Effective Solutions for Workforce Models: Staffing Nursing Positions

January 20, 2023

Having the right nursing workforce model is crucial for healthcare organizations to deliver high-quality patient care efficiently and cost-effectively. With the growing shortage of nurses, healthcare facilities need innovative and adaptive approaches to recruit, manage, and retain nursing talent.

Can Boosting Staff in Nursing Workforce Models Improve Efficiency?

Increasing nurse staffing levels has been associated with positive impacts on key performance indicators. Research shows that having a heavy nursing workload can adversely affect patient safety, which is why it's critical to ensure adequate staffing.

Traditional approaches to nurse staffing and scheduling can lead to inadequate staff numbers, high turnover, over-reliance on overtime, and can hinder long-term stabilization. Innovative workforce models allow organizations to take a data-driven approach to optimizing nurse staffing.

Effective workforce models leverage analytics on patient demand, acuity, and nurse availability to predict staffing needs. This enables proactive planning so that nurse staffing always matches patient demand.

Workforce models that incorporate internal resource pools and external hiring can expand access to qualified nurses when needed. Vendor-neutral technology streamlines candidate selection and placement, provides workforce visibility, and reduces costs associated with temporary staff.

Different Types of Nurse Staffing and Hospital Workforce Models

Healthcare facilities have a variety of options when designing their nurse staffing plans and overall workforce models. Each approach has its own advantages and disadvantages. Understanding the different hospital nurse-staffing models allows organizations to determine the best strategies for their needs and resources.

Staffing by Nurse-to-Patient Ratios

Setting nurse-to-patient ratios is a common approach to determining nurse staffing levels. Some states have legislated mandatory minimum ratios that hospitals must comply with. For example, some states require medical-surgical units to maintain a ratio of 1 nurse for every 5 patients (1:5). Other states may set a recommended ratio or allow hospitals to set their own policies for safe nurse staffing.

The advantage of ratio-based staffing is that it offers clear standards for an acceptable workload. However, it lacks flexibility in adjusting for factors like patient acuity and nurse experience levels. Hard-set ratios may not sufficiently account for the nuances of unit-level care needs. However, setting minimum ratios through regulation or hospital policy ensures a baseline for appropriate nurse staffing.

Patient Classification and Acuity-Based Staffing

Acuity-based staffing involves assessing each patient using a validated classification system to determine their nursing care requirements and complexity level. The assessed workload metrics for all patients are then aggregated to identify the total nursing hours needed. This data-driven approach matches staffing to patient needs.

The benefits of this system are that it optimizes workloads by aligning staff to patient complexity. But the model relies heavily on the accuracy of acuity measures. Frequent reassessments can also be time-consuming. Still, factoring acuity into staffing allows for better workload balance compared to ratios alone.

Demand or Census-Based Staffing

Demand-based staffing uses current and forecasted patient volumes as the key driver for nurse scheduling rather than acuity. Historical census trends are analyzed to predict fluctuations in unit workload demand. Staff levels are then planned according to expected patient numbers.

The advantage is that data-driven demand forecasting allows adjusting schedules for variability in daily, weekly, or seasonal patient volumes. However, census numbers alone lack clinical details on patient needs. If patients are more acute than average, the model risks understaffing for the true nursing workload required.

Demand-based staffing is optimal for flexibility but should be combined with acuity data to anticipate needs accurately. Patient classification provides vital insights, while census patterns identify staffing adjustment opportunities.

Fixed Shifts versus Flexible Scheduling

Most hospitals use set shift lengths such as 8 or 12 hours. The consistency makes planning schedules straightforward. However, fixed shifts limit aligning staff to fluctuating workload demands. In lower volume periods, this can mean more staff are on shift than what is actually needed.

Flexible shift start and end times based on peak periods allow better adaptation to census fluctuations. Nurses work only the hours needed to match demand. However, flexible scheduling is more complex for payroll, productivity tracking, and ensuring coverage of all shifts.

Blending fixed and flexible approaches can optimize benefits. Core standard shifts with flexible short-shift options accommodate both staffing consistency and workload-matching needs.

Team and Primary Nursing

Under a team nursing model, RNs partner with nursing assistants to jointly deliver care for a group of patients. This maximizes the use of all skill sets, with RNs handling complex tasks while assistants provide basic care. However, accountability may be diffused.

In primary nursing, each RN has total responsibility for a specific set of patients. This fosters greater continuity and accountability. But the RN must manage all care needs directly. Hybrid approaches can allow customization across units.

Self-Scheduling and Nurse Preferences

Some facilities give nurses more autonomy in self-scheduling based on their individual availability, shift preferences and work-life needs. This can promote engagement. But ensuring adequate coverage for all shifts becomes more challenging. Balancing organizational and nursing staff needs is key. Augmenting self-scheduling with acuity-based adjustments enables both flexibility and balanced workloads.

Relationship Between Staff-Related Outcomes and Nurse Staffing Models

As mentioned, higher nurse staffing levels have been linked to reduced lengths of stay, lower mortality rates, and fewer adverse events like infections and falls. Effective workforce planning has also been shown to decrease reliance on overtime and agency nurses, reducing labor costs.

