top pros and cons of agency nursing.

Nurses are one of the least professionally fulfilled groups in the country – with 45% describing themselves as unfulfilled. After all, once you’ve trained as a nurse and spent years gaining experience, it can be a difficult decision to change what you do. Clearly, you can change where you do it (you can of course change job) but, if you’re looking for a bigger change, you can always modify how you do it.

What are your nursing options?

In nursing, you can work full-time as a salaried nurse, you can work part-time, you can work for an agency, or you can supplement your normal salaried income with agency shifts, blending the NHS and agency work.  It is possible to be the master of your own professional destiny. Choosing which of those to do can have a profound effect on your professional wellbeing and job satisfaction.  

The best 10 things about agency nursing.

  1. Agency work is much better paid.  Your hourly rate could increase by as much as 66% and could double if you are prepared to work antisocial weekend night shifts.
  2. You can also pick and choose when you work.  You aren’t subject to a 7-week rotation which will probably include some nights and some weekends.  Don’t fancy dealing with the drunks on Friday night? No problem.  
  3. Not only can you choose when you’ll work, you can also choose where.  Don’t like that GP’s practice? Don’t take the gig. Life’s too short to work somewhere ghastly if you don’t have to.
  4. And you can leave a lot of the stress behind.  Working as a salaried nurse can leave you feeling stretched too thin.  In extreme cases, that leads to burn out. There might be less stress in agency life.  There is, frankly, less responsibility and less pressure. 
  5. You don’t have to worry about the politics of working in a team.  At the end of the day, you can clock out and go home.
  6. It’s also a different sort of work because you’re going to spend your time doing actual nursing.  Did you get into the profession to spend your time emailing the CCG? To handle complaints? For the stocktaking?  
  7. That’s not to say there’s no variety.  Working in agency, you are going to enjoy a much greater diversity of co-workers and patients. 
  8. There’s also less management in agency work, too.  “I hate looking after nurses – they’re crazy” one (particularly honest) practice nurse told us.
  9. Even if you suspect agency work isn’t for you in the long-term, it can be a great way to try out different working environments when you move to an area.  Katherine Wolf, a rehabilitation case manager living in East Molesey near Hampton Court, says she used agency work to test out different places to work when she moved to London.  “I left home to study for my BSc in Nursing at Leeds Metropolitan. When I graduated I moved back down south from Yorkshire, but I didn’t know where I wanted to work. Once I was in London, I spent a good six months undertaking agency work to get a feel for all the hospitals.  Eventually, I found a ward I liked, where a full-time position was open. I became a staff nurse at St Thomas’s and was very happy with my decision.”
  10. If you decide to go permanent somewhere, you might find you’ve already learned a lot.  “At the start of my career, being an agency nurse turbo-charged my professional development.  It helped me become a more confident and capable nurse,” says Queen's Nurse Liz Cross, a non-medical prescriber and an advanced nurse practitioner working at Attenborough Surgery in Bushey.  “I’ve gone on to win an NHS Innovation Award, trialling CRP point of care testing in general practice to reduce inappropriate prescribing of antibiotics. It might have been 18 years ago, but I feel that my agency experience has served me well.”

What are the downsides to agency nursing?

Of course, there are plenty of reasons to stay as a full-time, salaried member of staff.  

  1. Rather than having to decide how to save for your pension yourself, the NHS will do that for you. 
  2. Full time nursing jobs are predictable in terms of hours.  You might not like the shifts but at least you can make plans; you’ll know what you’re up to a month in advance.  As an agency nurse, your job depends on other nurses calling in sick. You might only find out if you’re going to work late the night before or on a 5am call that day.  It’s unpredictable – and when the work does come in, it may not always be when you want it.
  3. You’re part of a team and can build up a rapport with those around you.  Agency life can be a little lonely in comparison. It’s a somewhat transient existence – although, much as we may prefer not to admit it, it’s worth remembering that not all of us are team players.  
  4. As a salaried nurse, as well as your colleagues, you also know your long-term patients better.
  5. Full time, you have a better understanding of the infrastructure in your workplace: the way the department works, the procedures, the systems.  Of course, if an agency nurse gets to work for a long time on a ward, or gets repeat bookings at the same place, they’re going to feel that, too.  But it’s not something you have to consider as a full-timer.
  6. Less obviously, you don’t have to worry about selling yourself when you’re a salaried member of staff.  If you want a repeat booking as an independent contractor, you need to come with your game face on. As one nurse said, when we spoke to her, “Given you are going to take up a chunk of the senior nurse’s time and you want more work, it’s only prudent to be exceptionally nice when you turn up.  That’s a consideration.”
  7. As an agency nurse, you might find that you get a bit of a frosty welcome when you arrive for your first shift.  There’s a certain amount of resentment at the start of a contract and agency staff can find themselves on the back foot when they arrive on a ward.  Other nurses can be rude to you simply because they know that not only that they are going to have to help you – but that you make more money than they do for doing the same job.  
  8. On your first shift, you might not going be as much help as a permanent member of staff you are filling in for.  The regulars will probably have to hand over the easy jobs to you and focus on the difficult stuff themselves. Doctors are going to gravitate to the regular staff, rather than you.  They’ve been there longer, possibly with a good reputation, or at least wearing a familiar uniform. No one knows if you’ve done a particular task before. Because you don’t have an established reputation you’ll need, at best 90 minutes to show that you know what you’re doing and that that you’re capable.  At worst, it will take you a shift to demonstrate you’re one of the good guys. Knowing that’s coming can be daunting. Of course, it’s not always like that. When you arrive, you are a fresh pair of hands. Sometimes, you’re the cavalry.
  9. Insurance is also becoming increasingly costly.  You have to fork out an extra £1,000 a year in insurance as an independent contractor.  That’s going to cost a great deal on your hours.
  10. Finally, there’s the media.  NHS nurses get a pretty good press.  Sadly, the papers don’t extend the same courtesy to agency nurses.  Just remember that agency nurses are filling a need. The number of unfilled NHS nursing posts in London alone is just shy of 9,000 and vacancy rates at 13.5%, remain stubbornly hard to fill.  The NHS wouldn’t be using you if they could recruit and retain the nurses that they needed. But they can’t.

Can I have the best of agency nursing and be a salaried employee?

A blend of salaried work and agency work, working a full-time job and supplementing your income with a few extra shifts, can be the best of both worlds.  “For a time, I used agency work to complement my salary.  Well, for shoe money!” says Liz.  Your NHS salary makes it easy to get a mortgage while the extra cash from a few extra shifts means the monthly payments don’t feel like too much of a stretch.

It also means you can have your cake and eat it from a personal brand point of view.  Working for the NHS offers a certain kudos. “The NHS is a popular organisation and I want to be an NHS nurse.  I wear that badge with pride” says Liz.

Lastly, there are fewer formal opportunities for learning and development when you’re a full-time agency nurse.  As an independent contractor, you’re responsible for buying and sourcing your formal training. If you don’t keep on top of that, it can lead to professional stagnation.  But retaining your position as a salaried nurse means the NHS will continue to sort out (and fork out for) updates, courses and core modules. Learning new skills at work can make you more engaged and improve your job satisfaction.

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