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News Analysis: Is it worth working as an agency nurse?

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Agency nursing has been under scrutiny in recent weeks after it was revealed that a hospital paid more than £120 an hour for an agency shift. But as NT highlighted, this rate was paid under special circumstances and is certainly not the norm (NT News, 12 February, p4).

In fact, agency nurses face problems that are unique from other members of the profession.

Gail Adams, Unison’s head of nursing, explains that while many may be considered well paid, they do not have equality in terms and conditions with their NHS colleagues.

‘The difficulty is that agencies are themselves independent sector employers and they have the flexibility to set their own rates, terms and conditions. Sometimes [nurses] lack support,’ says Ms Adams.

Josie Irwin, RCN head of employment relations, agrees. ‘Permanent workers are protected from unfair dismissal but that is not the case for agency nurses,’ she says.

There are also suggestions that training provided by agencies is not up to the standards of that provided by trusts. Agencies are legally required to provide basic training – but nurses report this is often insufficient.

Sally Powell, an agency nurse from London, says: ‘In hospitals nurses get their mandatory training. But the agencies just push us through. Their knowledge is very poor. They think that what they need to do is put somebody in front of a computer and that is training.’

Agency nursing also requires extra skills that are not taught by either the agency or hospitals.

Nurses wanting to do agency shifts have to be able to think on their feet and quickly familiarise themselves with their environments – skills that are gained through experience.

Ms Powell says: ‘You have to map things out immediately – you are not given all the information that you need, you have to find that out within the first 30 minutes. If you don’t do that you have problems. It is no good saying after six hours: “I don’t know where that is”.’

Ms Powell adds that agency nursing may not suit everybody because of the pressures working shifts in unfamiliar surroundings and with unfamiliar colleagues can present.
‘You have to be unflappable… and have to get a feeling for the team. You have to be quite a strong personality – it is not for the faint hearted,’ she says.

However, this week NT outlines new details of planned legislation that, if introduced, could ease the lot of agency staff (p4).

A private member’s bill currently before parliament states that all agency workers – including agency nurses – should be treated in the same way as their permanent colleagues.

In proposing the bill Andrew Miller, Labour MP for Ellesmere Port and Neston in Cheshire, hopes to increase the pressure on the government to improve agency workers’ rights.

As a private member’s bill it is unlikely to become law on its own but parts of it could be tacked on to stronger legislation – and at the very least it will raise awareness of the issues facing agency staff.

Mr Miller’s bill includes measures originally proposed by the European Agency Workers Directive, a piece of legislation that has been opposed by the government because of fears expressed by business groups that its implications for pay would damage the UK’s economic competitiveness.

But unlike other agency staff, nurses are already well paid within the profession. Nevertheless, as NT revealed last week, headlines suggesting that hospitals regularly pay agency shifts at £120 an hour are wide of the mark.

Royal Chesterfield Hospital NHS Foundation Trust was at the centre of that particular controversy, which was sparked by a Freedom of Information request from the Conservative Party. The high rate the trust had paid was actually to employ a senior sister in A&E on Christmas Day when no bank were available to cover a sudden sickness absence.

Data from the same request revealed that, on average, agency shifts are paid at £15.66 per hour. A report published last year by the Commons public accounts committee put this figure at the slightly higher figure of £19.11 – based on calculations by the National Audit Office. This compared with £14.84 for a permanent band 5 nurse, £13.83 for a bank nurse and £13.51 for an NHS Professionals’ nurse.

‘Agency work is quite well paid,’ Ms Powell told NT. ‘If you were to do this job without an agency you would have to set
up your own limited company.

I don’t think everybody has that kind of nous about them.’

The main concern raised in the public eye about agency nursing rates has been their cost to the health service. This is a particularly contentious issue while trusts are under pressure to stay in financial balance and cut deficits.

The public accounts committee report said that trusts were still making too much use of temporary staff as a whole but noted that the use of agency staff was now falling. Trusts reduced expenditure on agency staff from £330m in 2003–2004 to £240m in 2004–2005, the report said, adding that this trend appeared to be continuing in 2005–2006 and 2006–2007 (NT News, 12 June, p3).

According to Ms Adams, the main problem is that hospitals are failing to plan ahead for sickness and holiday leave – and agency spend increases as a result. ‘Sometimes organisations underestimate the amount that they should allow for sickness in order to cut their financial expenditure in the short term. But in fact all you do is increase your agency cost,’ she says.

Even agency nurse Ms Powell agrees that many hospitals could be better organised in the way they use temporary staff.

‘It always surprises me how many agency nurses are working on the ward with me. It is a much higher rate in A&E,’ she says. ‘I can’t fathom out why. Perhaps wards could have sorted it out a bit better.

Despite arguments over cost, it looks likely that agency nurses are here to stay. For many hospitals they are an essential resource when permanent staff call in sick.

The new bill opens up the debate on whether they currently have adequate employment rights. It is due to be debated in the Commons on 22 February.

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