From Chaos to Coverage: Tips for Flexible and Proactive Healthcare Staffing Solutions
Nurse staffing. There is so much chatter about it because the struggle is real – not because nurses are more important than any other discipline in healthcare, but because they simply make up the largest portion and they are at the bedside 24/7.
Inpatient volumes continue to climb, patients are more critical and medically complex, and they require longer hospital stays with challenging discharge plans. All this is compounded by nurse vacancy and turnover rates that, although showing slight improvement, continues to leave hospitals looking for creative staffing solutions.
No wonder everyone is tired and frustrated.
Unfortunately, there’s no one-size-fits-all answer to solving the nurse staffing problem. But there are some best practices that I’ve seen work successfully. And while few organizations can execute on every suggestion, there are hybrid approaches that adapt to every unique situation.
What Staffing Pools Are Needed for a Flexible Staffing Program?
At the core, your staffing program should be designed to be proactive, flexible, and reliable. At a minimum, you should have scheduling standards or a timeline (when do time off requests need to be submitted, at what point do we allow overtime, when does the schedule post, etc.) to build upon. With these in place, you can identify when and how PRN (per diem or casual) or float pool staff help to supplement.
Here are some staffing pool options to consider and some guidelines for the skills and expectations for those pools:
PRN - This should be a group of individuals who come with some level of expertise. This may not be a great place for new grads who need some consistency to increase their confidence in their own practice. Leverage different tiers for hours expectations and be specific around when PRNs pick up their hours to alleviate some of the staffing panic (for example, the proactive approach is to pick up open shifts during schedule build).
Float Pool - This should be a group of individuals who understand the expectation will be ultimate flexibility. This could be new grads if you find the right person, so be open to considerations. Whoever oversees the float pool should have a good lay of the land. What departments have needs? How can the float pool prepare to support potential upcoming needs (extended periods of leave, department growth)? When building the float pool schedule, consider what other schedules look like, but make sure the float pool is NOT always filling in the undesirable shifts (if you want a good, flexible, reliable float pool - treat them fairly).
Continuous Observation Pool - Research who can fill these needs. Do they always need to be clinical? This may require the organization to categorize their 1:1 patients (acuity, fall risk, self-harm) and determine who can support this need. Extend this pool (maybe not always just nurses and techs - think outside the box) or maybe, like the PRN concept, hire people into this pool.
How Can I Create Flexibility in a Staffing Program Through Hiring and Cross Training?
It’s important to start by hiring differently. Maybe you have a population of applicants, but they can't work within the shift times outlined. Maybe it's students who don't get out of school until 3:30 but could start work at 4:00. Consider whether the risk is worth the reward. Flexible hiring gives you access to a different workforce and creates a pipeline for the future.
For any budget conscious leaders, all your staffing your staffing options could be executed within budgetary constraints. Don't have the FTEs to hire a whole bunch of new float pool staff? Identify people in various departments who might want to strategically cross train and leverage them (a win-win, since the organization benefits from their flexibility and they get to fulfill their desire to grow).
Another option is to borrow FTEs from departments that can't hire to their vacancies (if there's flexibility like that in your organization). PRN staff may be the answer to decreasing overtime and incentive costs, but you must provide the ongoing data to support this. Measure cost, quality, safety, and satisfaction and share what you find!
I am a strong believer that rescue staffing should not be managed at an individual unit level. This perpetuates silos and creates a perception of ‘haves’ and ‘have nots.’ It is also challenging to ensure consistent execution across each department leader. Consider having someone who executes centrally on guidelines while partnering with specialized departments for hiring, training and other specifics.
What Are Best Practices for Nurse Staffing that Meet My Long-Term Objectives?
So often, leaders build slap-dash staffing solutions without proper consideration for the objective. If the objective is as broad as simply getting skilled people in the door, you might find yourself frustrated down the road when the workforce you have gives you minimal output but costs a lot of effort (like annual reviews and education requirements).
Here are some best practices for creating a flexible staffing program that helps meet long term objectives:
Create clear objectives - be specific when identifying needs. Create guidelines and be sure staff know where to find them and review them annually. If you need night or weekend shifts filled, say it. If you need people who can support multiple areas, write it down Know what (or who) you are looking for so you don't get distracted and not make strides towards achieving your goal.
Notice of changes - be respectful and provide plenty of notice of changes to the guidelines. Share with the staff up front that adjustments may be made as the staffing environment shifts (example-weekend or off-shift commitment needs) but commit to what type of notice you will provide them for any changes.
Hold people accountable - if you have a total hours per schedule expectation, provide a report to the staff so they know where they stand. Ensure there is clarity around what happens if they aren't meeting those expectations; maybe there's a personal reason and they need some grace? Maybe they've worked in other places and no one ever really cared, so let them know you do. Create a system for follow-up, allowing staff members to make corrections, but don't let it linger. And be equitable with how you treat people. If you are going to provide grace to one person, make sure you can do it for another.
The Bottom Line on Best Practices for Flexible and Proactive Nurse Staffing Solutions
Not everything will work. Not everything will work right away. Not everything will work the first time.
Be willing to give time for the different methods to work. Make sure to include guidelines that help to outline what you need.
None of this can be done in a vacuum; you will need support from HR (they need to know how to post the positions and speak to it while screening applicants), payroll (to make sure how these staff clock their time is paying them how you have identified), leadership (it's a leap of faith to try something different, but it just might pay off), staff (they need to understand and support these approaches or they will fizzle out) and other leaders to help hold you accountable and be your sounding board.
Remember, it is easy to backslide when things get especially difficult. Learn more about our unique approach to solve most challenging needs in the healthcare industry with our unique and proven expertise.
About Ashley Kamla, MBA, RN, CENP
Ashley Kamla, MBA, RN, CENP is a healthcare Strategist specializing in workforce management strategy, operational design, and system implementation. Her work focuses on helping healthcare organizations translate complex staffing requirements into scalable, sustainable processes supported by technology. Ashley brings deep expertise in aligning clinical operations with workforce systems to drive efficiency, compliance, and improved care delivery.
Ashley Kamla partners with healthcare organizations nationwide to design and implement workforce strategies that strengthen operational resilience, support regulatory compliance, and improve the day-to-day experience of frontline staff.
About Improv
Improv partners with hospitals, dental groups, and ambulatory care organizations to design sustainable workforce systems that reduce administrative burden, improve staff engagement, and enhance patient care outcomes. Dr. Inman’s work combines practical experience, data-driven insights, and a deep understanding of the human side of healthcare operations. You can learn more about the team at www.improvizations.com.
