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Decision Guide

Guide to inpatient nurse staffing models

Nurse leaders are charged with deploying staffing resources to support the delivery of safe, high-quality, and cost-effective patient care. Over the years, organizations have experimented with a number of different staffing models to meet the needs of their changing patient populations and care environments.

Use this page to understand legacy and next-generation inpatient staffing models. Then, view the “additional resources” to the right of each model to see case profiles of how organizations have rolled out those models within their facilities.

Legacy staffing models


Staffing model

Capsule description

Benefits

Additional resources

Specialized PCA role


PCA role dedicated to completing specific, routine patient care activities

  • Improves support staff capacity to complete all patient care responsibilities delegated to them
  • Reduces chance of missed care

Unit-based expert roles

Expert RN elevated to clinical leader over the unit to proactively spot issues; expert RN also supports communication with the interprofessional team, patients, and families

  • Equips bedside nurses with targeted clinical support
  • Increases situational awareness within the unit to allow for improved efficiency
  • Provides additional support for improving unit outcomes
 

Team nursing

 

RNs each lead a team of nursing support staff to care for an assigned group of patients

 
  • Reduces labor costs by shifting nursing skill mix
  • Improves care quality by decreasing missed care and increasing efficiency
  • Improves staff satisfaction
  •  
     

    Variable shift schedules

     

    Staggered or shortened shifts that align staffing to peak census

     
    • Reduces labor costs
     
    • Learn how one organization reorganized their staffing strategy with staggered shift start times on pages 44-49 of Rising Above the Bottom Line


    Next-generation staffing models


    Staffing model

    Capsule description

    Benefits

    Additional resources

    Dedicated clinical support


    Dedicated ancillary support roles are assigned to unit-based care teams

    • Reduces duplicative care
    • Enables more precise and efficient care delivery
    • Find examples of how organizations have introduced dedicated medication reconciliation roles in the emergency department on pages 61-68 of Building the High-Value Care Team

    System-wide float pool

    System-wide flexible staffing that supports multiple facilities within the organization

    • Reduces premium labor costs
     
  • Learn how Legacy Health implemented a system-wide float pool in our webconference, How to Implement a Cross-System Float Pool
  • Find more resources for building an effective float pool on pages 64-69 of Rising Above the Bottom Line and in the Resources for Achieving Sustainable Labor Cost Savings in Nursing
  •  

    Role-based team nursing

     

    Team of RNs cares for assigned group of patients; each RN is responsible for a different set of clinical activities

     
  • Reduces chances for missed care
  • Allows novice RNs to focus on subset of care activities at one time
  •  
     

    Expert-led care team

     

    Team of RNs have roles differentiated by clinical competence and cares for an assigned group of patients on a unit

     
    • Scales the knowledge of skills of expert nurses
    • Promotes intraprofessional top-of-license care
     
     

    Virtual expert nurse

     

    Remote RN oversees multiple care teams on a unit; digital platforms allow for real-time information sharing between remote RN, staff, and patients

     
    • Scales the impact of expert nurses
    • Improves critical care length of stay
    • Reduces labor costs by shifting skill mix
     

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