When I retired from office nursing I still wanted to work part time, so I signed with an agency to do PRN work. The pay was attractive but the reality was almost a horror story. For a few weeks I worked in an urgent care center and it was just like office nursing and I loved it. Then the gal I was replacing came back from maternity leave. My next assignment was to a unit in a local nursing home! It was insane!  I went an hour early to get the lay of the land and the RN in charge immediately started barking orders at me and told me to pass meds..she was way behind. I had 42 patents and two aides (one of whom just got out of drug rehab ,she told me and they both were never found except out in courtyard smoking!) I did not know where anything was..the RN from previous shift threw the narcotic keys at me and left as soon as the clock said she could. She didn't even check narcotics with me!! That was OK as I didn't know where they were!!!

On my second round of meds, I saw a light from a doorway, but did not have that room on my med sheet! I peeked in and found a man  ON A RESPIRATOR, lying in the bed. No one was with him and I had no idea he was there! Turns out an agency was suppose to supply a temp to sit and care for him. No family around, no one! I almost fainted!!  I had two patients with sub clavicians that were supposed to get feeds and meds that way. I had NO IDEA what I was suppose to do. I had never seen the IVACS that they were hooked to before and had no idea how to set it up!! Remember I was OB before and then 17 years of office nursing! I called another unitl and got an RN from there to help.

I never got dinner, a break or anything and had to beg the aide to stand in office while I went to the lavatory for 30 seconds! Charting??? When was that going to be attempted?  I had a new antibiotic to pass and thank God my old skills kicked in and I asked her if she was allergic to any antibiotics. She said, "OH yes..Penicillin!" What did I have in my hand? Yup..Penicillin!! I went to her chart that was a foot thick and there was no mention of an allergy anywhere. I went back to her admitting face sheet and there at the bottom in tiny letter "allergic to PCN!"I called her physician who promptly started yelling at me because he had to call in another Rx.

The gal that replaced me 12 hours later had been there twice, thank God, and she told me that the unit is run entirely by PRN staffing and no one knows what they are doing!

I called the agency and told them what I had experieinced and they were "shocked"?? hmm maybe. However, I never did it again. I was taught to be a " safe and competent " nurse and that experience left me shaken. So many patients, so little time for any of them. Many just needed an understanding ear or a hug! No time!

Anyone else have any PRN stories??

Karin, Ohio

indy5150 says ...

I'm a new graduate nurse and a registry offered me a job.  At first it sounded good, but then I started to realize that they didn't seem to have their act together.  They wanted me to go to a skilled nursing facility.  I asked them if the facility knew that I was a new graduate and would need some kind of orientation.  The guy just said "Um, well, you could get their early and look around".  That scared me.  I'm glad I came to my senses.

I've never heard of an agency taking a new grad.  I'm sure it happens, but all reputable agencies I know of require at least two years of active experience, before they'll even consider you as a per diem nurse. 

I too have a host of horror stories.  Someday I'll share one or two when time allows.  To answer the question "Is it safe?"  GOD NO.  It is great for the extra money if your skills are up to date, and/or you're currently working in the field you're accepting assignments in, but even then...  More often than not, many facilities that can't keep their own staff due to working conditions, state inspection problems, (the list goes on) staff with agency.  Some agency nurses may have a full time assignment at that facility just for those reasons.  Weigh your decision to work agency very carefully.  It is not for the faint of heart or the new nurse without much experience under her/his belt yet!

Wow, what a story!  There should always be an RN that gives a rip.  It makes me sad and scares me that some people just  want to work until the clock says they can go home.  It is so important for patients to get the best care possible.

Yes , I agree it is really tought in skilled nursing homes not only for PRN agency nurses but also for regular nursing staff and it is getting worse due to medicare cutbacks and unrealistic guidelines..It is a nightmare...sometimes I wish I never became a nurse