Workforce Flexibility

In a nursing shortage, frontline nurses can demand what they want from an organization — including more flexibility. Leaders juggle recruitment, retention, and patient care while responding to real-time staffing needs. Meeting both organizational and staff demands requires creativity, which starts with understanding the nature of a flexible workforce.

Nurses and Flexible Work

A report from the National Nurse Staffing Task Force's think tank identified "work schedule flexibility" as one of its six priority topics for nurse staffing. The task force includes representatives from the American Association of Critical-Care Nurses, American Nurses Association, American Organization for Nursing Leadership, Healthcare Financial Management Association, and the Institute for Healthcare Improvement.

What is meant by flexible work? The Task Force defines work schedule flexibility as "a staffing schedule that encompasses flexibility in work options, policies, and scheduling with nurses cross-trained to various units, to support well-being during a shift that incorporates time for professional development and leadership engagement such as shared governance." Strategies to achieve flexibility include float pools (both single entity and system-wide), PRN nurses to supplement float pools, and an interdisciplinary care team that can provide support for certain tasks such as discharges.

But what does flexible work mean to staff? A study examining flexibility from the perspective of both nursing leaders and frontline staff found that self-scheduling (the ability to pick their regularly scheduled shifts) is seen by staff nurses as the most flexible work option (chosen by 59% of respondents), followed by gig or per diem work with no committed hours (17%) and the ability to choose the hospital or unit work location (8%). Self-scheduling also topped the list when nurses were asked to rank flexible work options in order of importance, followed by the ability to work shifts of different lengths (25%).

How does staff's view of flexibility compare to nurse leaders' views? In the same study, nurse leaders agreed with frontline nurses on the importance of self-scheduling and evaluating different shift lengths. In interviews, a common theme from leaders was the ability to find and adjust frontline nurses to meet staffing needs in real time to ensure every shift is filled while still considering the nurse's skill and competency to ensure safe staffing. Few leaders identified gig and per diem work as new models to consider with technology, and none mentioned balancing full- and part-time options to create additional flexible offerings for staff, yet these were highly ranked by frontline staff.

Flexibility — from both frontline and leadership perspectives — needs to be an organizational priority. Maximizing it means building a foundation that supports flexible work and operationalizing innovative programs.

Rules of the Road: Scheduling and Staffing

Before building a flexible workforce, one distinction is critical: scheduling and staffing are not interchangeable. They are separate actions requiring distinct strategies, policies, technology, and analytics.

Scheduling

Scheduling is usually accomplished through self-scheduling or pattern scheduling (a set schedule for the employee) practices set at the hospital or unit level. The goal of a manager in making a schedule is "the assignment of the right people to the right task, to the right time, and to the right place."

When creating a schedule, nurse leaders consider various external and internal factors during the building phase of the scheduling process. Common factors are federal and state regulations, patient characteristics, nurse characteristics, shift length, technology, cost, supply, and patient care models.

The basic concept in building a schedule is aligning demand (patients) with supply (nurses). Traditionally, organizations forecast demand using average monthly or daily census to predict anticipated patients for the schedule period. Finance typically handles this forecast yearly for budgeting.

Staffing

Staffing activities usually begin anywhere from 12 to 24 hours before the start of the impending shift. The process requires evaluating the actual number of patients; anticipated discharges, admissions, or transfers; and the unique patient conditions that require specific nursing skills for care and then comparing that evaluation to how many nurses were scheduled. This analysis identifies staffing overages (too many nurses) or deficits (not enough nurses).

Once an overage or deficit is projected, a staffing plan is created and operationalized. The plan contains specific staffing actions to ensure the assignment of the right nurse, for the right patient, at the right time. The staffing process is dynamic and can change in a matter of minutes. Everyday nurse staffing actions for efficient operations include mobilization of resource float pool, recruitment of nurses for open shifts, cancelation, flexing and floating, management of unplanned shift vacancies, and the daily maintenance of unit/department schedules to reflect what happened.

This distinction carries through the rest of the handbook: scheduling covers everything up to 24 hours before a shift; after that, staffing takes over.

Benefits of Flexibility

It takes time to implement a flexible workforce, but the benefits yield a significant return on investment for the organization. For example, a systemwide float pool can save money by ensuring efficient staffing.

AI-powered scheduling tools are accelerating what's possible. Intelligent systems can enforce scheduling rules, match preferences, and fill coverage gaps without manual intervention — making true self-scheduling at scale a reality rather than an aspiration. When paired with constraint-based optimization and dynamic pricing, these tools allow organizations to deliver the flexibility staff demand while maintaining the coverage patients require.