I see so much reporting on predatory staffing agencies, however, not all agencies are that. 

I own Vision Staffing, operating in Nebraska and Kansas, and am also licensed in Iowa and Colorado. I can honestly say that during the pandemic and after, we have not ever raised our prices to gouge. Our rates are almost half of what some others there are charging. 

What critics are not considering is the price of operating an agency. All of my staff are W-2 employees, so I have to pay out just the same as all long-term care centers and hospitals when it comes to taxes. 

Also, our worker’s comp rates are higher due to the amount of claims agencies have. They are even higher than LTC centers. Last year we paid out almost $80,000 in insurance costs. But no one is going after the insurance agencies, which keep raising their prices. Let’s fight to lower those costs. 

We do mark up our rates 50%, but what people don’t talk about are the costs aside from paying staff, such as taxes, insurance and all the overhead costs (payroll systems, scheduling software, continuing education, compliance, marketing, job boards, hiring costs, etc.).

My company makes only about $3 per hour per CNA. That’s $24 per shift! That might be OK if you have 100 CNAs working, but when you have eight, it isn’t enough to pay the bills. 

Right now, our profit is so low that I am not making enough to pay myself, as doing so puts us in a negative number for the week. We are not price gouging. 

As the owner and CEO, I am currently putting in 100-plus hours every week … why? Because I can’t afford to hire more management. My family sacrifices every single day for me to try to help as many people as possible, only for me to be looked at like I am a predator. 

We see every day that facilities are using agencies that have 1099’s, but they do not have management available, and hear that their staff don’t show up. And if there is an issue, there is no one to contact. How is that better than paying a staffing agency that you also receive additional management for less than the cost of the companies that have 1099s?

‘I want to help’

Some places may be gouging. But not all. The cost of running an agency is high. We make about 5% to 15% profit, even with a 50% markup. The cost for a CNA is about what the facility would end up paying a facility staff member, but we have a larger pool to pull from. We don’t “pocket” a 50% markup.  Facilities often mark up costs of briefs and supplies that their patients receive by up to 150% or more. But that is a normal thing, and no one talks about that.

We staff 40+ locations in two states. Running an agency is not not just sitting back and “watching the money roll in.” It’s more work than I have ever done while working for a facility. I have facilities that call at all hours of the day and night. I have staff call me about payroll and other issues in the middle of the night as well. I receive over 100 emails a day, 5000+ texts a month, and spend, on average, 150+ hours a month on work calls. My management team experiences the same thing.

The mental stress has put me through a rollercoaster of emotions on a regular basis. But I keep going. Again, why? I want to help. Truly want to help. It sickens me to be looked at as another price-gouging agency. 

Also, a word about buyout clauses: We have a buyout clause, but we also have something in our contract that we pay the facility if we would “steal” their staff. Buyout clauses help protect the agency. We spend the money on cost per hire. It is no different than a company outsourcing to a recruiting firm for permanent placements. They pay a cost to them as well, only with a buyout, facilities get to “try out” the staff, who wouldn’t be there if it wasn’t for us. We lose the staff as well. It’s essentially a placement fee which is no different than a company calling an outside recruiter. There would be a placement fee for that service. 

To me, it’s a business courtesy not to steal each other’s staff. And non-solicitation should go both ways. I can’t walk into a facility with my business cards and start handing them out, so why should it be ok for a facility to ask my staff how much they get paid and offer to match it or beat it if they come to work for them?

Facilities do not want to pay mileage pay to staff. However, our staff drive — sometimes at a moment’s notice — hundreds of miles to be there to help a facility in need when they don’t have anyone. They should be paid for their drive time and the cost of gas. They should be paid more than someone who drove 10-15 minutes to get to work. 

Not all agencies should be clumped together. My company is fighting to beat out those that are just trying to increase their bottom line. As a nurse of 13 years and being in LTC for 23 years, we are fighting to be part of the solution. That’s why our motto is, “Our Vision Works With YOU.” 

Yes, a facility is paying more for my staff to be there, but in that same breath, facilities are paying for my management team also — we are on call 24/7/365 — to be there if there is a staffing need or an issue. With us, you have additional support so your management does not have to track our staff. 

We are here to be an asset to the companies we staff with, not another liability. We are fighting for people to give us a chance, a chance they won’t regret.

Jessica White is a Licensed Practical Nurse and Owner of Vision Staffing LLC based in Omaha, Nebraska. 

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.