Enhancing Efficiency in Healthcare: The Impact of Nurse Staffing Models

January 13, 2023

Traditional nurse staffing models are proving inadequate to address today's unique healthcare staffing challenges. However, by embracing innovative care delivery models like enterprise float pools, flexible self-scheduling, virtual nursing, and data-driven forecasting, healthcare organizations can optimize their existing workforce. Efficient nurse staffing models can improve clinician satisfaction and retention while enhancing patient outcomes, reducing costs, and supporting the bottom line.

Nursing Shortages and the Need for Optimized Hospital Nurse Staffing Models

The U.S. healthcare system faces an ongoing shortage of nurses that is only expected to increase in the future. While demand rises with an aging population, not enough new nurses are entering the workforce to replace retiring nurses. This growing gap makes finding ways to optimize existing nursing resources through innovative staffing models more important than ever.

Traditional nurse staffing approaches rely heavily upon set nurse-to-patient ratios, shift-based scheduling, and temporary agency nurses to fill gaps. However, these legacy models lack the flexibility and efficiency needed to address today’s challenges. By embracing new models, hospitals, clinics, and other healthcare facilities can enhance nurse staffing efficiency, satisfaction, and quality of care delivery.

The Importance of Nurse Staffing

Nurse staffing levels have profound implications for clinical, financial, and cultural aspects of healthcare delivery. A few of the dimensions of healthcare that adequate nurse staffing impacts include:

Impact of Nurse Staffing on Patient Outcomes, Satisfaction, and Care Quality

Robust evidence confirms insufficient nurse staffing seriously jeopardizes patient outcomes, clinician performance, and the quality of care delivered:

  • Better RN ratios per patient correlate to lower odds of readmission and shorter lengths of stay.
  • Each additional patient assigned to an RN leads to an increased mortality risk. Higher workloads increase errors.
  • Units with poorer nurse staffing see increases in falls, pressure ulcers, infections, and medication errors.
  • Improved RN staffing is associated with higher patient satisfaction survey scores.
  • Mandated minimum nurse staffing ratios have led to lower patient mortality and failure-to-rescue rates.

Nurse Staffing Effects on Hospital Finances and Revenue

Optimal nurse staffing levels enhance quality, safety, and the patient experience while also supporting cost management and the bottom line:

  • Having a good RN skill mix is linked to reduced adverse events and lower variable costs per case. This is because the comprehensive skill set of your staff ensures the right care is provided based on a wide range of patient needs.
  • Units with RNs caring for fewer patients have shorter lengths of stay. Shorter stays improve hospital profitability.
  • Magnet-designated facilities known for exceptional nursing have strong financial performance. Nursing excellence influences revenue.

Nurse Staffing as a Marker of Organizational Culture

How an organization approaches nurse staffing sends a strong signal about its culture. Investing in transformative models reflects a commitment to nurses as leaders in care delivery:

  • Prioritizing elements like nurse engagement, flexible scheduling, shared governance, and professional development improves retention.
  • Adopting innovative, nurse-centric staffing models signals to nurses they are valued partners, not just personnel. This culture draws talent.
  • High satisfaction in the work environment leads to lower nurse burnout and higher nurse-reported quality of care.

Traditional Nurse Staffing Models

For decades, most hospitals have relied upon three primary traditional approaches to nurse staffing: fixed nurse-to-patient ratios, shift-based scheduling, and contingent agency nurses. Here is a breakdown of some traditional nurse staffing models:

Overview of Fixed Nurse Staffing Ratios

Traditionally, hospitals adhere to preset nurse-to-patient ratios which dictate the number of patients each nurse can be assigned on a given unit. For example, ratios may be 1:4 or 1:5 on medical-surgical floors and 1:1 or 1:2 in intensive care settings depending on patient acuity. These fixed ratios aim to ensure an adequate level of nursing resources and attention for safe patient care. However, adapting staffing to census fluctuations outside of the set ratios can be challenging. Hospitals can struggle to efficiently flex up or down with surges or lulls in patient volumes.

Pros and Cons of Shift-Based Scheduling

The nurses assigned to hospital units typically work set shifts, which cycle through a predetermined pattern. Standard shift options are usually 8, 10, or 12 hours in length. While predictable, shift-based scheduling tends to lack flexibility. Nurses get locked into set days and times which can contribute to poor work-life balance, especially for those working nights, weekends, and holidays. Turnover and burnout increase when nurses lack sufficient control over scheduling.

Innovative Nurse Staffing Models

Several innovative new approaches are emerging that aim to enhance the agility, efficiency, and nurse-centricity of staffing models:

Centralized Float Pool Models

Achieve enhanced staffing agility with dedicated, centralized pools of nurses who are extensively cross-trained to work flexibly across multiple hospital departments, specialties, and shifts. Nurses can build their clinical exposure and skills by working across diverse environments. Facilities can be more nimble and adapt nurse deployment up, down, and across units to changing patient census and acuity levels in real-time versus being confined to fixed unit-based staff. However, robust governance and training are required to ensure smooth operations of enterprise-wide float pools. Proper change management and culture building is also important to ensure success.

