Picture credit: iStock

But how do nurses get into agency work and what are the pros and cons?

Agency nurses work on temporary assignments in a wide range of health and care environments. They are used in the NHS and social care as well as in private hospitals.

You are not permitted to take shifts in your usual place of work in the NHS – you can only do so through the NHS bank system.

As an agency nurse, you will have a contract with your agency, which will often provide you with a uniform. In contrast, NHS staff banks are often run by NHS employers or groups of employers, and employees are able to offer to do bank shifts as extra on top of their contracted hours.

There is a wide variety of agencies that offer nursing shifts, from leading employment groups such as Reed, which has a healthcare arm, to smaller agencies that specialise in specific areas of nursing, such as mental health.

Most nurses on agencies’ books are thought to combine this work with full or part-time employment whether in the NHS or social care sector. But some do undertake agency work full-time.

How can I get involved in agency work?

Registration with an agency is usually free. You will be expected to provide proof of eligibility to work in the UK, Nursing and Midwifery Council (NMC) registration, professional nursing qualifications and your vaccination records.

Once you are registered, expect the agency to follow up with a call or even an interview. As an agency nurse, you are representing the agency, so they will want to ensure you are right for the roles they can offer.

Once that is completed and you are accepted on the books, you will then be offered shifts. Some nursing agencies have started using apps, where you can review all the shifts that come up in your area as well as the rates of pay. For example, Thornbury Nursing Services’ Quick Nurse app has a function to search for any shifts in whatever location you are in, and will automatically add to your calendar any shifts you accept.

Agencies without apps rely on nurses setting up email job alerts or using jobs boards on websites.

How well paid can I expect to be?

A key reason many nurses are attracted to agency work is the prospect of higher pay.

But Hunter Gatherer Mental Health agency director Declan Connor says it is important to be realistic about the rates available.

‘Some nurses think it is super-lucrative – that you can earn two to three times as much,’ he says. ‘You do hear about some really high rates, but they are the exception.’

He points out that agencies have to keep to the agency pay framework, which dictates that the NHS will pay a maximum hourly rate of 55% above the basic pay rates for an employee doing the same role. This can only be breached in exceptional cases, and is known as off-framework spending.

Mr Connor says even in the private sector shift rates only tend to be a little higher than in the NHS.

But rates of pay do vary, and it is possible to find basic weekday nursing shifts paying more than £30 an hour, rising to £70 for the most unsociable shifts, while shifts for senior nurses such as theatre managers can pay anything from £50 to more than £100.

However, it is important to remember these pay rates often include a supplement for holiday entitlement as agency staff don’t get paid when they take time off.

How does training and revalidation work?

Nurses who do agency work on top of their day job will normally get all the training and revalidation support they need from their employer.

However, many agencies will offer some level of training for full-time agency workers, mainly to cover mandatory training.

The biggest agencies, such as Mayday Healthcare and Florence, even have their own training academies that offer support covering everything from dementia care to intravenous therapies.

Others will use external training academies, with courses offered to nurses at discounted prices or sometimes for free, depending on how many shifts they have done for the agency.

Alongside providing training to meet the revalidation requirement of 35 hours of continuing professional development, many agencies will also offer other support, such as reflective discussion partners and confirmers for the revalidation process.

The RCN has produced a revalidation guide for agency nurses, urging them to make use of RCN networks for support as well as using RCN Learn.

What are the downsides?

A lot is expected of an agency nurse. ‘You have to hit the ground running,’ says Mr Connor. ‘It’s important to have some level of experience. Normally the nurses we work with have two or three years – and we ask for a minimum of one.

‘When starting a new role, you should expect to get some kind of induction – and of course when coming on shift a good handover is essential.’

Florence chief nurse Fiona Millington agrees. ‘Being an agency nurse is probably one of the most difficult jobs,’ she says. ‘You tend to be thrown into quite challenging circumstances where there are staff shortages or last-minute sickness. You may not know the environment, the team or processes.

‘And if something goes wrong, agency nurses will often get the blame, and there is a higher likelihood they will get reported to the NMC.

‘It’s important that agency nurses make good notes if things go wrong and double-check that policies have been followed.’

Flexibility and balance – why I would recommend agency nursing

Carolyn Blackshaw has worked as an agency nurse for the past 13 years, after leaving her job as a care home manager.

‘I was manager of a 110-bed home – it was a huge responsibility,’ says Ms Blackshaw, pictured. ‘I got to the point where I’d had enough and I could see I could earn just as much, if not more, as an agency nurse.

‘The flexibility is great. You can take a week off without actually taking any holiday if you plan your shifts right and you get to decide when and where you want to work.

‘That’s particularly the case now with the apps that you can use – they show you all the shifts that are available and the rates so you can choose. In years past, you were more reliant on the agency ringing you up and offering you something.

Work-life balance

‘When I was younger there were points when I used to work really hard – sometimes doing five night shifts a week to put away the money. I can’t do that now I’m in my 50s. But I am doing about three shifts a week on average.

‘You should expect quiet spells though. November is always quiet – staff want to do the overtime so they have extra money in their pay packets for Christmas. The same happens in May, ahead of summer holidays.

Supplement your salary

‘In the past, I registered with two or three agencies at a time, but now I am just with Florence. They are really supportive.

‘Agency working is a super choice for work-life balance or if you want to supplement your salary.’

What should I look for in an agency?

Establish how you will get paid. Most agency nurses are paid via PAYE, where deductions such as income tax and National Insurance are automatically taken from your earnings.

Setting up a limited company is sometimes considered the most tax-efficient way to get paid, but you then have to sort out your own tax arrangements as well as filing company returns.

A third way is through an umbrella company, which sorts out the tax and other deductions for contractors such as agency nurses. There is an administration fee for such services.

Ms Millington says: ‘The limited company approach has become less common after the crackdown on IR35 off-payroll working – we saw some of the big care firms stop employing nurses through limited companies altogether.

‘You must also check how the agency is taking its cut. At Florence we get paid directly by the employer so the rates we offer are what the nurses get paid. But that’s not the same with every agency – you don’t want a nasty surprise when you get your pay and see an unexpected cut taken.’

Ms Millington says another important consideration is the support your agency offers when things go wrong.

‘One of the most upsetting things for a nurse is to be referred to the NMC. I’ve heard of some agencies who just let them go if this happens.

‘We support them with regular meetings and reflection – looking at steps that can be taken, such as extra training so you can show the NMC you have learned from what happened.

‘Pastoral support is important. I would also recommend nurses keep up union membership alongside indemnity insurance – I’ve seen some stop because of the cost of living crisis.’