Scheduling, Staffing & Incentive Programs

Several strategies for scheduling, staffing, and proactive incentivizing promote workforce flexibility.

Scheduling

Scheduling flexibility starts with self-scheduling. Self-scheduling promotes engagement in the scheduling process and aligns with the trend towards a gig economy. Nurses feel a sense of ownership, and the ability to schedule within the context of external commitments reduces the likelihood of absences.

Typically, a 6-week schedule is open for 10 days, no later than 21 days before the start of the shift. Once the schedule is closed, the scheduler "balances" it to ensure adequate coverage.

Flexible strategies for scheduling include:

Different shift lengths (such as 4, 6 or 8 hours), which may attract nurses with other commitments
Auto-approval of shift trades, which allows nurses to adapt their schedules to unexpected events
Offering extra shifts after the schedule has been published, available to all qualified staff and posted in the electronic schedule

Best Practice

Rather than a "first-come, first-served" approach, create rotational groups, so each team member has the opportunity to pick their schedule first. Also, be sure to build in parameters to ensure trades are equitable from a financial and skill mix perspective. Use auto-trades to remove the need for manager or scheduler review.

Staffing

Staffing refers to deploying nurses for shifts, usually starting 24 hours before the shift begins. At this point, the staffer considers whether assigned staff is appropriate for patient census and acuity or if overstaffing or understaffing exists.

Options for correcting overstaffed situations:

Floating — Nurses are reassigned to other units for a specific shift
Low census on-call — A nurse is placed on-call for a regularly scheduled shift
Cancelation — There is a surplus of nurses, so the nurse is canceled for the shift

Options for correcting understaffed situations:

Mobilization of float pool resources
Last-minute recruitment for open shifts via text message technology

Best Practice

Float pool nurses also can help with census fluctuations or staffing shortages created from sick calls or unplanned absences.

Proactive Incentive Programs

Optimal staffing varies by shift due to the complexity of matching nurse numbers, skills, and patient demand. A proactive incentive approach reduces stress for managers and staff alike.

When operationalized correctly, a proactive incentive program alleviates last-minute recruitment frenzy and mitigates potential gaming of the process by frontline nurses holding out for the most money possible.

Step 1: Form a Team

The incentive program team should include human resources compensation experts, finance staff, operational nurse leaders, and frontline staff.

Step 2: Analyze Existing Policies

Gather all existing policies related to incentives at the unit, hospital, and system levels. Review the policies, identifying overlaps and key elements you may want to keep.

Step 3: Structure the Program

Consolidate existing incentive policies and integrate them into a single incentive program. Having one program improves efficiency and ensures leaders are not outbidding each other for the same talent.

Best Practice

Align your incentive policy with your staffing policy so both represent the incentive program. The program also needs to align with any union contracts.

Hourly rate: A tiered program with no more than three tiers — low, medium, and high dollar range applied as additional money per hour.

Best Practice

Review and assess incentive hourly rate on an annual basis and adjust as needed based on market trends.

Eligibility: Determine criteria for the workforce — full-time, part-time, PRN/per diem, float pool, internal agency, external travelers, and international staff each have different eligibility considerations.

Incentive rate criteria: Develop criteria for offering incentives for unfilled shifts. Less desirable shifts typically have a higher incentive amount.

Shift distribution: Define how to distribute open shifts, starting with the most qualified but least expensive nurse.

Step 4: Establish Open Shift Management Processes

Three key points to keep in mind:

1. Define roles and responsibilities. It needs to be clear who has the access and authority to offer incentive shifts.

Best Practice

Centralize incentive shift offerings in a central staffing office if you have one. The office will then have a high-level view of current staffing resources.

2. Determine timing. Incentives should be offered early, with the established dollar amount for the tier. Don't wait until the last minute.

Best Practice

Offer the highest tier for open shifts early, based on established criteria. Never offer the most expensive incentive offering right before the start of the shift.

3. Use staffing technology. Dynamic staffing technology enables automated shift matching and price transparency for frontline nurses.

Best Practice

Empower frontline nurses to own their practice and select their shifts. If they can do so on a mobile device, expect them to sign up for shifts themselves. Do not enter shifts for them.

Step 5: Launch the Program

Set a go-live date. Give yourself at least a month before go-live to educate managers, the staffing office, and frontline staff about the program.

Best Practice

Discuss transparent pricing, the process, and proactive staffing incentives with frontline staff to help reduce attempts to "game" the system.

Step 6: Follow-up

Data trends should be evaluated quarterly. Look for trends that could inform how to dynamically incentivize shifts by day of week and time of day. Review and update the program on an annual basis.

AI-Powered Incentive Automation

The tiered incentive model described above works well as a manual framework, but AI can automate and optimize the entire process. An AI-powered dynamic pricing engine can:

Automate tier escalation — Instead of manually deciding when to move from Tier 1 to Tier 2, the system adjusts pricing automatically based on fill probability, time until shift start, and clinician response patterns
Distribute shifts intelligently — Rather than broadcasting open shifts to all staff, AI targets shifts to the clinicians most likely to accept based on historical behavior, current hours, and preferences
Learn from behavior — As clinicians review and claim shifts, the system learns pickup patterns and adjusts future pricing to maximize fill rates while minimizing incentive spend
Reprice in real time — Every shift claim triggers automatic repricing of remaining open shifts. New needs from call-outs or census changes also trigger repricing.

Best Practice

AI-powered dynamic pricing doesn't replace the incentive program structure — it operationalizes it. The tiers, eligibility rules, and distribution order still matter. AI simply executes them faster, more consistently, and with better data than manual processes can achieve.