Flexible Shift Models and Self-Scheduling

Some hospitals are adopting more flexible nurse shift patterns and schedules. This may involve expanded shift options beyond just 8 or 12-hour shifts, easy shift swapping functionality through online platforms, and enabling nurses to self-schedule based on their preferences. The benefits include greatly improved nurse work-life balance, enhanced autonomy and control over calendars, and boosted engagement and retention. Unit-level fixed shifts can become more fluid based on nurse needs and patient demand. With the rise of self-scheduling, analytics on nurse shift patterns becomes imperative to ensure adequate coverage.

Telehealth and Virtual Nursing Models

Telehealth opens new opportunities for remote nursing – whether managing after-hours triage advice lines virtually or intensive care unit telemonitoring programs. "Virtual nursing" arrangements expand the talent pool available. They also encourage experienced nurses to remain in the industry without having to work at the bedside by offering a less physically taxing option. However, training on digital clinical communication, virtual care workflows, and grounding nurses virtually into the organization's culture remains vital for success.

Shared Governance Models

"Shared governance" represents a management philosophy based on empowering frontline nurses to participate in operational decisions alongside their managers. This may involve nurses actively participating in setting unit policies, evaluating new technologies, addressing staff concerns, and providing input into model design. The goal is to strengthen nurse engagement by fostering a spirit of true partnership between staff and leadership. Soliciting nurse input into new staffing model development is key to success.

Nurse Staffing Model Implementation

Implementing innovative nurse staffing models successfully requires much more than just designing an optimal workforce approach on paper. Proper change management, communication, training, technical integration, and continuous optimization enable new models to deliver intended benefits.

Securing Leadership Buy-In for Change

Gaining alignment and active sponsorship from nursing executives and the C-suite lays the groundwork for successfully rolling out any new nurse staffing models. Nurse managers and directors must take time to thoroughly brief leadership on proposed changes and make a compelling case for adoption. Where possible, organizations should conduct small-scale rapid testing of new approaches first and analyze data to prove value before pursuing major organization-wide implementations. Having visible leaders actively champion changes through their words and behaviors also helps to roll out new staffing models.

Fostering Nurse Engagement, Communication and Culture

Authentically engaging nurses in two-way communication channels makes staff feel like partners, not just recipients of change. Consider campaigns, focus groups, surveys, and open office hours to share updates and gather input. Emphasize culture as a partnership where nurses play an active role in designing workflows, training approaches, and optimization. Organizations should also provide robust feedback mechanisms to address concerns rapidly.

Integrating New Models into Existing HR Systems

Healthcare organizations must ensure smooth technical integration between any new nurse scheduling systems, automation tools, or on-demand staffing platforms with foundational HR infrastructure like payroll, learning management, and budget planning. An important step, along with training on new solutions, is prioritizing interoperability and up-to-date data flows across systems so all platforms share timely staffing data.

Change Management Best Practices

Organizations should apply thoughtful change management techniques like stakeholder analysis, impact assessments, and organizational readiness evaluations both before and during the rollouts of new nurse staffing models. Some best practices include:

  • Make the case for change compelling without being contentious.
  • Incentivize first adopters.
  • Provide ample training and support resources.
  • Closely monitor progress using scored adoption cards and refinement sprints.
  • Continually reinforce achieved wins.

Ongoing Optimization

To ensure ongoing optimization, organizations should:

  • Continuously collect staff feedback, analyze available data, and further optimize new models based on real experience.
  • Refine training approaches and workflows based on needs.
  • Have senior nurses mentor peers still learning new approaches.
  • Watch closely for staff burnout.
  • Update executives regularly on measurable progress against goals.

Evaluating Current Nurse Staffing

In order to evolve towards more optimized models, nurse leaders must regularly evaluate their organization's current nurse staffing approach, identify gaps, and assess readiness for change.

Methodology for Analyzing Nurse Staffing Gaps and Opportunities

Thoroughly evaluating existing nurse staffing requires analyzing current and historical data across both quantitative and qualitative metrics:

  • Hard numbers on turnover rates, vacancies, overtime spending, and patient falls.
  • Survey data from patient satisfaction scores and nurse engagement assessments.
  • Reviews of existing workflows, scheduling policies, and staff mix/skills.
  • Insight into the balance of time off and schedule adherence.
  • Temporary agency nurse usage and associated costs.
  • Unit-level productivity and case efficiency benchmarks.

Update evaluations frequently as needs shift. Every metric tells part of the workforce story.

Assessing Float Pool Readiness and Flexibility Needs

To determine the feasibility of float pool models, leaders must assess potential sharing opportunities across departments/units, existing policies on nurses floating between units, depth, and structure of cross-training programs, and nurse openness to working across specialties. Some methods to ensure readiness and flexibility include:

  • SWOT Analysis: Analyze the current nurse staffing approach. This highlights strategic insights for building a robust business case for change.
  • Staff Inclusion: Actively include staff nurses in evaluating existing models. Their daily experiences provide invaluable perspectives. Survey nurses anonymously on what works and what doesn’t.

