How Johns Hopkins Aramco Implemented Tiered Self-Scheduling

To address the challenge of excessive overtime, leaders at JHA introduced a tiered self-scheduling process that includes checks and balances. Tiered self-scheduling allows nurses to craft their own schedule with approval from nursing leaders. By choosing shifts that work for them, nurses are less likely to have unplanned absences that result in overtime.

There are four steps to JHA’s tiered approach:

1. Staff members enter their shifts into a master schedule up to eight weeks in advance using unit-based guidelines.


2. A unit-based committee, composed of two or three senior nurses, reviews the schedule with organizational targets and leave coverage in mind. The committee adjusts the schedule as needed to ensure that the unit has the right complement of staff on each shift (e.g., mix of novice and more experienced staff).


3. Unit managers review and approve the schedule and send it to the central staffing office.


4. The central office tracks daily variations and fills any unforeseen gaps, such as sick leave.

To ensure staff members select appropriate shifts, leaders at JHA set clear guidelines for self-scheduling. Any necessary adjustments to the schedules are based on these parameters, which eliminates potential contention over the changes.

Staff nurse guidelines

At JHA, nurses must follow three parameters when scheduling their shifts:

• Sign up for one or two weekend shifts monthly, depending on unit needs
• Sign up for five to seven night shifts every month
• Verify proposed leave time with managers before inputting into schedule

Unit-specific guidelines

The unit-based scheduling committee has their own set of guidelines to follow:

• Double check leave requests with leave allotment for the unit
• Confirm everyone has appropriate distribution of nights and weekends
• Ensure good mixture of experienced and novice nurses per shift

While these guidelines worked at JHA, they should be adjusted for each organization's unique needs. Consider how far in advance staff should sign up for shifts, weekend and night shift frequency, planned and unplanned leave, and experienced and novice staffing mix.

Leaders at JHA recognized that managers and staff would have questions about the self-scheduling process, so they proactively developed a two-pronged strategy for support. They first piloted self-scheduling on two units to demonstrate success. Next, leaders shared the pilot’s success with the rest of the organization. Finally, they implemented the process across JHA.

Nursing leaders also addressed managers’ fears of losing control and having to take on additional work. JHA educated managers on the benefits of this practice and emphasized how the tiered responsibility would alleviate manager burden.

Sample of apprehensions and responses to self-scheduling