Raising the Pillars
Part 2 · Chapter 1

Raising the Pillars

Core principles for operationalizing flexibility: team approach, policies, cross-training, education, goals, and starting small.

7 min read

Raising the Pillars

With a foundation in place, the next step is operationalizing the structure — scheduling, staffing, incentive programs, and vendor management (Part 2), plus innovative programs like internal travel agencies and gig programs (Part 3). Several core principles serve as pillars for all of these efforts.

Take a Team Approach

Changes to scheduling and staffing can be scary — even when the goal is more flexibility. People worry about personal impact, and may resist letting go of current practices.

A stakeholder team with clear expectations helps ease the transition. Flexibility doesn't mean "anything goes" — the organization still needs 24/7 coverage. But the capacity for flexibility is wide and serves as a powerful recruitment and retention tool.

Establish Scheduling and Staffing Policies

Based on the organizational assessment and policy review, revising or creating scheduling and staffing policies is essential for standardization, operational efficiency, and flexibility. Fair scheduling practices are linked to higher nurse satisfaction.

Scheduling and Staffing Policies

Core components particularly key for workforce flexibility:

  • Weekend coverage: If possible, use every third weekend instead of every other weekend
  • Early incentivization: Policies should promote proactive filling of open shifts with high-dollar incentives early in the staffing process
  • Offer and trade options: Building in offer and trade options for both partial and full shifts will increase nurse satisfaction
  • Weekend-only programs: Gives nurses raising a family or going back to school an important work option
Best Practice
Build in flexibility for how nurses meet weekend requirements. For example, a nurse could fulfill the requirement to work four weekend shifts in a 6-week cycle by working every Saturday for four weeks or by working two weekends in a row.

Cross-Train Staff

Cross-training deepens workforce expertise while expanding clinical experience and work options. Look for areas of practice similarity — for example, PACU and critical care staff both care for closely monitored patients, making them strong candidates for cross-training.

Best Practice
Keep an electronic record of training. The record should integrate with your staffing technology, so it's easy to identify those qualified to be offered extra shifts in a particular area. This will reduce the need for external agency staff.

Provide Education

As with any new initiative, education is key. Both managers and staff need to understand the purpose of flexibility, strategies for achieving it, and the specifics of relevant policies and operations. Be sure to allow enough time for education before the go-live date.

Best Practice
If you are spending more than 2% to 5% of your total labor spend on external labor, you need to bolster or build more internal flexible programs to account for seasonal demands or vacancies and reduce reliance on travel nurses.

Establish Goals

To stay competitive, plan for this workforce mix:

  • 2% to 5% for external labor
  • 20% to 35% for flexible workforce options (such as internal travel agency, system float, weekend, and PRN programs)
  • Remainder reserved for departmental core positions

Start Small

There's no one-size-fits-all solution. Start with one or two programs, evaluate success, gather feedback, and iterate.