Casual nurse and proud of it!

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Jess Morton is an undergraduate student paramedic – but that’s not what she’s writing about for Nurse Uncut. Jess works permanently in the Casual pool – and loves it. Here’s why.

I wasn’t like the others in my group when I finished my Trainee Enrolled Nurse year. Most of them had sought jobs on the wards they liked. A few had already applied and been accepted to start their RN degree the following year.

I’d become a nomad in the hospital after completing my eight week placements in stroke/neuro, acute geriatrics, paeds, oncology and general surgical.

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Jess Morton – casual nurse and proud!

I applied for two jobs prior to finishing: in the neuro ward at a major Sydney teaching hospital with an inbuilt HDU and in Emergency at another hospital. I was offered both jobs.

However, I’d become friends with staff right across the hospital I trained in and didn’t want to settle and become comfortable in one area.

I joined the casual pool and began working across two hospitals and all specialties except ICU and theatres while undertaking the College of Nursing’s Principles of Emergency Nursing course by distance.

Apart from a few secondments, I’ve spent the majority of the past 10 years working on the Casual pool, nurse banks and as an agency nurse.

I’ve walked into a department or ward and in my bubbly manner introduced myself , “Hi, I’m Jess. I’m the EEN working this afternoon”, more times than I could count. Of the hundreds of times I’ve made that introduction, a good number of them have been met with a glance up and down and, well, nothing!

nurse in hallway[1]

I could write an article the size of a microbiology textbook on the gripes of ‘us Casual nurses’, but I won’t. I’d rather tell you the less known benefits of the casual and why you should embrace them as a resource instead of dismissing them as a slow-down.

We know where things are. When your new admission arrives at 2130 and ED hasn’t given the bisoprolol, you can visualise that the rising BP will result in a clinical review by the 5am obs round. Your casual will most likely be able to tell you that just upstairs, Cardiac will have it as ward stock.

We know which wards have secret stashes of certain equipment, drugs and even pillows!

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We are flexible and adaptable. The nature of our role is unpredictable. We turn up for work and only then find out where we’re working for the shift. This means you can allocate us where you need us, we don’t mind who we go with on our breaks and if things change, we just get on with it. I have been sent to one ward, received handover, checked my charts, then received a call to go to maternity. I walked to the other side of the hospital to maternity, received handover again and introduced myself to my patients. The TL then got a call to say someone hadn’t shown up on another ward, so I was sent there. This was all in the first hour of my shift. I was cranky by then, but I put my big girl pants on, bit my lip and met my third lot of patients for the day.

Casuals often maintain perspective and can keep our heads when things get a bit hectic.

As we go from unit to unit, we are often told how they are one of the “busiest or heaviest” wards in the hospital.

busy

We get a good perspective as to what really constitutes ‘busy’ and ‘heavy’ as we get to experience the good, the bad and the average type of shift on each ward. It is for that reason we don’t have a baseline expectation of what a shift is like, let alone become perturbed when it sways too far from that midline. We should also let you know that everywhere is busy. No one department wins that category. There are different types of busy. There are various forms of sick. Heavy in orthopaedics is different to that in geriatrics. Remember, you are all good at what you do. Respect each other for the unique challenges nurses from all specialties face.

Your casual and agency nurse, beyond being an asset to you, can also be a wonderfully skilled and experienced addition to your nursing team.

We work everywhere; we learn the protocols, nursing management and presentations of a huge array of diagnoses and complications. I can recall several instances when the knowledge I’ve gained from working in one specialty led to a better outcome in another area. We’ve gained many hours-to-years of experience in more areas of specialty than many fulltime nurses gain in their career.

Some argue against the quality of being a Jack of all trades, but mistress in none. We would not be naïve enough to claim to be an expert in yours or any specialty. However, we may have enough knowledge when one of your outlier patients from another department deteriorates to recognise the issues and can suggest nursing interventions for that patient.

Some assume that the reason a nurse of any age or years of experience is working as a casual is because they’re not able to get a job elsewhere. I’ve even heard one RN suggest that another RN in her 50s may want to be an agency nurse so she can slip through the cracks and “no one will care or check her competency levels as she gets older”. I had the CNE turn up twice in the past week to check where I’m up to on mandatory training and redo my BLS, drug administration and other competencies. When I worked as an agency nurse, I was not able to book shifts if my yearly competencies were out of date.

I enjoy the range of experience and skills I gain from working on the casual pool.

blurry nurse

I was interviewed and offered a part-time position in the ED a few years ago. But it was four weeks before my marriage ended and I became a permanently single mum of two kids under five.  It was with much regret and sadness that I had to turn the position down. Twelve months later when the dust had settled, I started on the casual pool. I work when my boys are with their dad. I squeeze as many shifts into that period as I can and hope I don’t get cancelled.

