Registered nurse and health-tech founder Zara Lord is working to improve career prospects for casual nurses, eliminating barriers between charge nurses and agency nurses, while disrupting the traditional nursing agency model.

A Full-timer Supplementing with Agency Shifts

10 months ago, 8th year RN Zara Lord, was working full-time in a 58-bed ICU at a large Sydney hospital. With a love of travel, and while living in one of Australia’s most expensive cities, she had been supplementing her income doing as many as three agency nursing shifts a week.

“I have always worked agency shifts. I first started as an AIN while I was an undergraduate. Even when I was full-time and in charge of the ward, I picked up the odd agency shift when work had no overtime. Over the years, I’ve worked with several agencies.”

With experience on both sides of the fence – as the agency nurse and the nurse in charge – both roles highlighted several points of abrasion between agency nurse, agency, permanent hospital staff, hospital booking manager and patient.

In December 2016, Zara completed her Graduate Certificate in Critical Care Nursing, undecided as to ‘what next?’ in her career. Niggling unease about the disconnect between her agency and hospital experience led to nine months of research into how she could make the agency nursing experience better for nurse, hospital and patient.

The High Cost of Traditional Nursing Agencies

What she uncovered through that research revealed flaws across nearly every aspect of the system.

“I discovered that the Australian healthcare system spent at least $1.2 billion dollars on contingency workforce fees last year alone. In NSW Health, this figure is conservatively reported at $15 million, a figure that increased by more than a million dollars from the year before. That made me really angry – here I was working two jobs to get by comfortably – and that money that was not going on nurses wages – it was just on agency fees,” Zara explained.

“The cost to Australian hospitals for agency nurses cripples hospital budgets. It’s a vicious cycle. When budgets dry up, hospital beds get closed, contingency workforce is slashed, more pressure is put onto permanent nursing staff who burn out, and patients lose out,” she added.

Nurses Have Their Say

Zara’s next step was to speak to nurses direct. Surveys of over 500 agency nurses revealed what many felt about their career choices, how they were treated in hospitals, how hospitals viewed agency nurses, and confirmed what Zara had experienced herself as a casual agency nurse and nurse in charge, but felt powerless to change.

“It quickly became apparent that the nature of agency nurses being ‘anonymous ring-ins’ was affecting their ability to provide a high standard of care to patients.”

“Nurses repeatedly stated that they felt their qualifications, skills and experience were overlooked, which led to poor patient allocations, and low job satisfaction, and that overwhelmingly, they wanted this recognised,” said Zara.

One survey respondent summed up their experience: ‘I’m an RN with 12 years’ experience in Emergency and Cardiac Care. It’s demoralising to arrive on a ward thinking you’re there to make a difference, only to get allocated to low-care patients when you sometimes see inexperienced, full-time peers on the ward, struggling to manage patients with very complex and critical needs, especially when you know you would have been better placed to manage that patient. If Hospital Booking Managers had transparency about my skills and experience in advance that could be shared before shift allocations, I think that patient outcomes in these cases could be very different.”

Cancellations for agency nurses was also a common theme from survey respondents.

A 5th year surgical RN explained his experience: “I was booked for a shift at one hospital, only to be sent to another with a couple of hours notice. I ran into the Booking Manager from the original hospital during the shift, only to discover that she had been told by the agency that I had cancelled. I discovered later that I had been sent to the second hospital because it was paying a higher rate to the agency, meanwhile while my rate stayed the same. I won’t work with that agency again.”

Zara’s lightbulb moment came she realised that technology could have a significant impact for all by closing up the gaps – in knowledge, resourcing, and service – while saving hospitals tens if not hundreds of thousands of dollars each year.

Nursing Skills and Research meet Business and Tech

With no tech background or business start-up experience, Zara spent months developing her business plan and pitched her idea – a digital two-way marketplace that cuts out the agency middleman – to a start-up accelerator, who awarded her a grant to complete their program.

“It was a steep and rapid learning curve, and so different to anything I’d been exposed to in the past, but I knew that in order for it work, I needed more than just a passion for better outcomes for nurses, hospitals and patients – and the facts and figures to back it up – but also proof of concept.”

That proof of concept came when Zara got a prototype developed and got in front of two hospitals CEOs. Both were overwhelmingly supportive.

“Think TripAdvisor meets Uber in a mash-up of the traditional agency model,” explains Zara.

Zara quickly secured investors who were sold on the idea that the platform will save the Australian healthcare system billions of dollars over the next decade.

Investors were also enthusiastic about a platform that could see nurses get paid higher rates, and respect for their skills and experience.

“The response I have received from the business world has made me even more proud to be a nurse – the community is so behind us, with incredible admiration for the work we do,” said Zara.

Keeping Perspective

In December 2018, Zara scaled her hours back at her ICU job to launch uPaged.

“I still pick up casual shifts because it’s important to me to keep my finger on the pulse of what is happening in hospitals. At the same time, by choosing flexible shifts through uPaged, I get to test the platform from a user perspective to make sure the experience for nurses is everything we promise it to be.”

A first to market for the casual nursing workforce, nurses and hospitals are quickly seeing its benefits.

“I’ve come across so many nurses in my career, each with their own unique background and experience, but they get treated as outsiders by the ward staff and as headcount in the agency system. As nurses, we’ve worked really hard to get where are and we’re proud of our skills and experience. We want to be recognised for that, even when we’re working as on-demand nurses.”

Zara continues: “While the platform showcases those skills and experience for each nurse, some hospitals I’ve been speaking to are keen to recognise that with increased rates to nurses. They can offset this because they no longer have to pay exorbitant agency fees. It’s early days, but with small steps, I’m confident I can make a big difference.”

This article was written by Catriona Watt for uPaged.