At 5:30 a.m. Wednesday morning, Lamar McEntire is awakened by a ringing telephone. He turns over, hears the second ring - wants to go back to sleep - but reaches out and picks it up and utters a groggy "hello".
It is one of the nurses from Centennial Surgery Center where he works as the operating room manager. She can't come in today because her child is sick.
As he hangs up the phone he remembers that none of his regular "as needed" registered nurses (called PRNs) that circulate for a shoulder arthroscopy procedure are available to fill in. Within 60 seconds, he is on the telephone to one of the many temporary medical staffing agencies in Nashville. He requests one of their RNs with orthopedic surgery experience be at the ambulatory center he helps supervise by 7:15 a.m. He asks for a specific nurse by name.
Within five minutes the agency calls back with the news that the nurse he wants is available and will be there on time.
This activity occurs for the numerous Nashville area medical facilities every day, making sure the necessary trained medical staff is available for surgery and other patient care. Without them, the health care industry could be crippled - surgeries and other procedures would not be performed and patients could go unattended.
Tennessee has one of the largest shortages of RNs in the Southeast, according to Anne Duncan, executive director of the Tennessee Center for Nursing. Presently there are about 2,400 vacant positions or about 9 percent of the 25,000 RNs actually needed in the state. When a nurse calls in sick or has to take leave, it puts additional pressure on an already critical situation.
"Our clients do an excellent job to manage their staff base," said Jeff Christie, president of Advantage Support Services Inc. in Brentwood. "Staffing at hospitals is tight, so they use us when someone is sick and on heavy [patient] days. They have to control their costs by not overstaffing."
Like many of the other staffing agencies, Advantage handles not only nurses, but also other important medical staff such as surgical assistants and surgical technologists.
Their clients include Baptist, Saint Thomas, Vanderbilt and TriStar medical facilities.
The professionals are highly trained and usually experienced.
"Our average RN has 12 years of experience and has had experience in a number of specialties," said Nancy Westmen, director of clinical operations at Advantage. "Many have been managers."
Because staffing agencies work with the same medical facilities and their managers, they develop a true working relationship. Because of this continuous arrangement, when a need arises, nurses and other staff are often requested by name.
"When I schedule a surgery for 7:30 a.m., I want to know that the person coming in knows how to do their job, McEntire said. "Not having the right person can make or break the case."
There are a number of service options available to medical facilities wanting support. Besides the temporary staffing service there is temp-to-hire where an employee eventually becomes permanent after a contracted period of time.
In cases where the facility wants the employee fulltime before the end of the contract term, it can buy out the contract.
In situations where an employee has worked on an as-needed basis, the medical facility management may request a direct hire or permanent placement arrangement.
There are many reasons an RN would want to work for a temporary staffing agency.
"The pay is great, I have flexibility in my schedule, I don't have to work holidays and there is no commitment," said Joy Biola, an RN and a former operating room director at Baptist Hospital. "If I am not happy with a facility I don't have to go back."
"Every operating room has its own personality," Biola said. "The staff is glad to see you because they know they can get the case done. I like taking care of the patients. It really is a lot of fun."
A nurse moving to a new area gets a chance to work at different places until he or she finds the right facility to become a permanent employee, according to Biola.
Temporary RNs can earn from $25 to $45 an hour. The upper end is for those willing to travel to other cities.
The importance of staffing is so vital that HCA Inc. has established its own staffing company called All About Staffing Inc., headquartered in Sunrise, Fla. The Nashville division has about 340 employees available for TriStar Health Service facilities.
"We look for employees that want to work in a flexible structure," said Paula Beecher, regional vice president of operations for All About Staffing. "Besides the educational qualifications, we require one year minimum of experience and an extensive background check."