Models that allow nurses more control over scheduling may also help with higher job satisfaction and retention. Building adequate resourcing and rest periods into schedules can lead to lower burnout as well.

Role of the RN in Hospital Nurse Staffing Models

Registered nurses play an indispensable role in care coordination and delivery. Having appropriate RN staffing is essential for safe, high-quality care. Insufficient RN staffing can result in missed care, delays, complications, and mortality.

In workforce planning, determining evidence-based RN-to-patient ratios for different units and shifts enables hospitals to staff appropriately for their patients' needs. Models should also account for the complexity of the RN's role by factoring in non-direct care duties like coordination, documentation, and training.

How Does Effective Nurse Staffing Impact Quality of Care Delivery?

Beyond staffing numbers, several aspects of workforce models influence care quality:

  • Skill Level Matching: Care quality is optimized by aligning nurses' expertise and scope of practice with the needs and acuity levels of the patients.. For instance, having an adequate number of RNs available and assigned to care for complex, high-acuity patients promotes reduced length of stay, lower mortality rates, and fewer adverse events.
  • Care Continuity: Fostering consistent nurse-patient assignments, where patients see familiar caregivers at each encounter, facilitates stronger therapeutic relationships and more holistic, personalized care. Continuity improves quality by enabling nurses to detect subtle changes in a patient's condition.
  • Specialization: Allowing nurses to focus their practice within specific patient populations, diagnoses, or hospital units builds valuable expertise that improves care quality in those areas. Specialty training and certification in fields like oncology, pediatrics, or critical care nursing enhances nurses' capabilities.

Can Hospital Nurse Staffing Models Contribute to Sustainable Healthcare?

Sustainable healthcare balances optimal care delivery with responsible resource utilization. Thoughtful nurse staffing is essential for sustainability.

Effective workforce planning helps improve long-term stabilization and lowers labor costs. It can also moderate overtime usage, preventing nurse burnout and turnover expenses.

Optimized staffing allows for delivering excellent care efficiently without undue waste of resources. Overall, data-driven nurse staffing helps control costs while enabling high standards of care.

The Influence of Nurse Retention on Cost Effectiveness of a Staffing Model

High turnover drives up costs associated with recruitment, orientation, and training of replacement nurses. It also leads to care disruptions that can negatively impact quality and patient satisfaction.

Retaining experienced nurses makes staffing more cost-effective by reducing turnover expenses and fully leveraging nurses' expertise. Effective nurse staffing models incorporate factors like manageable workloads, adequate wage levels, competitive benefits, flexible scheduling, engagement initiatives, and career development opportunities. Investing in retention upfront creates noticeable downstream savings,improves  continuity of care, and  helps boost hospitals’ reputations.

How Health Carousel Can Help Organizations with Nurse Staffing Workforce Models

As an experienced healthcare staffing partner, Health Carousel can help organizations optimize their nurse staffing through:

  • Managed services to effectively handle total talent management using internal and external hiring pools. This provides workforce stability and flexibility.
  • Integrated nursing solution model offers a wide range of specialties and flexible assignment durations to meet both short and long-term needs.
  • Cutting-edge VMS technology for streamlined, vendor-neutral hiring and staffing management. This reduces workload and costs.
  • Robust analytics for data-driven planning and decision-making around dynamic staffing needs.
  • A clinically and CNO-led team with approximately 200 combined years of acute hospital and nurse leadership. They serve as an extension of your team, supporting strategic workforce design, recruiting, hiring, and retention. This clinically led guidance strengthens models.

With Health Carousel's customized solutions and real-time reporting, healthcare organizations can build adaptable workforce models to hire and manage nursing talent effectively while advancing care quality and financial performance. If you're looking for innovative staffing solutions customized to your healthcare organization, click on Request our staffing services today to get started.

Frequently Asked Questions

What are the benefits of nurse‐staffing models with higher levels?

Increasing nurse staffing levels allows nurses more time for direct patient care and surveillance. Research shows higher staffing is linked to reduced mortality rates, fewer medication errors, shorter hospital stays, and better adherence to discharge processes.

How does patient acuity factor into nurse staffing models?

Patient acuity refers to the level of nursing care a patient requires based on their condition and complexity. Acuity-based staffing involves assessing each patient using a validated classification system to determine their care needs. Staffing levels are then matched to the total nursing hours required for the aggregated patient workload. This data-driven approach aligns staffing to patient acuity for balanced workloads.

What are the pros and cons of flexible nurse scheduling?

Flexible shift start and end times allow better adaptation to fluctuating patient volumes compared to fixed shifts. However, flexible scheduling is more complex for payroll, productivity tracking, and coverage. Blending fixed and flexible approaches optimizes benefits. Core standard shifts with flexible short-shift options enable both consistency and demand-matching.

How does RN staffing impact the quality of care?

Research shows higher RN staffing levels reduce mortality, complications, and lengths of stay. RNs play an indispensable role in care coordination and delivery. Having appropriate RN staffing enables safe, high-quality care. Insufficient RN staffing can result in delays, errors, and adverse events.

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.