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Our Take

Building a flexible nursing workforce

15 Minute Read

Organizations can no longer rely on the traditional staffing methods of years past. Covid-19 accelerated changes to the nursing workforce that require new staffing solutions. Nursing is headed toward a shortage, the experience-complexity gap is widening, and the needs of the nursing workforce are changing.

Building a more flexible nursing workforce has the potential to address all three of these challenges at once. We recommend implementing four strategies to do so.


Conventional wisdom

To meet productivity targets and care for patients, nurse leaders have taken the same approach to staffing for decades, primarily relying on benchmarks and ratios to determine the right unit-level staffing. At the same time, the popularity of 12-hour shifts in acute care, RN specialization, and primary nursing models grew. This traditional approach to staffing worked well enough across the last decade because provider organizations had the RN supply to meet patient demand and could keep premium labor costs low enough with well-established float pools. However, staffing became increasingly difficult in recent years due to changing patient needs and emerging workforce trends.

Emerging patient, workforce trends impacting nurse staffing

  • Increasing vacancies caused by more RN turnover and burnout
  • Fewer experienced RNs due to baby boomer retirements
  • Increasing patient acuity

These staffing challenges were further exacerbated by Covid-19. Organizations didn’t have enough nurses to meet demand and had to quickly redeploy staff across different locations to ensure coverage. Leaders also experimented with different staffing models that scaled the expertise of experienced, critical care nurses through team-based approaches. Unfortunately, this left non-Covid-19 units and care sites with fewer experienced nurses, worsening the already present experience-complexity gap.

This experimentation was necessary to respond to the pandemic and encouraged nurse leaders to think differently about what staffing could and should look like moving forward.

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Our take

Organizations cannot return wholesale to the nurse staffing approaches used prior to Covid-19. In addition to exposing staffing shortfalls, Covid-19 accelerated changes to the nursing workforce that will make it more challenging to staff as organizations once did.

1. The surplus of nurses is disappearing—and trending toward a shortage.

Nurses are already leaving the profession due to the tremendous stress and burnout caused by working in a pandemic. We expect that trend to continue across the coming year, particularly among late-career nurses who choose to retire early. We also expect mid-career nurses to continue to leave (or not return to the workforce) due to evolving family obligations. The unknown here is the RN pipeline. In the short term, disruptions to clinical rotations and the NCLEX could slow down the transition from academia to practice. But we’ll have to wait and see if overall enrollment numbers keep up with demand in the years to come. Bottom line: organizations should expect nurse shortages for the next few years.

2. The experience-complexity gap is quickly turning into a chasm.

Despite some work before the Covid-19 pandemic to close the experience-complexity gap, most nursing leaders found progress slower than they hoped. Now, organizations are losing experienced nurses at a faster rate than previously predicted. Additionally, Covid-19 itself has added a layer of complexity to the care environment that is challenging for any clinician, let alone a novice nurse.

3. The wants and needs of the nursing workforce are changing.

In the United States, 96% of professionals, including nurses, want more flexibility at work, and many industries are headed in that direction. But more importantly, many nurses need more flexibility. Amid the pandemic, parents struggled to cover childcare and other home obligations while working. While some organizations offered short-term solutions to meet this need, it was not enough. We are now seeing more nurses leave the profession or seek flexible roles outside of acute care that better accommodate personal lives. This trend will continue if organizations can’t meet the growing needs of the workforce.

Provider organizations face more barriers to flexibility than other types of organizations due to 24-hour operations for many and the highly specialized workforce. But staff demands along with the impact of Covid-19 on the workforce makes building a flexible nursing workforce an imperative for all provider organizations. Having a flexible nursing workforce is the best strategy to help organizations staff with fewer FTEs and experienced nurses, while also actively retaining and attracting more nurses to the bedside role.

What is a flexible nursing workforce?

A “flexible nursing workforce” is more than a float pool. While traditional inpatient float pools are a vital resource, many organizations have maximized their impact over the last decade. A truly flexible nursing workforce must move beyond this—and include different RN roles, locations, hours, and responsibilities. However, a flexible nursing workforce does not mean all nursing FTEs must have flexibility. Specialization is still critical to provide safe patient care and is an engagement lever for many RNs. Rather, it’s a balance.

To do this work well, the strategies you implement must meet the individual needs of your organization and staff. Historically, staffing focused primarily on the needs of the organization. As the workforce changes, their needs and preferences need to be weighted equally. This dual mandate should serve as your north star for this work, only selecting mutually beneficial solutions.


Four strategies to build a flexible nursing workforce

Building a flexible nursing workforce is a long-term ambition and an iterative process. To guide this work, we’ve outlined four strategies that meet the dual mandate by meeting the needs of staff and the organization. You do not need to implement every strategy. In the near term, start with strategies that are an easy win or where your organization already has momentum. Then build on this work over time to address your organization’s most urgent staffing and workforce challenges.Dual mandate for building a flexible nursing workforce

  • Strategy

    Provide shorter shifts and nontraditional roles to keep experienced nurses at the bedside

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  • Strategy

    Cross-specialize nurses with similar technical skills to address experience and specialty shortages

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  • Strategy

    Scale experience with expert-led staffing models

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  • Strategy

    Enable non-float nurses to regularly practice across multiple settings

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Parting thoughts


During the pandemic, nurses were remarkably willing to flex where, when, and how they work. They became members of a system-wide workforce, abandoning their unit- or location-based identifies. Leaders must take advantage of this temporary shift in frontline nurses’ perspective and use it to reinforce nurses’ identity as system citizens first, and members of their unit or care site second.

We urge nursing leaders to define short-, mid-, and long-term plans to build system citizens. This will expand the possibility of what RN flexibility can look like in 5, 10, or 20+ years. We are at the early stages of creating RN staffing of the future, and much of this success will depend on nurses’ identifying as an employee of their system, not a specific unit.

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