3 years of flexible nurse schedules — how it's going at Bon Secours Hampton Roads

Bon Secours Hampton Roads (Va.) market has embraced flexible nursing with autonomous scheduling and float shifts between hospitals for years.

The system's prioritization of flexibility has helped keep nurses in the system and reduced the need for agency nurses.


Bon Secours Hampton Roads has built a strong pipeline of new nurses through its Accelerated Clinical Experience program, which supports newly graduated nurses through their first year on the job and comes directly after the nurse residency program. 

The ACE program helps new nurses gain confidence in general skills while improving their specialized learning, Leanne Shelton, BSN, director of nursing practice at Bon Secours Hampton Roads, told Becker's. ACE nurses meet with leadership on a regular basis to discuss what they need and what areas they struggle with. The nurses then get additional training in those areas. In three years, only one nurse opted not to stay with the system. 

Float schedules

Like many hospitals, Bon Secours Hampton Road allows for float schedules. But unlike other systems, these staff members — who act like internal travelers — are regular, full-time employees with no contracts. 

Float schedules are set up on a tiered basis. In tier one, nurses can float between units at a single facility. In tier two, the nurses can float between hospitals within the market. And tier three nurses can float between any of Bon Secour Mercy Health's 49 hospitals, Robin Baldauf, MSN, RN, chief nursing officer at Bon Secours Hampton Roads, told Becker's

The program allows any nurse with at least one to two years of experience to participate, starting in tier one and moving up as they gain more experience.

Autonomous scheduling

For three years, the system has offered completely autonomous scheduling. Nurses approve their own time cards and schedules, and they can switch schedules without involving a manager. 

"If you don't want to work 12-hour shifts on a nursing unit, we have opportunities and shared services where nurses could work an eight-hour shifts or only weekends or maybe only early morning shifts," Ms. Baldauf said.

The schedules are overseen by a staffing optimization center. The schedulers, who work from home, create new schedules every month. For a two-week period, nurses sign up for the shifts they want. The schedulers then take those shifts and overlay them with the float nurses from tiers three, then two, then one. Then, working with managers in each unit, they balance the schedules to ensure there is a mix of new and experienced nurses in each unit and that staffing levels are met. Any remaining shifts are sent out for nurses who would like to pick up additional work. The final schedule is completed a month before the start date.

"This reduces open shifts that we need to pay overtime and incentive on," Ms. Baldauf said. "It reduces agency and a lot of times replaces agency."

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