Career advice

Agency nurses: why we need to challenge outdated stereotypes

How the right support and training can make the most of this vital healthcare workforce

How the right support and training can make the most of this vital healthcare workforce

Picture: Jamie Williamson

All too often, agency nurses are seen as the poor relation to their contracted colleagues, even being blamed for spreading COVID-19 between care homes, according to an unpublished study from Public Health England.

The rhetoric around agency nurses has always been relatively poor, says Fiona Millington, chief nurse with Florence, an online platform that connects nurses and carers looking for shifts with care homes looking for temporary staff.

Who plugs the health and social care vacancies gap if it isnt agency nurses?

They were seen as a key element of high infection numbers in care homes, which made me feel really

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How the right support and training can make the most of this vital healthcare workforce

Picture: Jamie Williamson

All too often, agency nurses are seen as the poor relation to their contracted colleagues, even being blamed for spreading COVID-19 between care homes, according to an unpublished study from Public Health England.

‘The rhetoric around agency nurses has always been relatively poor,’ says Fiona Millington, chief nurse with Florence, an online platform that connects nurses and carers looking for shifts with care homes looking for temporary staff.

Who plugs the health and social care vacancies gap if it isn’t agency nurses?

‘They were seen as a key element of high infection numbers in care homes, which made me feel really sad,’ she says. ‘If we look at the health and social care sector, there are 120,000 vacancies - who plugs the gaps if it isn’t agency workers? We can’t do without them.’

In reality, temporary workers have been pivotal to managing health and social care safely throughout the pandemic, she argues. ‘We are constantly listening to the dialogue that says agency nurses cost a lot of money, provide poor care and are associated with lots of incidents. But our experience doesn’t reflect that,’ says Ms Millington.

Fiona Millington: ‘Let’s recognise agency
staff for the work they do’

Recognise agency workers’ contribution to care

Since taking up her post a year ago with Florence, which enables nurses to book temporary shifts directly with care home providers, she sees part of her mission as challenging outdated and unfair stereotypes of agency workers, instead celebrating their contribution to delivering high quality healthcare.

‘As I work with agency nurses more and more, it’s evident this is a highly skilled, well-educated and experienced workforce that wants to do their very best,’ says Ms Millington. ‘Let’s recognise them for the work they do, which is exceptional, and often in the most difficult circumstances.’

Top tips for agency nurses

  • Never apologise for being an agency nurse, says Ms Millington. ‘You have a real wealth of experience,’ she says. ‘You’re going into an unfamiliar environment and taking charge. That takes a huge level of skill’
  • Ensure your CV is kept up to date ‘Note every experience you’ve had and make sure it really sells you as a professional nurse,’ says Ms Millington. ‘Detail what ignites your interest and how you’ve developed yourself with different courses’
  • Look for employers that offer support, including a good induction when you first arrive. ‘Know where to access policies and procedures,’ suggests Ms Millington. ‘We sometimes have situations where handover is poor, including one nurse who got stuck behind a fire door because she hadn’t been given a code. Staff need to be welcomed’

Making the shift from NHS roles

After qualifying in 1989, Ms Millington worked in the emergency department at Royal Stoke University Hospital for ten years before moving into education with a lecturing post at Keele University. She returned to the hospital – part of University Hospitals of North Midlands NHS Trust – in 2008 to become a matron, where she was able to pursue a long-standing interest in frailty.

‘We developed what we believed to be the first frailty assessment unit, removing the need for medically unwell older people to go through the traditional A&E department,’ she says.

After being promoted to associate chief nurse for the trust’s medical division, in 2015 she took up her first role outside the NHS, as a director of nursing with Brighterkind, part of the Four Seasons healthcare group, which provides a range of care homes.

The move gave her the opportunity to develop her knowledge of governance, compliance and fitness to practise.

The challenge of staying up to date in an agency role

In 2019, she was approached by Florence to help it set up new systems of governance, monitoring, professional regulation and support. ‘It’s a brand new post, so very exciting,’ says Ms Millington. Launched just three years earlier, the organisation has grown rapidly and currently has around 50,000 nurses registered.

Ms Millington says a particular challenge for agency nurses is keeping updated professionally. ‘They are passionate about learning, but the opportunities are very different from those within the NHS,’ she says. To meet their needs, Florence has its own training academy, which provides statutory modules alongside other professional development courses, and is mostly free.

When things go wrong, agency nurses are often scapegoated or treated differently, she says, with many reported to the Nursing and Midwifery Council (NMC) almost immediately, she adds. ‘I believe there is a disproportionate likelihood that nurses working for agencies will be referred to the NMC when incidents occur,’ says Ms Millington.

‘Here we don’t refer unless we’re absolutely certain it’s the right thing to do. For some organisations, it’s the first line.’

Employers must begin to show how much they value their agency staff, says Ms Millington. ‘Often they can be quick to pick up the phone when things are wrong, but actually we’d like them to contact us when things are really good too,’ she says.


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