Organizational Assessment & Design
Many organizational factors impact nurse scheduling and staffing, making design assessment essential. The assessment should cover overall structure and how scheduling and staffing work is currently performed, then compare results against best practices to identify refinements.
Questions that should be part of an organizational assessment include the following:
- Is the hospital a part of a health system? If so, are there shared resources such as a float pool with other hospitals in the system?
- Who makes the schedule and manages the timecard?
- Is there a central staffing office?
- Does the organization have system policies for staffing, scheduling, open-shift recruitment, incentive programs?
- Is shared governance in place for monitoring, trending, and evaluation?
- Is there a staffing committee?
- Is there a per diem or gig program?
- Does the organization use a scheduling and staffing technology platform? If so, is it being used effectively?
- What is the process for requesting and onboarding agency/contract labor?
- Does the organization use technology (such as a vendor management system) for agency management?
Who Does the Work?
Who makes the schedule and does the staffing work — a nurse, a manager, a secretary, an educator? Many organizations lack dedicated scheduling and staffing teams. Instead, various people share the work, which — however well-intentioned — leads to fragmentation, errors, and duplication.
A dedicated team provides the support needed for successful scheduling and staffing operations. Those on the dedicated team need good communication skills, problem-solving abilities, basic math skills, and proficiency with technology.
An effective dedicated scheduling and staffing team has formal job descriptions, titles, and defined responsibilities. The scheduler/staffer role should be a clerical professional—not a nurse—who works closely with frontline nurses and nurse managers and is managed by the nurse director or manager.
Nurse managers own accountability for their units but shouldn't get caught in the minutiae of schedule moves, open-shift recruitment, or daily coding entries. Likewise, frontline nurses shouldn't be pulled from patient care for clerical scheduling tasks — their training is better spent practicing at the top of licensure.
Here are suggested scope, responsibilities, and accountability parameters for those on the scheduling and staffing team:
Scheduler/Timekeeper (1 FTE to support 250–300 employees):
- Creates and edits schedules
- Maintains employee scheduling templates
- Approves and denies schedule requests
- Assigns specialty roles
- Fills open shifts
- Updates schedule with changes such as staff shift trades
- Responsible for timecard management and daily schedule maintenance up to 24 hours before the start of the shift
Staffer (1 FTE to support 150–300 employees):
- Mobilizes clinical staff through employee recruitment to meet daily needs less than 24 hours before the start of shift
- Manages unplanned shift vacancies due to factors such as sick calls
- Firms up the staffing plan by matching the number of people to actual census and acuity
- Updates daily unit/department schedules with staffing changes in the electronic system
What Do Policies Contain?
Organizational policies should address both scheduling and staffing. Check for these core elements.
Scheduling Policy Core Elements
Schedule length and timing: Whether the schedule is posted for a 4, 6, or 8-week rotation and guidance for the timing of scheduling events.
Shift lengths and times: Day, evening, night, or mid shifts that range from 4 to 12 hours long.
Skill mix is identified as needed.
Weekend coverage is set at the system, hospital, or unit level.
Shift trades are a like-for-like trade regarding hours, skill set, and pay.
Holiday and vacation recommendations are set at the organizational level per human resources policies.
Self- or patterned scheduling is at the unit level when a schedule is being created.
Staffing Policy Core Elements
Nurse floating parameters are outlined, including requirements for rotation and who is responsible for tracking.
Maximum continuous work hours are defined.
Low census cancelation parameters are defined with an algorithm for who is canceled first.
Sick call responsibilities are defined for the nurse and for those responsible for receiving and recording sick calls.
Incentives for extra and open shifts are defined with timing guidelines.
Is Shared Governance Engaged?
Shared governance is essential for successful scheduling and staffing. The shared governance council, which should be led by a frontline nurse and the nurse manager, evaluates programs, policies, and outcomes.
Follow these tips to promote an effective council:
- Have diverse frontline staff representation
- Establish a charter that includes goals
- Outline accountability (for example, in some organizations, unit shared governance councils report to system-wide councils)
- Rotate members
- Set regular meeting times
Shared governance doesn't only apply at the unit level. Hospital or system shared governance councils can assess and analyze trends and modify operations to optimize scheduling and staffing. Representatives from human resources and information technology can be helpful to the council's work.
AI Readiness
As AI-powered scheduling and staffing tools mature, the organizational assessment should also evaluate readiness for AI adoption:
- Data infrastructure — Does the scheduling system capture the data AI needs (shift history, preferences, availability, workload coverage)? Is data clean and standardized?
- API-capable systems — Can the current workforce management platform exchange data with external AI tools via APIs? Integration capability is a prerequisite.
- Change management capacity — Is leadership willing to pilot AI-assisted scheduling? Are managers open to reviewing AI-generated recommendations rather than building schedules entirely by hand?
- Governance for AI — Who will oversee AI tool adoption, validate outputs, and ensure the system respects organizational rules and union contracts?
Once the assessment is complete, the next step is choosing a scheduling and staffing model.