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Workforce management strategies in times of uncertainty

By: Karlene Kerfoot, PhD, RN, FAAN

Rely on data, technology, policies and processes, people, and patient-centered staffing.


  • A data-driven workforce strategy can reduce chaos when the unexpected occurs.
  • Five key outcomes—clinical, staff engagement, patient experience, compliance, and financial—help measure healthcare organization success and sustainability.

Healthcare rarely experiences a “normal day”; no two patients are alike, and each staff member is unique. However, unexpected events such as pandemics, earthquakes, fires, protests, strikes, and ever-changing government and payor regulations and reimbursements challenge health systems to deliver quality care to patients while protecting and growing staff. Health systems are on the front line of the community’s response to each crisis. They must be adept at quickly and effectively meeting the needs of the communities they serve, while respecting and valuing their employees. Well-run systems make themselves crisis-ready by strategically building a long-term workforce management infrastructure to handle small and extreme variations and to care for patients in all types of crises.

Building a stable, data-driven workforce strategy to smooth out variation and reduce chaos when the unexpected occurs is the foundation for resiliency and success and will positively impact patient satisfaction and staff engagement. However, health systems must recognize that workforce management is an ongoing journey; it’s not a one-time initiative.

For all healthcare organizations, five key outcomes—clinical, staff engagement, patient experience, compliance, and financial—help measure success and sustainability. Organizational goals should be based on a balanced approach in achieving these outcomes; over­emphasis in one area negatively impacts another. To achieve outcome excellence and balance, an effective workforce management process should include these essential enablers: data, technology, policies and processes, people, and a patient-centered staffing approach.


Workforce management should be data-driven. Employee, patient, and operational data must all be considered when making staffing and scheduling decisions. Health­care systems have an abundance of this data, but if it’s not organized into actionable insights, it won’t provide value. Data must enable an organization to make informed decisions quickly as demands change.


Effective workforce management technology bridges the entire enterprise, pulling information together from many systems. Integrated scheduling and timekeeping facilitate productive and cost-efficient workload balance based on data-driven insights. Bridging scheduling to data from the electronic health record (such as nursing documentation and census) helps ensure equitable staff assignments that can flex as needed.

Daily, weekly, and monthly monitoring of automated analytics and dashboards facilitates proactive information use to empower managers to make better staffing decisions and ensures staff can serve their patients effectively. In addition, mobile workforce technologies support staff and manager work preferences and provide for equitable work–life balance.

Workforce technology benefits can be maximized by expanding them to ancillary and support services departments. By going beyond nursing, a health system has better support for streamlining and standardizing across the organization, while containing costs and fostering staff engagement with groups outside of nursing.

Policies and processes

Many health systems have workforce management policies and processes that have been in place for years and have drifted into a state of entropy. New methods may be developed, but the status quo can persist in daily operations, even if it no longer meets the organization’s current needs. Ongoing standardization of policies and processes makes it possible to take a systemic and systematic approach to staffing and provides an opportunity to fix policy or process flaws and update work based on new data and evidence. Workflows can be streamlined, and policies and processes can be fine-tuned to optimize staff, contain costs, and improve patient care. With variations reduced and processes standardized to best practice, patients can be assured of the same level of care across all facilities and functions in the system.

From a leadership perspective, helping an organization standardize to best practices is an important way to attain better quality, productivity, and sustainability while minimizing silos. Standardized staffing policy, consistent job descriptions, and continuous cross-training empower staff to confidently provide care outside of their home unit in times of crisis. In addition, with standardized pay and scheduling policies, staff know that everyone is treated fairly and equitably.


Everything that happens in healthcare is for people, by people. Every person in a hospital or health system plays a role in achieving clinical and financial outcomes, and all staff impact the patient experience, the bottom line, and the success of the organization.

Workforce management connects human resources, nursing, clinical education, payroll, information technology, finance, nursing informatics, and other clinical disciplines within healthcare organizations. Creating a multidisciplinary ecosystem with a shared oversight and governance structure that spans individual facilities and the system can ensure collaboration. When transparency exists and people are invited to participate in developing processes and finding solutions, more innovative alternatives emerge, resulting in greater support, utilization, and adoption of the workforce management system.

Whether or not an organization experiences a crisis, a clear picture of the entire pool of available staff, their qualifications, credentials, and skill sets—regardless of their home unit or facility—makes it possible to quickly and accurately match caregivers with patients. An enterprise-wide approach, supported by full transparency, allows qualified caregivers to move from areas of low need to areas of high need, which is both cost-effective and patient-centered.

Patient-centered staffing approach

Each patient is unique and their needs may change during hospitalization, making staffing a complex process. However, that process can be simplified when data, effective technology, people, and processes are integrated. A patient-centered staffing approach delivers more than an acuity or ratio-based approach; it enables healthcare systems to deliver excellent patient care in day-to-day and extreme situations.

Crisis and opportunity

The workforce impacts everything that happens within healthcare organizations. Creating a stabilizing workforce management strategy is imperative in “normal” times and becomes mandatory when chaos strikes. Every crisis gives us the opportunity to re-examine what we’re doing and to reframe our future. Unfortunately, “chasing the next shiny object” can replace strategically “looking around corners” to determine what the organization needs in the near and distant future.

Diana Berkland, PhD, RN, FAAN, vice president of nursing and clinical services at Sanford Health, cautions that innovation should contribute to a positive workplace environment and make the work less complicated. Mary Beth Kingston, PhD, RN, NEA-BC, chief nursing officer for Advocate Aurora Health, notes that innovations must focus on creating a safe clinical enterprise and evaluating performance based on a balanced set of metrics. Berkland, Kingston, and their colleagues share more of their perspectives in the two case studies that follow this article.

Crises ranging from natural disasters to changing government regulations to social unrest will continue to challenge health systems nationwide. Building organizational resiliency through a strong workforce management strategy is mission-critical. One of the most important lessons of crisis readiness is recognizing that best practices are built before the crisis and evaluated after to create new and more efficient practices for the future.

Karlene Kerfoot is the chief nursing officer at API Healthcare and for its parent company, symplr, in Houston, Texas.


Ashe L. The importance of adequate staffing. Nurs Manage. 2018;49(12):7.

Paulsen RA. Taking nurse staffing research to the unit level. Nurs Manage. 2018;49(7):42-8.

Shin S, Park JH, Bae SH. Nurse staffing and nurse outcomes: A systematic review and meta-analysis. Nurs Outlook. 2018;66(3):273-82.

Supported by an educational grant from API Healthcare, now a part of symplr


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