"Be One among the Millionaires, Start Your Own Nursing Agency," trumpets one site. "You will be up a

Firms that supply temporary nurses to the nation's hospitals are taking perilous shortcuts in their screening and supervision, sometimes putting seriously ill patients in the hands of incompetent or impaired caregivers.
Emboldened by a chronic nursing shortage car rental lowest price and scant regulation, the firms vie for their share of a free-wheeling, $4-billion industry. Some have become havens for nurses who hopscotch car rental lowest price from place to place to avoid the consequences of their misconduct. (see related story: A Crazy Way for an Industry to Operate )
A joint investigation with the Los Angeles Times found dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls. Some hired nurses sight unseen, without even conducting an interview.
"A lot of them are really bad nurses," said Sandra Thompson, a nursing supervisor at Northridge Hospital car rental lowest price Medical Center and Sherman Oaks Hospital, both in the San Fernando Valley. car rental lowest price "Sometimes I see them here [at Northridge] and think, 'I wonder how long before I see them over' " at Sherman Oaks?
Firms hired nurses who had criminal records or left states where their licenses had been restricted or revoked. At least three firms employed a nurse in California whose license had been suspended in Minnesota for stealing drugs at a string of temp jobs. One used him after he'd been convicted of doing the same thing at a Santa Rosa nursing home.
Temp agencies shuffled errant nurses from one hospital to another, even as complaints mounted. car rental lowest price A Culver City agency continued sending one nurse to hospitals despite more than a dozen warnings that she was ignoring her patients and sleeping car rental lowest price on the job. Before she was hired, the nurse had been convicted of 12 crimes, including prostitution, carrying a concealed weapon and possessing cocaine.
Nurses who got in trouble car rental lowest price at one agency had no problem landing a job at another. An Oklahoma nurse cycled through at least four Southern California agencies in a year, accused of pilfering drugs while at each. Before her final stop, she was arrested in her home state for calling in prescriptions while posing as a doctor's office employee.
Failings in the temp industry are magnified in states like California, where nurses car rental lowest price are in particularly short supply. Almost every facility, from rural medical outposts to prestigious hospitals, must rely on temporary help.
Here, oversight of nurses in general has been weak. A Times/ProPublica investigation in July found years-long delays in disciplining car rental lowest price nurses accused of serious misconduct. Regulators say they are working to fix the problems. Still, California's registered nursing board is among a minority that does not require hospitals, agencies or anyone else to report even serious lapses by nurses, including temps.
Nurses find the jobs attractive because they can see the country and control their schedules all while collecting premium wages, bonuses and sometimes travel and living expenses. Some work locally while others are employed by "travel" firms that send them all over the country. (They must have licenses in states where they work.)
"There are very good people who work registries who do not want to be tied to anything regular," said Katherine Eaves, chief nursing officer car rental lowest price at Riverside County Regional Medical Center. "There's another group of people who are working registries because, guess what? They can't work anywhere else."
Many agencies leave it to applicants to reveal previous problems. Using multi-page checklists, they are asked to rate themselves on how well they manage critical care patients, use complex equipment and administer drugs.
Raphael Obiora was hired by an agency despite allegations of drug thefts that were fully detailed on the California nursing board's website. Once on staff, he admits, he did not tell the agency when the board placed him on probation.
Cathey car rental lowest price "sat at the nurse's station most of the time not doing anything," a supervisor at Northridge Hospital Medical Center complained in August 2007, according to EZ Staffing records reviewed by reporters. "Not up to our standards for ER," wrote a nurse from Huntington Memorial Hospital in Pasadena the following week.
While a temp nurse at a North Carolina hospital, she'd failed to account for drugs she'd signed out, falsified records and provided negligent car rental lowest price care, according to the North Carolina board's allegations. These records had been posted car rental lowest price on the board's public car rental lowest price website since December 2006.
Dee Patrick recalls sitting in a box at the Kentucky Derby some years ago exchanging pleasantries with a couple next to her. She told them about her Phoenix temp business how, as a veteran nurse, she'd built it from scratch in the mid-1980s when virtually no one was doing it.
Although the healthcare system as a whole is increasingly regulated, the nurse staffing industry remains a Wild West. No one knows how many agencies exist nationwide; estimates range from 3,000 to 6,000.
