities for networking, learning and earning some decent wages. These tips will help protect you and your NMC Pin number while you’re doing that!

Topics Covered In This Article

Introduction

1. Choosing The Right Nursing Agency

2. Be Aware Of Umbrella Companies!

3. Accepting Shifts

4. Know Procedures For Emergency Situations And Essential Contact Numbers

5. Your Behaviour While On Shift

6. Query Prescriptions If You Are Unsure

7. Improve On Your Nursing Clinical Skills

8. Find Out What You Can And Cannot Do At The Start Of Your Shift

9. Ask To Be Taught New or Unfamiliar Procedures

10. Document! Document! Document!

Introduction

During the past 10 years of my nursing career, aside my permanent job, I have also worked as an agency nurse in many different settings including acute (NHS) hospitals, community hospitals, hospices, and nursing homes.

Working as an agency nurse provides me the flexibility of when and where to work agency shifts.

I have come across many agency nurses on my agency nursing journey; the good and the not-so-good.

Below are 10 pieces of advice that I would give to anyone who is already working as an agency nurse or considering agency nursing.

1. Choosing The Right Nursing Agency

When deciding to sign up with any nursing agency, do well to ask around. Ask other agency nurses about the agencies they work with; their pay rates; training and support provided.

Do not choose an agency just because of the high pay rates they offer; look for more from them.

Also, learn to set boundaries with the agency. Let them know the types of areas that you will or will not work in and why.

Tell them how many shifts you can do per week and why, so they do not bother you with phone calls and texts on days when you choose not to work any shifts.

You need a good rest between shifts so again, do not feel pressured to accept shifts if you are already too tired from working.

Remember, the more tired you are, the more likely you are to commit errors. Also, you are unlikely to provide safe and quality care to patients if you are too tired.

2. Be Aware Of Umbrella Companies!

Most nursing agencies pay their nurses through the Pay As You Earn (PAYE) system, where tax and National Insurance (NI) contributions are deducted before you get paid.

Other nursing agencies who do not have the PAYE system in place pay their nurses via umbrella companies; some use a particular umbrella company while others ask you to find an umbrella company of your choice.

There are different types of umbrella companies around, each with their own weekly fees and offer of “guaranteed take-home pay” for nurses.

Shop around when it comes to umbrella companies. Some will offer you 85% and above take-home pay.

Be on your guard though as some of them are unscrupulous. Most recently, I heard stories that some umbrella companies were deducting taxes from agency nurses’ pay, but the taxes were not forwarded to HMRC. So, in the end, HMRC was chasing those nurses involved for their unpaid taxes.

It is your responsibility to pay the right tax to HMRC. Paying the wrong tax could get you in trouble with Her Majesty’s Revenue & Customs (HMRC), even if it is the fault of the umbrella company. Read more about umbrella companies and taxes here.

To avoid any surprises, ensure that whichever umbrella company you decide to sign up with is transparent in its services, fees, the amount of tax you will pay and your weekly take-home pay.

3. Accepting Shifts

When deciding to accept / work shifts offered by your agency, do not feel pressured: accept shifts only if you feel up to it, and if you feel you can provide safe care for the patients.

This might be hard when you have not worked a shift at the hospital or care home in question.

But if it is a place where you have worked before and you feel the environment is unsafe, you have every right to refuse the shift.

In fact, if you turn up to a shift and you find out that the staffing level or conditions are unsafe, you have every right to refuse to work the shift (after informing your agency, of course!)

I personally have refused to go back to some healthcare organisations to work agency shifts after I had worked shifts with them.

This was mainly due to the unsafe conditions in which me and other staff had to work in.

Working in such conditions meant that patients’ care was compromised in one way or another. At the start of this year, a nursing agency that I used to work for contacted me out of the blue to offer me shifts in a local hospital.

The contract was to work on a dedicated covid-19 ward, which was full of covid-19 positive patients. Being a BAME nurse and knowing I was at high risk of contracting the virus, I politely declined to work on that ward.

The booking consultant tried to convince me and even offered me £38 / hour, just to get me to work the shifts for them. Again, I declined the offer and thanked them. I also explained to the booking consultant that, whenever I accept shifts, its not all about money, but also about my health as well providing safe care for the patients.

Some hospitals or care homes have not-so-great reputations, so nurses tend to avoid accepting shifts in these organisations. You need to stand your ground when it comes to accepting shifts from your agency.

The bottom line for many nursing agencies is money; the more you work, they more money they stand to make.

So, there are some agencies who may not be as concerned about the organisation they are sending you to as you are.

You may not get offered many shifts if you keep declining shifts but at the end of the day, you cannot be forced by the agency to do so.

Remember, you are in control! Always have it at the forefront of your mind how hard you worked to get your Nursing and Midwifery Council (NMC) PIN.  This will help you when it comes to deciding which shifts to accept and which ones to refuse.

4. Know Procedures For Emergency Situations And Essential Contact Numbers

Two of the most important things you need to be aware of when attending for an agency shift is to firstly know emergency procedures for that department. This includes knowing the locations of resuscitation trolley/crash trolley, fire call points, fire panels, fire extinguishers, fire exists as well as other emergency equipment.

