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The power of flexibility

By: Danielle Bowie, DNP, RN, NE-BC

Smart scheduling drives a satisfied nursing workforce

“The more you use the reins, the less they use their brains” is one of my favorite leadership quotes. It reminds me to loosen my grip, lead from a place of trust, and recognize the power of my most precious resource: people. Increased turnover, low retention, unsafe staffing scenarios, and burnout aren’t new. I’m sure many of you reading this are thinking, “Here we go. We’re circling the mountain again.” And yet, I wonder why we are circling the mountain again. How do we pivot to advance the discussion from circling the mountain to taking the mountain and conquering it? I propose we start from a place of flexibility, loosen the reins, and lead comfortably with an open mindset that lets us get a little messy and try new approaches.

Start with flexible scheduling. This option can critically empower your frontline with autonomy and control over their schedule while also creating professional accountability. Lead with shared decision-making to engage frontline nurses in evaluating a variety of approaches, including self-scheduling, pattern scheduling, shift lengths, and weekend expectations. Based on the evaluation, consider using a combination of these offerings: self-scheduling, pattern scheduling, and weekend programs to build a comprehensive framework. Consider making self-scheduling a primary approach. To be true to the nature of flexibility, it must support the generational needs of workforce-related life stages, and recognize that some stages may require more stability and predictability than can be found with pattern scheduling. Be open to both and get creative with mixing and matching. If self-scheduling is the complete model for a unit, create an equitable approach using scheduling groups to rotate who gets to sign up for the schedule first.

If your health system has scheduling and staffing technology, use it. Paper scheduling restricts flexibility and doesn’t permit the control and visibility the frontline asks for when it comes to their schedules. Creating data insights from paper processes becomes manual, siloed, and limited. If the existing technology doesn’t support flexibility, automation, or innovative workflows, start an optimization journey to improve the user experience and design. I’ve implemented three of the newest systems and found that scheduling solutions have the same functionality, but most need optimization rather than replacement. After optimizing the existing technology, consider innovative add-ons to meet gaps in automation and predictive capabilities. A smart staffing technology add-on to support existing technology is a much easier financial investment and operational lift and will help target gaps that optimization couldn’t improve.

For example, scheduling solutions have limited capabilities related to automating open-shift recruitment and intelligent pricing of unfilled shifts. The work usually falls to the staffing office or nurse manager to manually recruit for every single shift, resorting to phone calls or one-off text messages within 24 hours before the start of the shift when the need is critical. The chaos of filling shifts tends to lead to high spend and less lead time to find the right cli­nician who isn’t overworked. An innovative staffing technology can fill these gaps by automating the process. Through a mobile app, open shifts distributed weeks ahead of the need allow for seamless communication among the manager, staffing office, and frontline clinician.

Replacing a scheduling technology usually takes 1 to 3 years, and it still wouldn’t have the capabilities to meet these specific needs. Implementing a smart staffing technology add-on can be achieved in less than 3 months.

At least 10% of the workforce should be flexible (part-time, prn, float programs, etc.). The lower the flexibility percentage, the higher the traveler utilization rate. Start with the basic programs and then push for innovative options such as internal travel and enterprise gig systems. Several approaches to flexibility can help change our narrative as a profession and impact culture, staffing levels, and the overall health of the profession.

Danielle Bowie, a member of the American Nurse Journal editorial board, is chief nursing officer and vice president of clinical strategy and transformation at Trusted Health in San Francisco, California.

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