We choose to be a nurse on the casual pool or agency because it fits with our other life requirements, our roster and for some, yes, sometimes financial needs.

We don’t choose this path because we are lazy, a misfit, incompetent or don’t like our job.

If I had my wish, I would be working part-time in the ED. I would work whatever roster was given to me. However, my life hasn’t worked out that way. I just work when I can, wherever I am sent.

You can make our time with you more fulfilling, efficient and easier with a few of the following:

Welcome us and introduce yourself, especially if you are the shift TL. Please introduce us to who we’ll be directly working with. Be the first to offer to show us where the main things are.

Please be prepared to show us how to work any specialised equipment or procedures for the patients you allocate us. This may be as simple as showing someone how to hook a patient up to telemetry in the cardiac ward or how to set up, run and monitor CAPD in renal or the protocol for monitored patients in the stroke unit.

Communication is an absolute basic necessity in healthcare.  There have been countless shifts (mostly nights) where the team almost fails to acknowledge my existence. I have been ignored, had backs turned on me and been excluded from conversations for long, long night shifts. This can and does lead to poorer patient outcomes and job dissatisfaction. We often receive second rate or even no handover on our patients when we start the shift. This is due to a whole myriad of reasons – however, they are not excuses. I have seen it repeatedly lead to poorer or delayed care or unnecessary use of resources such as the MET team, all simply because an appropriate handover was not received.

The moral of my story is ‘Be nice to your casuals’! We are there to help, we can surreptitiously ‘acquire’ pillows when you need them and we can be a cool, calm and collected addition to your team who knows a few little things too!

 Find Jess on Twitter @ems_Junkie

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6 COMMENTS

  1. Hi Jess, great article! As an RN at a major hospital, I will always welcome you and other casuals simply because you are all great help. When I was studying, I was on the casual pool as an AIN (not quite the scope of practice – but I knew where things were!), so I’m hearing what you are saying. Thanks!

  2. Hi Jess,
    You have written brilliantly, just brilliantly. After I graduated from an EEN course (was also employed for 12 months) in 2007, I ended up working in a nursing agency at a leading hospital. I had similar experience in some wards I went to, others were not bad.
    Jess, what you highlighted is so important, acceptance, inclusion at work, not only essential for best patient care, also essential for work satisfaction, as you rightly discussed.
    Thank you for being the voice of many of us, otherwise we would continue doing a great job but silent in isolation.

  3. Hi Jess,
    I had not actually read your post until now, but last week I did share it on FB hoping to come back to it later and have a read. It turns out one of your aunties and I are friends and she read it and commented that you are the nurse she was telling me about the last time we caught up.
    I too am an Agency Nurse and have been since I graduated in 2008 after I did my New Grad. So 6 1/2 years later, I would not have it any other way. Everything you wrote is true. We are multiskilled nurses and it is a great thing to be these days. I am now a Clinical Facilitator and have been for over 4 years and love my job. I can work in nearly every area of nursing and work with students to make them better and confident to come out at the end of their course and know that fulltime Nursing is not always the option. (Limited New Grad positions doesn’t help either.)

    I so enjoyed reading your story and can fully relate to every word. I’m so pleased someone was able to put it in words…
    Thanks so much.

  4. I am a rehabilitation assistant working in 2 hospitals (affiliated) as a casual. I had a part-time permanent (0.5 on 5 days) and I decided to go back on casual 4 months ago to get more hours and flexibility. Best decision! I get to choose my hours, I get to refuse shifts if I don’t want them, I get to switch floors/therapists/clientele so I don’t get bored so easily. I feel like my brain is working again, instead of just going through the motions.
    Plus, I can actually have time off around Christmas and during the summer for the first time in a very long time!
    It’s not all roses, I relate to being ignored or questioned on some floors, having to adapt constantly to new procedures/ways of doing things from one floor to another, being called last minute (the worst aspect for me), no job security, etc. But for me it’s worth it at the moment.

    And working in the health field I get paid really well with a college degree, can still contribute to my pension plan even if working on casual, so I don’t have to work full-time. So far I’m aiming at 30h/week and I get the hours that I need.

  5. Love this article … and love being a casual. I completely agree with the poor handover part. I am usually the last to get told anything but the first to be questioned when things go wrong on a ward – but I have been a nurse for long enough to handle these situations. I think a lot of permanent nurses treat casuals like they have limited knowledge because we have no real ‘home ward’. It’s funny though because I have witnessed senior nurses relieving on other wards and they act like it’s their first day being a nurse haha…

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