Staffing Models
Part 1 · Chapter 3

Staffing & Scheduling Models

Centralized, decentralized, and hybrid models — advantages, drawbacks, and principles for choosing the right fit.

9 min read

Staffing & Scheduling Models

The right scheduling and staffing model improves patient outcomes, cuts costs, and increases nurse satisfaction. The best fit depends on organizational structure and culture. Three primary options exist: centralized, decentralized, and hybrid.

Centralized Scheduling and Staffing

Centralized staffing reflects its name: It's a single department or team of staffers and schedulers who manage nurse staffing across an organization. Similarly, centralized scheduling refers to a system where scheduling is handled by one person or team organization wide.

A centralized model can operate at the system level across multiple facilities or within a single hospital. Either way, one team of schedulers and staffers works with nurse managers to build balanced schedules based on staffing needs, patient volumes, and acuity.

In the centralized model, scheduling and staffing work in tandem. Scheduling covers building the 6-week schedule 8 weeks out — managing trades, PTO requests, and proactive recruitment for unfilled shifts. Staffing kicks in within 24 hours of the shift to fill remaining gaps.

Decentralized Scheduling and Staffing

In a decentralized model, individual units or departments manage their own schedules and day-of staffing, deciding how many professionals are needed to cover requirements.

Hybrid Scheduling and Staffing

Some organizations use a hybrid scheduling and staffing model. For example, the unit manager might be responsible for building and maintaining the unit schedule up to 24 hours before the start of the shift. The manager approves trades and vacation/PTO requests, adjusts the schedule to account for leaves of absence or resignations, and recruits to fill unfilled shifts. Within 24 hours or less, the central staffing office takes over management of the schedule, including managing sick calls, recruiting staff for last-minute needs, and adjusting staffing plans through floating, cancelations, or overtime.

Another example is an organization that increases flexibility of a decentralized staffing model by holding daily staffing meetings with nurse managers from each division and weekly staffing meetings with nurse directors.

Benefits and Drawbacks

Both centralized and decentralized scheduling and staffing models have their benefits and drawbacks.

Pros and Cons of Centralization

Pros:

  • Consistent staffing levels across the organization, maintaining patient safety and quality of care
  • Scalability and efficiency — one staffer can support more than 500 nurses across 16 units vs. 6 decentralized managers scheduling for 80 nurses each
  • Increased transparency — greater visibility into staffing levels across an organization
  • Standardization — standardized rates, scheduling policies, and cadences
  • Cost savings — better leverage of resources from overstaffed units and available float pools

Cons:

  • Reduced flexibility — may be less responsive to individual unit or department needs
  • Increased bureaucracy — additional layers of decision-making
  • Resistance to change — some nurses may resist if they feel it takes decision-making power away
  • Higher initial cost — additional resources and investment required upfront, though it can lead to long-term savings

Decentralized models can provide greater flexibility and autonomy but may result in inconsistent staffing levels, less standardization, and unnecessary incentive or overtime spending across an organization.

The choice depends on organizational needs and priorities.

AI and Staffing Models

AI is changing the calculus. Centralized models benefit most from AI because they provide a single data source, consistent rules, and enterprise-wide visibility — exactly what optimization algorithms need. But AI can also give decentralized models centralized-level consistency without requiring organizational restructuring. An AI layer that sits on top of individual unit schedules can enforce system-wide rules, balance fairness across departments, and surface cross-unit staffing opportunities — even when each unit manages its own schedule.

Choosing a Staffing Model

Questions to consider before choosing:

  • What's the overall vision for the nursing scheduling and staffing model?
  • Is the hospital part of a multihospital system that will share resources?
  • Will the organization use a scheduling and staffing technology platform?
  • Is there an employee union?
  • Will shared governance teams play a key role in development and implementation?
  • What is the patient volume?

Universal Principles

Regardless of model, three principles improve scheduling and staffing effectiveness:

  1. Obtain nurse input. When nurses have input into scheduling and staffing processes, the model will better incorporate their needs, implementation will be smoother, and nurses will be more committed to it.

  2. Maximize flexibility. Scheduling and staffing flexibility allow an organization to adapt quickly to changing patient needs, including changes in patient census and acuity and varying available staff levels.

  3. Prioritize transparency. Transparency and collaboration increase trust in the system and maximize scheduling and staffing issue solutions.