Secondly, you need to know essential contact numbers for doctors on call for that shift, resuscitation and outreach team or the manager-on-call if working in settings such as a care homes.

Phone numbers are usually posted on walls at nurses’ stations but some of these phone numbers are not always up to date.

The best practise is to ask the nurse-in-charge for the numbers when you attend your shift.

Also familiarise yourself with the bleep system of that organisation as it may vary slightly between organisations.

5. Your Behaviour While On Shift

It is quite easy for agency nurses to have an I’m-only-an-agency-nurse mindset. But remember that while working as an agency nurse, not only do you represent the nursing profession, but you also represent the nursing agency you work for as well as all agency nurses.

What you do or otherwise can have positive or negative effect on the perception others have of other agency nurses who work in that organisation.

Unfortunately, agency nurses have gained a some-what bad reputation, mainly because of the behaviour of some agency nurses when they attend for shifts. When agency nurses have bad behaviours or under-perform while on shifts at an organisation, this may be reported to the organisation by the Ward manager.

The organisation then can decide to stop the particular agency nurse working shifts for them, or in extreme cases, they may decide not to use the nursing agency again for their staffing needs.

The nursing agency may gain a bad reputation if this is to occur.

Always endeavour to remain professional and uphold the reputation of the nursing profession as well as the nursing agency.

6. Query Prescriptions If You Are Unsure

If you are unsure of a prescription, either the dosage or the unit (milligrams, micrograms, litres, millilitres etc), do double check with another nurse, the prescriber, or the doctor.

Recently I was on a shift with another agency nurse who questioned a prescription and found out that a higher dose of the medication was prescribed by mistake.

The patient had high potassium levels in their blood and to help correct that, the patient was prescribed Calcium Gluconate 10 % w/v Injection BP which comes in as 2.25mmol of Calcium in 10mls ampoule. The usual prescription is one ampoule, but the prescriber had prescribed 9mmol, which would have meant giving the patient 4 ampoules of the medication, instead of one.

The agency nurse double-checked the prescription with me, and another agency nurse and we both agreed with her that the prescription was incorrect. The agency nurse then contacted the on-call Senior House Officer (SHO), who then agreed that the prescription was incorrect and prescribed the correct dosage.

7. Improve On Your Nursing Clinical Skills

Due to the nature of nursing these days, nurses are expected to and do carry out lots of skilled nursing tasks such as venepuncture, cannulation, urinary catheterisation, Arterial Blood Gas (ABG) sampling, Blood Culture collection etc.

If you realise that you tend to get more shifts on medical and surgical departments or other clinical areas where nurses are expected to have these skills, ensure that you are competent in these and other required skills for those type of clinical settings.

If you do not possess those required skills, you could always ask your agency if they provide training for them. If they do not, then you may have to self-fund such training courses. The more skilled you are, the more clinical settings that you can work in.

Remember: Do not perform any skills/tasks that you are not competent in.

8. Find Out What You Can And Cannot Do At The Start Of Your Shift

In some healthcare organisations, especially hospitals, agency staff are not allowed to perform some nursing tasks.

Examples of such tasks are flushing or administering medications through Peripherally Inserted Central Catheter (PICC) Lines or insertion of urinary catheters.

At one of my recent shifts, one of my patients became unwell and needed a urinary catheter to be inserted. As I got my trolley and catheterisation equipment ready, one of the agency nurses I was working with stopped me and explained that, in that Trust, agency nurses were no longer allowed to insert male urinary catheters due to an incident which involved another agency nurse. Previously, when I had worked shifts at that Trust, this was not the case.

These types of restrictions are normally imposed on agency nurses due to some negative incidents that had happened in the past involving agency nurses.

Whenever you attend a department or ward for a shift, make it a point to find out from the nurse-in-charge which tasks you can and cannot perform as an agency nurse.

9. Ask To Be Taught New or Unfamiliar Procedures

While working agency shifts, you are likely to come across procedures that you are unfamiliar with.

Some procedures are unique to particular wards or departments. For example, you will find patients with merit bands on a Cardiac Care Unit (CCU), patients with tractions on orthopaedic wards or those with tracheostomy on Ear, Nose and Throat (ENT) wards.

Make it a point to ask the staff at the department to show you how new or unfamiliar procedures are performed.

This is one of the surest ways for you to learn on the job. You may not become an expert at those procedures but at least you may gain a working knowledge of them, which may help you in your future assignments/shifts in other areas.

10. Document! Document! Document!

The importance of documentation cannot be emphasised enough. Document conversations that you have with patients, substantive staff members on the ward and the ward doctors.

Wherever possible document the names, time, and date that you had those conversations.

Document orders you take from doctors, lab results that you receive from the lab or instructions that you received from the CT or Xray departments as well as any incidents that occurs on your shift. It is better to over-document than under-document when working as an agency nurse.

You may just be working on that ward for just that shift and may never return to work there again so there is no way of defending yourself if there is any investigation and your documentation is found to be wanting.

Conclusion

Working agency shifts is fun and creates lots of opportunities for you to network, learn new skills and earn some decent wages on the side.

So, being mindful of the above and being self-aware will help protect you and your NMC Pin number, always.