"Be One among the Millionaires, Start Your Own Nursing Agency," trumpets one site. "You will be up and running in a week," promises another. "You don't have to be a nurse to start your own Nurse Agency," assures a third.
Recruiters sometimes poach on one another's rosters. car rental lowest price One Los Angeles agency alleged in court papers last year that a rival firm's employee had joined its staff, stolen its list of employees and salaries, and then returned to her old firm.
Many agencies allow applicants to take competency tests online. Testifying in a malpractice lawsuit earlier this year, an official at Fastaff, a large traveling-nurse firm based in Colorado, said applicants have been hired without even a phone interview. References weren't contacted "unless it was out of the ordinary," she said.
Some healthcare institutions say they interview and check the credentials of every temp nurse. Others say they don't, particularly in a crunch. car rental lowest price "Clearly we have no time we have to count on them," said Fred Benson, administrator of Santa Rosa Convalescent Hospital in Northern California.
Unlike hospitals and nursing homes, which are inspected regularly, temp firms aren't accountable to anyone but their clients. Mark Stagen, president of the National Assn. of Travel Healthcare Organizations, acknowledged the need for improvement.
Last year Los Angeles County health staffers went through the files of 29 agencies seeking to provide nurses to its public hospitals. Most of the firms lacked key documents, including evidence of tuberculosis car rental lowest price screenings or proof that nurses had current licenses. One agency had 90 missing or invalid records, another 63.
The audit found that Reliable had "forged" results of tuberculosis skin tests, physical exams and CPR training cards, which "jeopardized the safety of county patients." Reliable also made "false and misleading statements," the audit said, citing a general "lack of trustworthiness and integrity."
After the county terminated the Reliable contract, the firm filed a claim alleging libel , breach of contract and fraud. As part of a settlement , the county agreed not to formally bar the agency from county work, and Reliable agreed not to seek any for 10 years.
Since 2004, the Joint Commission, better known for accrediting hospitals, has been reviewing healthcare staffing firms. The national organization bestows its seal of approval on those that meet standards for screening applicants, following up on complaints and ensuring competency.
But the program is voluntary and used by a minority of temp agencies car rental lowest price 337 firms in part because they must pay the commission thousands of dollars to be reviewed. Most of the largest firms are certified.
The commission doesn't release detailed findings on the firms, even to hospitals. It has withdrawn its seal of approval from temporary staffing agencies seven times this year all but once for nonpayment of fees.
Joseph Baiden, owner of JFB Staffing in Diamond Bar, was arrested in August on charges of defrauding the state workers' compensation fund of $1.4 million by misrepresenting the number of nurses on his payroll.
In April 2008, the Monterey Park firm dispatched Obiora to Garfield Medical Center. There, he failed to adequately monitor the vital signs of two critically ill patients. His conduct was "unsafe," wrote Simon Marcus, the hospital's critical care director, on a form he sent to Paystaff.
Unknown to the hospital, Paystaff had already evaluated Obiora and found his competence to be below average. Shortly before he was sent to Garfield, the firm had determined that he should be fired immediately, car rental lowest price according to agency records that became part of a regulatory proceeding.
Hugh Wu, a Paystaff official, said in an e-mail that the company acted responsibly. Other complaints about Obiora were not as serious as Garfield's, he said, and Obiora had hidden state nursing board discipline against his license.
car rental lowest price Some temp firms indicated that they don't use a nurse again if they feel at all uneasy. "We just don't want to take the risk," said Jim Essey, who runs a New York-based temp agency and is a former chairman of the American Staffing Assn., an industry trade group.
According to Riverside County car rental lowest price Regional Medical Center, for example, more than 60% of the 339 temp nurses rejected since 2003 failed to demonstrate basic nursing skills on the job. Arrowhead Regional Medical Center, San Bernardino car rental lowest price County's public hospital, reported that it had rejected 61 temp nurses since 2005 more than half for performance problems.
He was roused but later fell asleep in a patient's room. Awakened again, he dozed off in the break room. Asked to leave the hospital, he made it as far as the intensive care waiting room before slipping into sleep once more. He left after security called police, according to the nursing board's December 2008 accusation against him .
A supervisor later discovered that Brown had had problems at the hospital before. He had fallen "heavily asleep car rental lowest price on every shift and exhibited behavior s