Introduction

The goal of healthcare is wholistic care — treating the disease, not just the symptoms. Oxygen alone won't cure pneumonia; it manages the symptom while the underlying illness is treated.

Yet nurse leaders often treat only the symptoms of the staffing crisis — not the root cause. Organizations pour energy into hiring, overtime, and last-minute shift deals, heroically managing daily staffing shortfalls with minimal long-term success. The missing piece is thinking about the problem wholistically — moving beyond symptom management to solving it.

This handbook shows how a wholistic approach tackles staffing differently, with a special emphasis on flexibility. It provides guidance and tools — tested across many hospitals and health systems — for building workforce models that address the root cause of the nurse staffing problem: a lack of flexibility. The content is divided into four parts.

Part 1: Build the Foundation covers what's needed to set the stage for a flexible workforce, including organizational assessment and staffing model selection.

Part 2: Operationalize the Structure describes how to put that structure into practice — scheduling and staffing strategies, and vendor management software.

Part 3: Incorporate Flexible Workforce Programs covers the nuts and bolts of innovative programs like internal travel agencies and gig programs.

Part 4: Leverage AI & Analytics covers how artificial intelligence is transforming workforce management — from the scheduling lifecycle and auto-balanced scheduling to forecasting and dynamic pricing.

Throughout, best practice boxes highlight tips drawn from real-world experience, and tools — like a checklist for launching an internal staffing agency — help smooth implementation. AI-enabled capabilities are woven into every part: from technology selection and incentive automation to intelligent shift matching and predictive demand planning. These tools are now making the vision of a truly flexible workforce operationally achievable.

Wholistic staffing management is easier said than done, but it is possible. Nurse leaders are well equipped to tackle the problem head-on and bring transformational change to their organizations. The key is carving out uninterrupted time each week to move beyond daily firefighting and into strategic problem-solving. It means shedding past practices and sacred rules, and leaning into fresh, novel ideas — including AI tools that can automate the manual work that consumes leadership time.