Future Outlook for Nurse Staffing

Looking ahead, nurse workforce experts foresee staffing models will continue evolving to become even more flexible, personalized, and enabled by technology.

Projections for How Nurse Staffing Will Evolve

Experts believe that nurse staffing will evolve as described below:

  • Improvements in staffing technology will enable nurses to pick up open shifts that fit their schedule across units based on competencies, experience, and preferences.
  • Integrated scheduling automation and predictive analytics will enable sophisticated demand forecasting and deployment of nurses in a data-driven manner.
  • More roles like telehealth nurses, transitional care nurses, and care coordinators will provide remote working opportunities aided by video and data sharing.
  • Increased usage of mobile acuity assessment tools, wearables, and tracking will provide real-time visibility into the unit and patient needs to inform responsive staffing.
  • More dynamic, self-scheduling based on nurse input and AI optimization will emerge, with nurses gaining more control over calendars.
  • Specialization and cross-training will increase, requiring more precise matching of specialty nurses to patients.

The Growing Role of Technology and Automation

There is no question that technology like predictive analytics, automation, and AI will enable more real-time, data-driven approaches to nurse staffing. However, human insight will remain critical to set strategic models aligned with organizational goals. Finding the right balance of technology and nursing expertise will drive optimal staffing efficiency.

Importance of Agile, Data-Driven Staffing

Given the continual changes underway in healthcare models, regulations, technology, and patient expectations, nurse leaders must embrace agile management principles. Linear or static staffing models will become outdated quickly. Leveraging robust workforce data to dynamically adapt nurse staffing strategies will only grow in importance.

Key Takeaways on Nurse Staffing Optimization

With compelling evidence showing the impact of nurse staffing, leaders must prioritize innovative models like enterprise float pools, flexible self-scheduling, telehealth, and acuity-based algorithms to improve efficiency. Technological advances provide new opportunities, but a sharp focus on change management and nursing culture remains equally vital for success.

The time is now for nursing leaders to take an honest look at their nurse staffing models and assess where more agile, optimized approaches can strengthen efficiency, finances, and care quality. Don't wait for a crisis to spur action. Be proactive in evaluating new models and engaging nurses in solutions.

Choose Health Carousel for Your Nurse Staffing Solution

Developing optimized, agile nurse staffing models is more important than ever given the mounting challenges facing today's healthcare systems. Health Carousel is an ideal partner for hospitals and health systems looking to enhance their nurse staffing.

Specialized Talent

Through extensive domestic and global recruiting, Health Carousel provides access to expanded pools of qualified nurse talent and allied health professionals to help fill shortages.

Strategic Advisory Services

Beyond just staffing, Health Carousel serves as a strategic advisor to clients. Our experts help assess current nurse staffing models and identify opportunities to implement leading practices that boost efficiency.

Cutting-Edge Analytics

Robust analytics and reporting provide data-driven insights around workforce utilization, overtime expenditures, and other metrics to inform dynamic nurse staffing strategies.

Focus on Nurse Culture

Health Carousel's solutions emphasize nurse engagement, communication, satisfaction, and retention – aligning with the cultural best practices needed for success.

Innovative Solutions

With forward-thinking nurse staffing solutions grounded in analytics and culture, Health Carousel enables hospitals to evolve their workforce management capabilities. We deliver strategic, customized solutions needed to address the challenges facing today's healthcare organizations.

If our solutions sound right for you, request staffing today.


What are the main pros and cons of float pool nursing?

Float pool nursing allows nurses to work flexible schedules across different units and facilities. The pros of float pool nursing are the exposure to diverse patients, conditions, and treatments, which can expand nursing knowledge and skills. Floating provides a break up in routine and allows nurses to try new areas before committing. It also provides facilities with needed staffing coverage and flexibility. However, the cons are that float nurses do not establish the same bonds and teamwork with the regular staff and patients. Being unfamiliar with each unit's routines, policies, charting, and equipment can be challenging.

How can I make a case for more nurses in my healthcare facility?

The nursing shortage is a critical issue affecting patient care and nurse burnout across the healthcare system. Increasing the number of nurses at a facility can have significant benefits for patient outcomes, staff well-being, and organizational costs. To advocate for more nurses, it's important to use objective data to demonstrate the need, such as nurse-to-patient ratios above recommendations, high turnover due to burnout, and metrics showing impacts on patient care like higher readmission rates. Any cost analysis should factor in expenses from adverse events, infections, and poor outcomes linked to inadequate staffing. Emphasize it's an investment in quality care. Collaborate with nursing leadership on a proposal, engage doctors and administrators, and demonstrate support from staff and community members.

What technology is best for optimizing nurse scheduling?

Nurse scheduling is a complex process that requires balancing many factors to ensure adequate staffing levels while being fair to nurses. The right technology depends on a hospital's specific needs and situation. However, optimizing nurse scheduling through technology helps retention, performance, care quality, and the bottom line. The key is finding the tools that work best for a given hospital's culture and needs.

About Health Carousel

Health Carousel is committed to partnering with world-class healthcare facilities across the country, providing rewarding assignments for Registered Nurses and Allied Health Professionals, and attracting the best internal talent at all career levels.