How much flexibility is too much in nurse staffing?

Hospitals have been on a quest to give nurses more flexibility at work in order to retain employees and improve satisfaction and well-being. 

The pandemic highlighted the need for more flexible options as many experienced nurses burned out and left, and the next generation came in with greater demands for work-life balance.

Systems have met the demand in a number of ways, including implementing virtual nursing options to offering internal traveler and gig programs.

"I think the possibilities are endless, especially with AI coming on board and the idea of virtual nursing," Robin Baldauf, MSN, RN, chief nursing officer of the Bon Secours Hampton Roads (Va.) market, told Becker's

But how much flexibility is too much?

Becker's found a common theme in how systems determine where to draw the boundaries with flexibility: The moment it negatively impacts patient safety or staff, it's a no-go. 

"You have to put guardrails in and you need to ensure that you're keeping an eye on the very core principles of the work we are trying to deliver," Terry McDonnell, DNP, RN, senior vice president and chief nursing executive at Durham, N.C.-based Duke University Health System, told Becker's. "If it's going to erode the satisfaction and the ability of the team to come together and work effectively, you also have to deprioritize those."

Many forms of flexibility

Although all hospital leaders agree that patient safety is a priority regarding staffing, there is no one-size-fits-all approach.

Virtual nursing has been rising as a popular form of flexibility.

Nashville, Tenn.-based HCA Healthcare is increasingly hiring nurses to work from home in its virtual nursing program. 

Lawrence + Memorial Hospital in New London, Conn., requires its virtual nurses to work onsite and take on bedside shifts two times a month.

At Renton, Wash.-based Providence, a virtual nurse program called Co-Caring, conceived by nurses, is being implemented across seven Western states. "Our facilities believe they’re achieving the right balance of work flexibility, as defined by our nurses who have implemented Co-Caring," Syl Trepanier, DPN, RN, chief nursing officer at Providence, told Becker's

Systems are also testing new flexible schedule options for bedside nurses.

Duke Health offers internal gig work, internal traveler options and float schedules. 

Similarly, Bon Secours Hampton Roads has an internal traveler program that allows nurses to float within a hospital, within the market or between hospitals across the system. 

Bon Secours Hampton Roads and the south region of CommonSpirit Health, based in Chicago, also offer self-scheduling for nurses.

"Flexibility is dependent on your delivery model, and I think people forget about that," Jennifer Mensik Kennedy, PhD, RN, president of the American Nurses Association, told Becker's. "If you have a residency program or a fellowship program for nurses, then I think you can be much more flexible because you really prepared nurses differently. Maybe if you had a dedicated nurse practitioner on the floor, you can be really flexible because the structure and the support structure is different. But if everybody — including your educator and your charge nurses taking patients — [is] coming and going, then you might have to look at how flexible you can be because you do need that consistency somewhere."

Deciding what flexibility to offer

Finding balance in providing top care and staffing while also giving staff the best experience is no easy task. Leaders lean on several factors when deciding which flexible options to offer. 

"It's important to discuss how collaboration between bedside teams, clinical leadership and administration can solve for work-life balance and burnout," Dr. Trepanier said.

Veronica Martin, DNP, RN, chief nursing officer of the South Region of CommonSpirit Health, said giving bedside caregivers the opportunity to have input on how their unit resources are used is important. 

"I think what healthcare systems and hospitals departments have to look at is the ebb and flow of volume within their departments," she said. "It's marrying how patients are admitted and discharged within that department against peak volume time so that you have the right numbers of people, with the right care for patients, at the right time of the day."

Dr. McDonnell said she focuses on what is going to meet the needs of the patient and those of staff. 

"When those two things align, that's the work you focus on," she said.

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